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Prescribing incentive plan condemned as 'a betrayal'

The national ethos of the quality framework is under strain from local initiatives and loopholes – by Cato Pedder and Rob Finch

GP leaders have condemned prescribing incentive schemes that aim to control the drugs bill by offering vastly inflated pay-outs for certain quality framework points.

Such schemes betray the spirit and letter of the new contract, which was meant to ensure GPs earn the same for equivalent quality work regardless of where they practise, claims the RCGP.

A scheme in the Isle of Wight has attracted particular criticism, after offering highly lucrative 'platinum points' for some quality indicators.

The row broke out as it became clear that prescribing incentive schemes are set to survive in many areas, despite the Government's decision to drop PCTs' obligation to run them.

Under the Isle of Wight PCT scheme an average three-partner practice will receive the normal £75 per quality point for meeting a PCT prescribing expert and agreeing three targets – but the four points available for hitting those targets will be worth up to £5,900 each, depending on the size of the practice.

The PCT has set aside £150,000 to fund the initiative, aiming to cut the higher-than-average cost of prescribing across the island.

Dr Jim Kennedy, RCGP prescribing spokesperson, said the moves would undercut

the national ethos of the new contract.

'I would be very concerned if they did this. It would be against the spirit and the actuality of the quality and outcomes framework, if something is £25 in Newcastle and £10 in Brighton for example.'

But he said there was a place for incentive schemes aimed at promoting high-quality care.

'There is an opportunity with prescribing schemes to encourage and reward good practice in areas not covered in the quality and outcomes framework,' he said.

But he added: 'There is a real concern that some PCTs will concentrate purely on a few key areas.'

Dr Peter Fellows, GPC prescribing sub-committee chair, warned PCTs should not fund the schemes through their enhanced services budgets.

But some PCTs are doing so – Chesterfield PCT is finalising details of a locally enhanced service for prescribing.

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