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Commissioning dilemma: Your PCO insists on savings you feel are inappropriate

Your local Primary Care Organistion is insisting on savings you believe are inappropriate under the new quality and productivity indicators, including end use of several branded medicines you think are important. Dr Trish Edney advises GPs on what to do.

Ideally this sort of situation should no longer happen. As a GP commissioner you should have started negotiating with the medicines management staff at the PCO. You are going to need their expertise and advice on cost and clinical effective prescribing if you are going to be able to manage your budget.

As GP commissioner you are going to have to consider the wider aspects of health care and will have to work with others and use their expertise. Sometimes you will have to make hard decisions about the cost and clinical effectiveness of treatment.

Doctors traditionally become attached to and feel familiar with certain drugs and none of us like change. But often GPs have only seen the evidence about a drug from the pharmaceutical company which is understandably convincing.

PCO pharmacists look at the wider evidence of comparisons of drug effectiveness.

As a good GP commissioner you should ensure that there is a forum involving primary and secondary care together with pharmacists such as an area prescribing committee where drug switches and formularies are decided. You should find your clinical input attended to but you may need to compromise on some decisions.

Having agreed the actions on prescribing your really difficult job is then to disseminate these and convince your GP colleagues to act, but that is another question!

Dr Trish Edney is a GP in Sheffield and member of the GPC's commissioning and service development subcommittee

prescribing dilemma


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