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Letter of the Week: Drug initiation plan will be costly and dump work on GPs

The Government’s recommendation on outpatient prescribing under its quality, innovation, productivity and prevention (QIPP) programme is another example of a poorly thought through and costed initiative.

(See: GPs handed drug initiation job)

How is minimising outpatient prescribing and moving to an advice-to-GP system going to be cost-effective?

Firstly, such a process will result in patients being asked to return to their GP for the advised medication, so the Department of Health cannot have costed GP time into any assumed savings.

Secondly, when patients book appointments to see their GP for the advised medication, the outpatient letter will usually not be there, resulting in an unnecessary consultation.

Thirdly, patient treatment will be delayed by weeks by this change in process.

And fourthly, the prescribing cost will be transferred to primary care’s prescribing budget rather than the secondary care pot. Most outpatient tariffs under payment by results include an element for prescribing, so secondary care will be paid for something it is not providing.

There are also medico-legal issues with GP prescribing of some drugs licensed for secondary care initiation or prescribing only. Many GPs are already taking a risk with repeat prescribing of these, even when shared-care arrangements with secondary care are adequate.

We need a patient-centred prescribing arrangement allowing secondary care to prescribe on an FP10 and patients to have the choice to get their medication from any community pharmacy.

Dr Ahmed Nana

GPs will be faced with making decisions on unfamiliar specialist drugs GPs will be faced with making decisions on unfamiliar specialist drugs