Anger over private firm’s role in prescribing controls
pharmafile | February 19, 2009 | News story | | NHS
Pharmacy and GP representatives have attacked plans for a private company to oversee primary care prescribing costs.
Private provider Assura is now in talks to take over the management of prescribing costs at two PCTs.
The company is already a major provider of finance and management services in primary care, and has a large portfolio of GP surgeries across the UK which it owns or part owns with GP partners.
It says it is now in early-stage negotiations with two unnamed PCTs to take on medicines management and prescribing budgets, and believes it can deliver big savings by eliminating waste and unnecessary prescribing.
But pharmacy body the RSPGB and doctors' organisation the BMA have attacked the idea in the strongest terms.
The RSPGB says plans to incentivise GPs to prescribe fewer medicines are "irresponsible bribery that potentially places patients at risk."
Dr Peter Fellow, chair of the BMAs GPC prescribing committee, told the GP newspaper Pulse the idea was 'despicable'.
The scheme has some similarities to the well-established prescribing incentive schemes which have become an increasingly popular tool for PCTs to control GP spending.
But Assura's offer is different in that it will take some of the savings made from schemes as profit.
The RSPGB is concerned that private companies offering medicines management services could undercut or take work away from pharmacists, who increasingly rely on income from supplying such services.
For the BMA, the move further impinges on GPs' prescribing freedom, and also represents the further advance of private providers into core NHS services, which it has long opposed.
Assura says it can reduce PCT drugs bills by greater medicines management, including reducing waste and unnecessary prescribing. A spokesman for the company denied the deals would focus on more generic prescribing.
Dr Vivienne McVey, medical director of Assura Group, told Pulse that the company's offer was attractive to PCTs. She said Assura would take on the financial liability for the deal, and predicted it could achieve £500,000 in savings for Trusts, and reduce spending by 10 per cent.
She indicated this could generate profits of up to £2m, which Assura would share with GP partners.
The company is in contact with at least six other trusts, and could be extended nationwide if it proves successful at reducing the NHS drugs bill.
RPSGB Director of Policy and Communications David Pruce called it the 'wrong approach' and said it would compromise clinical judgement.
He said: "Prescribing is a core role for GPs and the proposals to reward doctors who change their prescribing habits when it may not be in the best interests of patients is unacceptable."
Pruce says the move would effectively cut pharmacists out of prescribing conversations for the sake of financial reward. He says this is not only morally wrong, but could put the lives of patients at risk.
He concluded: "PCTs should use their money to improve their prescribing rather than allow private companies to bribe doctors in to providing patients with cheap medicines."
The government has put increasing pressure on PCTs to cut back on prescribing. GPs are already given financial incentives to use generic versions of drugs like simvastatin, but Assura says its proposal will not include generic prescribing incentives.
A spokesman for Assura tried to reassure its critics, and also responsed to some of the accusations.
"Assura believes that pharmacy has a critical role to play in medicines management across the board", he said.
"The conceptual model we are looking at does not involve paying doctors to prescribe cheaper drugs. It involves working with doctors to ensure the best health outcomes for patients through managing their medicines better and reducing waste."
He added that negotiations were still at an early stage and Assura was not in a position to identify the PCTs before any contracts were signed, but would release details when the model is more developed.
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