Calls for GMS rules on prescribing cost

The GMS contract should be altered to make GPs prescribe more cost-effectively, according to a report from the Office of Fair Trading (OFT).

The money spent on statins, proton pump inhibitors (PPIs) and hypertensive treatments in particular is ‘significantly out of line with patient benefits,’ it says.

The report claims some drugs prescribed in large volumes are up to 10 times more expensive than substitute treatments that deliver similar benefits.

Pointing the finger at GP prescribing habits, it says that GPs often do not understand the cost implications of what they prescribe. It cites the results of a survey of 1,000 GPs that showed ‘GPs’ ability to rank branded drugs in order of price proved no better than chance’.

‘The results suggest that GPs may have a systematic perception that off-patent brands have the lowest prices of all brands in a therapeutic group,’ it says.

‘But in fact off-patent brands often do not significantly fall in price in this way.’

It continues: ‘We found that the GMS contract is likely to exert the strongest financial influence on GPs’ prescribing behaviour. While the contract offers many and varied financial rewards to GPs who meet certain clinical standards it provides limited incentives for cost containment. Its net effect is therefore likely to dull GP price sensitivity.’

GPC negotiator Dr Peter Holden did not think that it was necessary to incentivise GPs through the contract because ‘most GPs are doing it already’.

‘I think the OFT is not aware of just how aware GPs are,’ he said. ‘When GPs do a prescription the various prices come up on the computer screen — GPs are very aware of price.’

The report comes just a few months after news that GPs could be forced to switch patients to simvastatin. Dr Stephen Green, from the DoH vascular team, raised the possibility that the quality framework could be changed to force a move to the cheaper statin (GP, 3 November 2006).

Dr Rubin Minhas, a GP expert member NICE statins committee, said: ‘Since simvastatin has become generic, several million pounds of taxpayers money is being wasted. The ethical arguments for using it are so great it’s difficult to defend any other policy.’

The OFT study also recommends that the current ‘profit cap and price cut’ scheme be replaced with a value-based pricing scheme, in which the prices the NHS pays for medicines reflects the therapeutic benefits they bring to patients.

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