Delegates at the England LMCs conference warned that CCGs were imposing local restrictions that undermine GPs' ability to provide clinically appropriate medication for patients, creating a 'prescribing lottery'.
LMCs backed a motion calling for the DH to review GP prescribing regulations and entitlements and for delegated CCGs to 'remove pressure on CCGs to reduce or limit clinically appropriate prescribing'. The motion was approved despite a GPC warning that asking for the DH review could be 'risky'.
Opening the debate at the London conference Dr Katie Bramall-Stainer from Hertfordshire LMC urged delegates to stand against the ‘covert rationing’ taking place through local CCG restrictions on prescribing.
‘This is inequitable and indefensible decision-making without any evidence base to support quality,’ she said.
‘GPs are being asked not to provide clinically appropriate medication based on cost or availability. GPs have a contractual obligation to provide this treatment – it’s a random prescribing lottery with GPs exposed to risk.
‘If patients complain to the ombudsman then you, not the CCG, are responsible for recompensing that patient. They're leaving us with the fallout and complaints.’
She argued that the DH should create new legislation if it wants to reduce costs by restricting prescribing of certain drugs.
‘GPs shouldn’t be prescribing some items,’ she said. ‘I think this is what it comes down to. We need national policy, not local rationing.
‘The DH could easily create an alternative commissioning route for provision of these. If the government wishes to reduce costs, then let government produce the evidence and legislation on this. The existing measures are not fair on patients – and they're not fair on us.’
GPC clinical and prescribing lead Dr Andrew Green warned delegates that asking the DH to review prescribing regulations and entitlements was a ‘brave’ move.
‘There are those within the establishment that would love our requirement to prescribe to be taken away from us; it would enable CCGs to do what they're already trying to do.
‘Asking the big boys on the beach to knock down your sandcastle on the basis you're trusting them to build something better is a big decision, so please think hard on this.’