PCTs look to contract loophole to fine GPs

PCTs are threatening to use a clause in the GMS contract to impose fines on practices with low generic prescribing rates, GP can reveal.

NHS Bedfordshire is trying to claw back prescribing costs by using the GMS contract’s Annex 8, which states that practices can be in breach of contract if they prescribe excessively or inappropriately.

The PCT has given practices six months to hit generic simvastatin prescribing rates of 74%, Bedfordshire and Hertfordshire LMC chief executive Dr Peter Graves said.

The PCT set out its plans in a letter to the 80 practices in Bedfordshire in the summer.

However, practices cannot exception report patients who are unsuitable for treatment with generic simvastatin from inclusion in this target.

GPC prescribing subcommittee chairman Dr Bill Beeby said the GPC was aware PCTs had been trying to extend Annex 8 beyond its original remit. So far, LMCs had fought off such attempts, he said.

Dr Graves said that the idea of using Annex 8 had also been raised in Hertfordshire.

NHS Bedfordshire head of medicines management Andy Cooke said that despite a lot of work, practices in Bedfordshire still varied considerably in their use of generic statins.

‘Our executive committee has therefore agreed that, in line with principles set out in the GMS contract, it is now reasonable to set a threshold for this indicator that all practices should attain as a minimum,’ he said.

‘The vast majority of GP practices both in Bedfordshire and nationally are already above this and have been for some time.’

But Dr Beeby said Annex 8 should only be used in extreme circumstances, in lieu of contract termination. ‘At the point at which they could do something very, very drastic they would only do something very drastic,’ he said.

PCTs were trying to interpret it more liberally and even to use it to change antibiotic prescribing practice, he said.

‘Annex 8 should be for the most recalcitrant of people in the most extreme situations,’ he said.

He urged GPs to alert the GPC if PCTs misinterpreted the contract. ‘If people are aware of it happening, contact the GPC. We would be grateful to hear of individual cases.’

Editors' Blog: Why let GPs take on NICE’s drug rationing role yet fine them for ‘inappropriate’ prescribing?

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