MEMORANDUM BY SHROPSHIRE HEALTH AUTHORITY
PRESCRIBING BRIEFING (GD2)
BACKGROUND
The primary care drug budget for Shopshire is
£42 million. PCG and practice drug budgets for 1999-2000
were based upon historic spend uplifted by 7 per cent to take
account of increase in prescribing costs, adjusted according to
the practice potential to make savings.
This gave PCGs a realistic budget on which savings
could be made. However the PPA are predicting an overspend on
the drug budget of £1.55 million, due primarily to the increase
in the cost of generic products.
Telford & Wrekin PCG has a population of
approximately 150,000 and is predicting to overspend the PCG Primary
Care drug budget by more than £500,000.
1. GENERIC PRESCRIBING
Percentage Generic prescribing has been highlighted
as an "Efficiency Target" in the recent Department of
Health "Quality in the NHSHigh Level Performance Indicators"
and is the major target for all PCG Incentive Schemes in Shropshire:
See Attachment D.[1]
The increase in the cost of generic
drugs and Category D changes in the Drug Tariff has reduced the
possible savings in this area for Shropshire by more than 25 per
cent (see attached graphs and table A,B,C).
Where calculations have been done
on this, it appears that the increased costs of generic drugs
may add 5-7 per cent to the total drug bill, depending upon the
practice/PCG percentage generic prescribing.
This increase is unlikely to be off-set
by the 4.33 per cent reduction in branded product prices negotiated
through the PPRS as companies appear to have been able to select:
less commonly used products within
a drug group eg fluticasone 125mg inhaler rather than higher strengths
products which are about to lose
their patent and therefore a generic (cheaper) product would become
available anyway
Some products which may only
be used in secondary care and make no savings in primary care.
The increase in generic prices has
come about through unavailability of products and has caused problems
in supply for pharmacists and dispensing doctors. The way such
prescriptions have to be endorsed before submission to the Prescription
Pricing Authority (PPA) has led to a reduction in the actual percentage
generic medicines prescribed by some dispensing practices, so
disadvantaging them in the Incentive Scheme.
12 of the 13 Health Authorities in
the West Midlands are expecting to overspend their prescribing
budgets (by between 0.6 and 10.5 per cent). This will severely
reduce the PCG scope for developments next year.
The increased cost of generic drugs
has reduced the savings identified in the Health Authority Prescribing
Action Plan and Medicines Management Section of the Health Improvement
Programme by several hundred thousand pounds, hence less money
to invest in other areas of prescribing.
2. HEALTH AUTHORITY
CONCERNS
Potential loss of financial control because
of information time lag and lack of incentives for GPs.
Impact on PCG budgets and development plans
for 2000-01.
Risk of technical difficulties with closing
the account for 1999-2000 and reconciling income and expenditure
and cash because of the delay in PPA information.
Erosion of incentive for high generic prescribing
thereby reducing the practices ability to meet the targets for
the PCG Prescribing Incentive Scheme.
Patricia Campbell
Pharmaceutical Adviser
Shropshire Health Authority
| Cost for 28 Days Supply of Drug
|
Drug Name and Strength | Sept 98
| Dec 98 | Mar 99
| June 99 | Sept 99
| % Increase Sept-Sept |
Atenolol 50 mg | 90p | 87p
| 102p | 122p | 146p
| 62 |
Atenolol 100 mg | 122p | 117p
| 136p | 157p | 192p
| 57 |
Thyroxine 50 mg | 19p | 24p
| 44p | 79p | 87p
| 360 |
Thyroxine 100 mg | 21p | 24p
| 67p | 144p | 162p
| 670 |
Warfarin 3 mg | 82p | 76p
| 106p | 158p | 170p
| 107 |
Warfarin 5 mg | 121p | 126p
| 160p | 258p | 276p
| 128 |
Bendrofluozide 5 mg | 15p |
15p | 15p | 32p |
100p | 567 |
Bedrofluozide 2.5 mg | 15p |
15p | 18p | 32p |
86p | 473 |
Asprin 300 mg | 12p | 13p
| 13p | 13p | 13p
| 8 |
Frusemide 40 mg | 26p | 28p
| 28p | 193p | 214p
| 723 |
Amoxycillin 250 mg (15) | 47p
| 47p | 71p | 83p
| 169p | 260 |
Amoxycillin lig 125 mg/ml/100 ml | 91p
| 96p | 103p | 107p
| 134p | 48 |
Amoxycillin lig 250 mg/ml/100 ml | 153p
| 162p | 174p | 181p
| 225p | 48 |
1 Not printed. Back
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