There is scope for further considerable savings in the prescribing of drugs and medicines in the General Medical Services (GMS), according to the Comptroller and Auditor General, Mr John Purcell, in a report published yesterday.
He said it was not possible to establish whether the investment in developing GP services represented good value for money as no evaluation had been carried out by the Department of Health or the health boards.
Mr Purcell was reporting on an examination carried out on prescribing practices and the development of general practitioner services under an incentive scheme known as the Indicative Drug Target Scheme (IDTS). This scheme was introduced in 1993 to "encourage more rational and economic prescribing.".
The main finding showed that over the four-year period to 1996, GPs whose prescribing costs were under target achieved savings of £18.3 million while GPs who exceeded their targets overspent by £43 million. Only 5 per cent of GPs achieved savings in each of the four years while 27 per cent did not achieve savings in any year.
The report found that the maximum possible savings achievable, if every item prescribed was at its lowest unit cost, would be £460,000 per month or £5.5 million a year. The full substitution of generic drugs for more expensive proprietary drugs could provide savings of £1.3 million a year.
He believed there was a potential for further significant savings in the following areas: a switch to less expensive but equally effective first-line treatment for depression could save £640,000 per year; a minor shift in some expensive therapies for stomach ailments would achieve significant savings; in the absence of good scientific evidence as to their effectiveness the use of mucolytics which cost some £700,000 a year should be reviewed; a switch to less powerful antibiotics would have long-term benefits in medical care and reduce costs. A shift of 10 per cent could save £100,000 a year. The prescription of medical foods cost £3.8 million in 1996 and should be subject to regular review.
The report said a target of 80 per cent for computerising GP practices by 1997, set in the 1994 strategy document, had not been achieved, with only 58 per cent of practices computerised by February 1997.
The Minister for Health, Mr Cowen, said he remained satisfied with the success of the scheme and believed it continued to have a positive influence in achieving more rational and cost-effective prescribing. The average annual rise in GMS drugs cost had fallen to approximately 6 per cent as compared to 10 per cent prior to the inception of the IDTS.
He said prescribing remained at the absolute discretion of GPs in the exercise of their clinical judgment.