A review of a national GP drug saving scheme has found little evidence of quality prescribing and has concluded the scheme is no longer viable.
According to an analysis of the Indicative Drug Target Savings Scheme (IDTSS) carried out by the National Centre for Pharmacoeconomics (NCPE) at St James's Hospital at the request of the Department of Health, "the IDTSS, in its current form, is no longer achieving its stated objective".
However, the Irish Medical Organisation (IMO), which was a party to the review process, said the scheme worked well when it was managed properly by the Health Service Executive (HSE) and the Department of Health but that the level of information and advice available to doctors had been inadequate in recent years.
The analysis found that in 2005, just 2.75 per cent of the 2,200 family doctors who look after patients with medical cards came in under target on their prescribing budget. The savings for the year fell to €670,462, well below those achieved when the scheme first commenced.
Following agreement between the IMO and the Department of Health, the IDTSS was introduced in 1993 in response to concerns about the rising costs of drugs under the medical card scheme. As an incentive to lower their prescribing costs, general practitioners are given a prescribing target for the year.
If the total cost of drugs they prescribe is below target at year-end, then the savings made are divided so that 50 per cent goes to individual GPs and 50 per cent to the local GP unit of the HSE. All savings made are invested in the development of general practice.
Many doctors achieved savings by replacing branded drugs with cheaper generic versions of the same medication. But the NCPE report states: "Analysis of prescribing data from 1998 to 2005 indicates a reduction in generic prescribing in terms of items prescribed and associated costs."
Dr Martin Daly, chairman of the IMO GP Committee, said family doctors had been given no specific prescribing advice since 2000. "The last time we got a drug budget was in 2004 and we only got that year's budget in February 2005. So there was no possibility for individual doctors to come in on target," he said.
"It would be disingenuous and counter-productive to our shared aim of quality, cost-effective prescribing to suggest that doctors have been remiss in operating the scheme."
It is understood that GPs are concerned that any decision to abolish the IDTSS could result in the loss of "locked-in" savings already committed to the development of practice premises and the provision of additional services such as psychology and physiotherapy. The NCPE report acknowledges that "the importance of such investment is appreciated and this will need to be considered in future developments".
The report's author, Dr Michael Barry, director of the NCPE, said: "Should an alternative incentive scheme be considered in the Irish healthcare setting the focus should be on rewarding quality prescribing and quality care."
A HSE spokesman told The Irish Times it had suspended the IDTSS and had commissioned the NCPE review. "The HSE and the IMO are both actively reviewing some of the initial findings already made by the review with a view to achieving cost- effective prescribing among GPs," he said.