Bowing to ever-increasing pressure to run the practice like a business,
we have spent a year trying our hardest to reduce prescribing costs
without compromising patient care.  We managed to save a substantial
sum by searching out the most cost-effective solution for each patient.
This took up a lot of staff time.


For example, changing to the cheaper and easier-to-use
automatically-triggered inhalers for our asthmatic patients seemed like
a simple enough project.  However, despite clear and simple
demonstrations of the device to each patient (Look, no pressing
required) patients mannaged to misuse it in an amusing variety of ways.

    One patient actually dismantled the device so that she could press
    it, and still managed to mistime the inhalations.

    Another patient repeatedly blew into the device, in the belief that
    she was taking the drug.

    Several patients insisted that this drug (same drug) didn't work
    even one half as well as the other one.

    One patient read the leaflet (DrugCo2 were stupid enough to put the
    possible side-effects on their leaflet while DrugCo1 didn't) and
    said that she had never had all these side-effects with the old
    inhaler.  After reassuring her that the drug was the same, and that
    the side-effects only happen to some people (if they didn't happen
    to her with the old inhaler, they would not happen with the new
    one), she returned the very next day complaining of _every_
    side-effect listed.

The work needed to reassure these patients was in addition to the
explanation and demonstration given to every patient as they were
changed over from one inhaler to the other.  It was beyond our staff to
convince all the patients, and several have been put back on the old
inhalers, despite the fact that they were clearly not using them
properly.


For all this effort, we received a remuneration of £160, to be spent on
the surgery.  The reason that the reward was so small: in the previous
year we had come well below the national average anyway, and our
allowance had been reduced accordingly.  Or something like that.

IIRC, the govt. did the same thing to the first wave of fundholding
practices.  After being told that they could use any money, saved in
the first year, on their practices, the saved amounts were not only
removed from the annual budget for succeeding years, but were not
forthcoming as promised in the first place.


My question to you experienced businesspeople is,

  "What is the optimal strategy when offered fiscal incentives
   by the government, considering your position as one of many players
   in a game where the objective is to maximise long-term profit?"


As far as prescribing is concerned, I personally conclude that the
friction between patients and staff caused by cost-saving incentives,
and the resulting loss of patients and revenue, is too great a risk to
justify the minimal and short-term gain offered by complying with the
aims of the government.  Roll on New NHS.

--
Joe Chacko <[log in to unmask]>


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