A more practical solution to this problem - and I speak with some authority
here, since I am one of the few people ever to have taken an overspent HA
into a recurrent prescribing underspend of >500k is to do the reverse of
what Ahmad says.
It must have struck most people reading this list for any length of time
that GPs are strongly motivated by money, and it is often the main topic of
discussion here.
No-one has ever tried real financial penalties for GPs who fail to perform,
although it occurs to me that some of the more zealous PCGs might.
Anyway...
The system we use (which has worked, and continues to do so) is to reward
progress. Only small amounts of lucre are needed to do this, plus plenty of
encouragement. Our system rewards practices which improve the quality of
their prescribing, which *reduce* their overspend (if they have one), and
which improve improve their generic prescribing rate (HA average now about
69p.c.) The chronic underspenders - some of whom are actually
underprescribers - only get rewarded if the quality of their prescribing
meets certain standards. This is backed up by a reasonably sophisticated
system for management of new drugs and primary/secondary care liaison.
If you don't reward progress by the overspenders, the situation simply gets
worse. I can produce numerous examples of this in other HAs although one of
the other list members will kill me if I do so!
Bearing in mind that prescribing is going to be 20pc of a PCG budget and
that it inflates faster than anything else, it would be a good idea not to
let the zealots, therapeutic nazis and dreamers into the driving seat.
If anyone is interested, I can let them have the document have circulated to
our locality groups on prescribing.
Andrew
Dr. Andrew N. Herd MRCGP
Family Physician, Medical Adviser to Durham Health Authority
Medical Editor, Practice Computing
> -----Original Message-----
> From: [log in to unmask]
> [mailto:[log in to unmask]]On Behalf Of Ahmad Risk
> Sent: 05 April 1998 19:14
> To: [log in to unmask]
> Subject: Re: PCG and practice drug budgets (was Branded drugs)
>
>
> On 04/05/98 06:04:19, Katabront <[log in to unmask]> wrote:
>
> >In a message dated 05/04/98 09:51:38 GMT, Jon Rogers wrote:
> >
> ><< Thus those that reduce their "overspend" will be rewarded, as
> are those
> > that "underspend". >>
>
> I have been thinking about this one for a while and still can't get my
> tender brain round it.
>
> 1. If there are 'overspenders', that means the overall budget is in
> the red.
>
> 2. If you do nothing, you are a) in trouble, and, b) can't reward
> anybody
>
> 3. if the pverspenders reduce their costs, that makes the overall
> budget *less* in the red, nevertheless, still in the red; and item 2
> still applies
>
> 4. If the overspenders cut their spending so that they are
> 'budget-neutral',
> you are in the black by the amount the underspenders 'saved'
>
> 5. It is only now that you might consider rewarding the overspenders
> and the underspenders
>
> 6. But that amount would be small....
>
> 7. And, if I were an underspender, I would want to reward my fellow
> savers and certainly not subsidise rewards for those who just managed to
> be neutral (at best) or cut their deficit but still in the red (at
> worst)!
>
> 8. can you give one good reason why I should do that?
>
> >This is the key. If we are allowed to build in realistic
> incentives then we
> >can make it work. If you don't bring any flour you can't eat any cake.
>
> Equally, if you don't bring in the right amount or the right kind of
> flour, you can't expect the same size piece of cake, yes?
>
> Ahmad
>
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