[log in to unmask],Net wrote at 16:52 on 26/04/98 
about "Re(2): PCGs need to take over pharmacies and dispensing
Drs[wasRe: RE: Panorama]":
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>akmidgley> with one's colleagues is that some are at present being
paid to
>akmidgley> prescribe higher volumes of more expensive drugs.
>akmidgley> 
>akmidgley> I refer to dispensing doctors.
>Bollocks! (Nothing personal you understand!)

Nothing personal indeed.  But you cannot be serious ((c)MacEnroe) if 
you are contending that there is not a payment to dispensing 
doctors, or that the payment is not greater the higher the cost of 
the drugs (I love implanting 3 months worth of Zoladex (r) myself 
and that is just the FP34D end of the scheme) 

and surely you would not suggest that dispensing doctors on average 
have lower or equal rates of generic prescriptions (with excellent 
medico-legal product liability reasons to be sure) to non-dispensing 
doctors?

The fact that other incentives - eg being paid to prescribe less and 
cheaper - are on offer, and that the effect they are intended to 
incentivise has occurred in close spatio-temporal relation is 
irrelevant to the note I made above.

This is not the only example of a perverse incentive, for instance 
our local HA prescibing adviser and other senior FHSA people have 
made strenuous efforts (which must cost £50 per person per hour I 
suppose, counting heating lighting housing pay and so on) to 
discourage GPs in Devon from carrying out a task which the NHS pays 
a specific fee for them to do.  Now you may call me naive and 
simplistic if you like, but I would think renegotiating the payment 
of the amount intended to be paid to GPs to deliver that fraction by 
some other means would have been a more efficient and effective 
method than distributing a forged SFA amendment and then holding a 
series of meetings, adding to the excess amounts of paper on GPs 
desks ( table: http://www.bmj.com/cgi/content/full/316/7140/1291/Fu4 )
and generally going into competition with another department of the 
NHS.  

Now, if somebody of unimpeached academic credibility could just show 
for us that the way in which dispensing doctors are paid has no 
influence on what they do, toward increasing income, then we could 
use it as an argument to remove much of the crude and conflicting 
rubbish from the tottering structure that is our pay and 
conditions...

Releasing, in the process, many hours of medical time in practices, 
and many highly trained and capable administrators and the senior 
managers who are essential at present to control those ht&c droids 
in HAs.

Imagine, all that from a proof that GPs don't get influenced by what 
they are paid for.  Carry on imagining it, please.

--- OffRoad 1.9r registered to Adrian Midgley


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