On Sun, 26 Apr 1998 19:40:43 -0000
[log in to unmask] (Adrian Midgley) wrote:
y> Nothing personal indeed.  But you cannot be serious ((c)MacEnroe) if 
akmidgley> you are contending that there is not a payment to dispensing 
akmidgley> doctors, or that the payment is not greater the higher the cost of 
akmidgley> the drugs (I love implanting 3 months worth of Zoladex (r) myself 
akmidgley> and that is just the FP34D end of the scheme) 

No, of course I do not dispute your facts, only your assumption that the
dispensing income makes doctors, on average, prescribe unethically.

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

Generic rates are a red herring as the PPA needs a generic script for
say, lisinopril to be endorsed as the brand. What counts is the number
of top 20 drugs in the PPA returns that have generic alternatives. Now I
couls well agree that *branded generics* feature more highly on disp.
than non-disp. drs. returns, but I re-iterate that it is the *total*
prescribing cost that has to be taken into account. When you account for
the pharmacists dispensing fees etc, there is an argument that
dispensing is actually a lot cheaper for the NHS.(Am I right, Jeff....Jeff....
are you still here, Jeff?....Aww, don't go!) That aside, there certainly
is *no* evidence that dispensing doctors prescribing costs are higher
than the national average. Cost per item, maybe. Mine certainly is, but
then I give 2 or even 3 month scripts at a time to save people a 10-15
mile trip every month.

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

Sorry, you've lost me there.

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

Sorry, I don't know what you are talking about!

akmidgley> Now, if somebody of unimpeached academic credibility could just show 
akmidgley> for us that the way in which dispensing doctors are paid has no 
akmidgley> influence on what they do, toward increasing income, then we could 
akmidgley> use it as an argument to remove much of the crude and conflicting 
akmidgley> rubbish from the tottering structure that is our pay and 
akmidgley> conditions...
akmidgley> 
 akmidgley> Releasing, in the process, many hours of medical time in practices, 
akmidgley> and many highly trained and capable administrators and the senior 
akmidgley> managers who are essential at present to control those ht&c droids 
akmidgley> in HAs.
akmidgley> 
akmidgley> Imagine, all that from a proof that GPs don't get influenced by what 
akmidgley> they are paid for.  Carry on imagining it, please.

I'm trying to, I really am!

Cheerio!

Graham


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