The indicative drugs target savings scheme, IDTSS, was introduced from 1 January 1993 on foot of a negotiated agreement between the Department of Health and Children and the Irish Medical Organisation, IMO. The agreement provided that both parties were committed to the achievement of responsible and cost effective prescribing. The scheme was established in line with 1992 policy document, The Future of General Practice in Ireland.
Under the terms of the IDTSS, participating doctors receive annual prescribing targets and the savings realised by them may be used for health board approved practice developments. From 1993 to 1998, the terms of the IDTSS allowed for 50% of the savings realised to be allocated to health boards to specifically fund general practice developments within their area. The participating doctors could access the other 50%. Since 1999, this has changed and the doctors involved may access 100% of their accrued savings.
The drugs savings which accrue under the scheme relate to prescriptions for general medical services scheme patients. GMS patients receive their approved prescribed drugs and medicines free of charge. Non-GMS patients are entitled to avail of the drugs payment scheme, DPS. The DPS provides that no person or family unit has to pay in excess of €78 per month for approved prescribed drugs and medicines. There is a common list of reimbursable medicines for the GMS and DPS. This common list ensures that prescriptions provided to patients relate to a common usage of drugs for both GMS and other patients. For an item to be included on the common list, it must comply with certain criteria which include authorisation status, where appropriate, price and, in certain cases, the intended use of the product.
Clinical decisions in relation to prescribing are taken by a general practitioner based on the symptoms of the presenting patient. In 1997, a review of the IDTSS was completed by Michael Murphy, professor of pharmacology at University College, Cork. The purpose of the review was to determine the effects of the IDTSS on quality of patient care in the GMS, with particular reference to changes in prescribing patterns. The review found that "there were changes in prescribing behaviour as a result of the indicative drugs target savings scheme. Some doctors made savings through enhanced prescribing of generic medications and there were no discernible negative effects on overall quality of prescribing".
Under the IDTSS savings may be used by the general practitioners involved to provide additional or enhanced services which impact on patients. These include information technology, practice premises, clinical equipment, research, education, training and recruitment of extra primary care expertise on fixed term contracts, for example, paramedical, counselling etc. Savings made cannot be used to subsidise normal practice expenses. Health boards are required to approve applications from participating GPs for the use of the savings made under the IDTSS.
