Vol. 427 No. 7
10 Mrs. Owen asked the Minister for Health the number of GPs who are implementing the indicative drug prescribing policy as at the end of February 1993; the projected annual saving; and the percentage of the saving which will be retained by the GP.
21 Mr. Cox asked the Minister for Health the procedures, if any, which have been established in order to achieve a responsible commitment to cost effective prescribing of drugs under the arrangements for the prescribing of drugs under section 58 of the Health Act, 1970, between himself and the Irish Medical Organisation; and if he will make a statement on the matter.
30 Mr. McGinley asked the Minister for Health if he will guarantee that the indicative drug prescribing policy will not result in GMS patients getting unequal treatment to that of private patients; and if he will ensure that modern drugs, particularly the SSRI range for combating depression, will not be withheld from GMS patients due to cost.
69 Mr. Harte asked the Minister for Health if his attention has been drawn to the concern among GPs that the indicative drug prescribing policy could result in an increase of negligence suits; and if he will accept responsibility for professionally indemnifying doctors against all such claims.
I propose taking Questions Nos. 10, 21, 30 and 69 together.
The use of indicative drug targets does not interfere with the right and duty of the doctor to prescribe as appropriate for each patient. Accordingly, there is no question of unequal treatment for GMS patients as a result of their use.
Under the scheme each doctor is encouraged to examine his existing prescribing practices with a view to availing of any available opportunities to make prescribing less expensive and more effective for all his patients. Assistance and support to doctors in the achievement of this objective will be provided on a monthly basis by the General Medical Services (Payments) Board and the individual health boards. In addition, the IMO has established a co-ordination stucture which will provide information and support at both the individual doctor level and to groups of doctors.
As the scheme came into operation in January of this year, and prescriptions dispensed in January are currently being processed for payment, it is not possible as yet to establish the impact of the scheme. The structure of the agreement means, however, that 50 per cent of all savings made by GPs on the target expenditure will be returned to the GPs for investment in agreed practice development.
I welcome the Minister to the House. Is the Minister aware of the disquiet among many doctors about the ethics of this scheme? Any money they save on prescriptions clearly has to be put back into improving doctors surgeries and so on. Is the Minister aware that doctors are concerned that this policy will discriminate against the most socially disadvantaged in our society, that is, the GMS patients? There is a risk that in order to make savings doctors will prescribe what are termed older drugs which are cheaper. They may be able to prescribe more expensive and modern drugs for their patients, particularly for those who are suffering from depression. Is the Minister concerned about this issue? Will he keep a close watch on this policy as it is practised to ensure that no one is discriminated against and that they receive the very best and most appropriate medicine for their ailments? The medical council has declared that it would be unethical for doctors to use the new indicative drug prescribing programmes as a means of making financial gains for themselves. This is a serious concern.
As I said, the targets are purely indicative. They do not interfere with the right, and obligation, of doctors to prescribe exactly the drug he or she deems necessary for the individual patient. There is no threat or possibility of sanction against any doctor who precribes a drug he or she believes a patient needs.
In regard to the point about the ethical view and the view of practitioners, I would remind the Deputy that this agreement was worked out by my predecessor with the full support of the IMO, the doctors' representative body. I have not been made aware of any disquiet in this regard. In fact, I have had meetings with the IMO on this issue and I hope this programme will improve the position substantially not only in regard to the cost of drugs but, more importantly, the regime of drugs available to GMS patients.
In regard to patients who are sent by their consultants to a private practitioner with a prescription for a certain brand of drug, what will be the position for a doctor if he or she changes the drug to a generic drug? Are doctors open to legal action by patients or their survivors if anything happens to them as a result of being given a different drug not by the consultant but by the general practitioner?
As the Deputy is aware, I am not a medical person. A clinical decision on the most appropriate form of treatment or medicine is entirely a matter for the doctor concerned. It would be totally inappropriate for me to try to dictate or suggest that a certain form of treatment would be appropriate in any particular case.
The consultants do not have to save money.
I am sure all consultants and general practitioners will continue to exercise total clinical independence.
The Minister used the term, "agreed practice development". Does this mean that the ways the money is spent will be monitored? How will this be done? Have the procedures for the spending of this money been developed?
Question No. 18 deals with this issue, and I do not want to anticipate the answer now.
Let us not anticipate that question now.
In view of his comments regarding inducements offered by drug companies, would the Minister agree that there is a danger that the same kind of ethos could build up in this scheme whereby GPs would be encouraged to prescribe cheaper rather than the most appropriate drugs? In regard to the assessment of savings, does the Minister intend to assess the referral rate of GPs as well as the prescribing rate? I suspect that these rates may be in inverse proportion to one another. General practitioners who take the initiative to try to keep patients at home may end up prescribing drugs more heavily while GPs who tend to send patients directly to hospital may appear to be saving money and consequently benefit from the scheme but will cost the State more money at the end of the day. Is there a system in place whereby the referral rate by GPs can be assessed?
The Deputy has made a very good point. General practice units have been established in each health board area. Since I took up office I have asked for these mechanisms to be put in place quickly. I have received the co-operation of the IMO in achieving this. It will be the job of the general practice development units, together with the General Medical Services (Payments) Board and my Department to monitor ongoing developments in this area. The whole thrust of the developments, and my thrust as Minister, will be to improve primary care so that people will not necessarily be referred automatically to secondary care if they can be better treated by their GP. I hope during my term as Minister for Health to improve the area of general practice generally. I have already taken a number of initiatives in this regard.
In the event of the targets not being met, can the Minister say if his Department will undertake to make up any shortfall which may occur?
The attitude of the Department is that it will plough back the savings into the development of general practice anyway. Therefore, there will be no net saving to the Exchequer. I hope that the targets will be met and the investment will be available to bring about the improvements which most people realise are necessary at a general practice level. Because of the attractiveness and focus on secondary or hospital care in recent years, the general practice service has not received the attention it deserves. I hope that resources will be available both this years and next year to make improvements in the general practice service. I hope to establish one or two pilot programmes to improve this area over the next year or two.
Will the Minister confirm that the package his predecessor, Dr. John O'Connell, agreed with doctors to prevent a strike in the GMS system indicated that a certain sum of money would be available, half of which was to come from this scheme? If that portion of the money does not come from the scheme, will the Minister's Department augment the money which has been promised? Otherwise, he will face another threatened strike by doctors?
I do not want to be pessimistic about the targets being achieved. I am confident from my discussions with the IMO and general practitioners that these targets will be met. We will be constantly reviewing the implementation of the scheme. I am very confident from the support the scheme has received that the targets will be achieved during the course of this year.
Let us move on to deal with Question No. 11. I am disappointed at the lack of progress made on questions today. The House will agree that the disposal of some ten questions in 67 minutes is totally unsatisfactory.
Questions to the Taoiseach took half an hour.
This is the first occasion the Minister has taken Question Time.
If the Taoiseach answered the questions——
Question No. 11, please.
