Current prescribing in primary care in the UK. Effects of the indicative prescribing scheme and GP fundholding.

The costs of drugs prescribed in primary care in the UK continue to rise despite a variety of government initiatives. Two of the major initiatives are considered here in detail: the Indicative Prescribing Scheme (IPS), and general practitioner (GP) fundholding, both of which began in 1991. Other more recent initiatives are also described, including the selected list, the Pharmaceutical Pricing Regulatory Scheme and the move to relicense drugs for nonprescription sale. The IPS has generally failed to control the rise in drug costs because of unrealistic targets, organisational difficulties (including the lack of adequate data to set budgets properly) and because there was neither incentive nor penalty to encourage compliance on the part of the GP. The IPS stresses cost containment, and makes little allowance for the consideration of quality of appropriateness of prescribing. Despite this disappointment, the IPS is continuing, and the future of the scheme is discussed here. GP fundholding, in contrast, has reduced the rate of rise of drug costs in participating GP practices, although it has not actually reduced drug costs. There have been a number of studies of this model, which are discussed here. The clear financial incentive to fundholders encourages them to restrain drug costs. Attempts to extend similar incentives to nonfundholding GPs are also described. Although there is a commitment on the part of the government to encourage and make use of data about economic evaluations of drug therapy and other medical interventions, so far the emphasis has been exclusively on cost containment. In this paper, we consider possible mechanisms by which this might be improved.