A scheme in Oxfordshire reportedly offers GP practices “cash back” for money saved from drug budgets for the frail elderly, attracting a backlash from the medical community. While Health officials said the incentives aimed to encourage family doctors to “review the quality, safety and cost effectiveness of their prescribing”, patients' groups stated it amounted to an attempt to “bribe” GPs into putting financial savings before the needs of the elderly.
In a desperate bid to save at least £1.45 million, NHS Oxfordshire clinical commissioning group (CCG) set targets for GPs. Practices were told to cut medication spending by at least £2 per care home resident, out of which £1 per patient were for them to keep along with half of any other savings if made. The CCG advised family doctors to “rationalise” prescribing of drugs to frail patients over 70, suffering from various health problems. A number of GPs rejected the scheme as local medical committees in Berkshire, Buckinghamshire, and Oxfordshire advising them against it.
Joyce Robins from Patient Concern said, “I am absolutely horrified by this, its simply a bribe. GPs ought to do the right thing for their patients, not be being swayed by having money waved around in front of them.” Dr Andrew Green of the Britis Medical Association said many elderly care home residents were on too many different types of medication and should have their pills reviewed. He said the CCG was wrong to approach the issue with an eye to reduce costs. “It might well be that the result is cutting costs, but that mustn't be the aim. The aim must be to get appropriate care to the right patient.”
A spokesperson for NHS Oxfordshire CCG said, “The aim of the Prescribing Incentive Scheme is to review medicines and prescribing in care homes and with the frail elderly in order to optimise medication. There is multi-morbidity and poly-pharmacy in this group of patients leading to many potential problems, including side effects, non-adherence and medication waste. The incentive scheme will encourage practices to audit and review their prescribing in this group of patients to optimise their medicines management.”
He added, “The decision has been taken to go ahead as we believe the scheme offers the right balance of incentive to the practices whilst also evidencing good governance of quality and funding.”
