GPs should and would reduce drugs which a re potentially harmful to the elderly. However, it takes time, and persuasion in some cases to achieve the desired result. GPs are overwhelmed and overloaded, and hence they protect themselves by going part-time. Consultations with elderly multiple pathology and multiple pharmacology patients take time…. This perverse performance management is exactly what is derided by the profession.. Why not appeal to our professionalism? The emotive language of “bribery” for what is good practice is the fourth estate at it’s worst. Canada uses humour to achieve the same objective.
GPs will receive half the money saved when they cut the number of drugs given to elderly patients in care homes under a scheme that has been condemned by doctors’ leaders.
Bosses in Oxfordshire want to give GP surgeries a “financial incentive to reduce prescribing costs” by sharing savings from giving fewer medicines to the frail elderly. Patient leaders criticised the plan as a “bribe” and doctors said that it was wrong to focus on cost-cutting rather than patient needs.
Many experts believe that vulnerable elderly people often take too many drugs that do little good and may cause side-effects, with an estimated third of the over-75s taking more than four medicines. Last year Keith Ridge, chief pharmacist of NHS England, said that it was a scandal that a fifth of pills taken by elderly patients were pointless, with hundreds of thousands taken to hospital because medicines interacted badly with each other.
Dozens of GP surgeries in Oxfordshire have been asked by their clinical commissioning group to look at using fewer medicines without harming care, with a target of saving £2 per patient. If they achieve that, surgeries will be paid £1 per patient and get half of any further savings. The scheme aims to save at least £1.45 million.
Andrew Green, prescribing lead for the GP committee of the British Medical Association, said: “The danger here is that [bosses] should not approach it from the view to reducing costs. They should approach with a view to getting the right care for the patient.” He told the magazine Pulse, which uncovered the plans: “In frail elderly patients in care homes it is highly likely that it is a case of stopping, rather than starting, medication. So it might well be that the result is cutting costs, but that mustn’t be the aim.”
Joyce Robins, of the pressure group Patient Concern, said: “It feels a bit like a bribe. Telling GPs you can be better off financially by prescribing less to patients doesn’t seem like a good idea. You would like to think patient care was their main priority, not cost savings.”
The Berkshire, Buckinghamshire and Oxfordshire local medical committee, which represents GPs in the area, has rejected the scheme and is urging surgeries not to agree.
Paul Roblin, the group’s chief executive, said that it was confusing and bureaucratic. “The scheme may not pass the bottom line test on workload versus reward, especially as those doing the work are not directly rewarded for the time they spend,” he wrote in a message to colleagues.
The scheme comes after controversies over arrangements in which local health chiefs paid GPs to refer fewer patients for tests and scans, including those for cancer. The BMA has criticised such payments for contaminating the doctor-patient relationship by making people question GPs’ motives.
An investigation by the BMJ this year found that GPs were being overruled by private companies that were paid by local health chiefs to stop patients being referred to hospital.
NHS England also ran a scheme that paid GPs £55 for each person given a dementia diagnosis. It was condemned as an “ethical travesty” amounting to cash for diagnosis. The number known to have the condition rose by a fifth while it was in operation.
A spokeswoman for Oxfordshire clinical commissioning group 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 . . . The incentive scheme will encourage practices to audit and review their prescribing in this group of patients to optimise their medicines management.” She promised safeguards against distortion of priorities using “nationally endorsed tools”.
Bohemian Polypharmacy – a parody of Queen’s classic song Bohemian Rhapsody – a song all about polypharmacy – taking more medicines than are clinically indicated.