Dáil Éireann - Volume 480 - 30 September, 1997

Written Answers - Prescribed Drugs Costs.

294. Mr. N. Ahern asked the Minister for Health and Children the number of complaints received in 1996 or other recent year in relation to the refusal of general practitioners to prescribe certain drugs on the grounds that they were not available on the GMS; the system of incentives or inducements, if any, offered to general practitioners who keep the cost of their prescriptions under control; if he has satisfied himself that patients are receiving proper medical prescriptions; and if he will make a statement on the matter. [14954/97]

Minister for Health and Children (Mr. Cowen): The position is that there is a comprehensive list of essential drugs and medicines under the general medical services (GMS) scheme, which are available free of charge to medical card holders, on foot of a general practitioner's prescription. A number of products, generally those available without prescription on an over-the-counter (OTC) basis, are not available under the scheme. Approximately 15 representations are received each year by my Department on behalf of members of the public seeking to have OTC products included on the list of items reimburseable under the scheme. As a prescription is not required for OTC items, the question of a doctor refusing to prescribe these products does not arise.

With regard to the second element of the Deputy's question relating to incentives for doctors to prescribe efficiently and effectively, I should point out that the indicative drug target (IDT) scheme was introduced for general practitioners contracted under the general medical services (GMS) scheme on 1 January 1993. The introduction of the IDT scheme followed a review of the GMS scheme in 1992 by the Department, the health boards, the Irish Medical Organisation, and the Irish College of General Practitioners.

In the course of the review mentioned above, it was agreed by all sides that medicines were not always prescribed in the most effective manner and that there was significant potential for an improvement in prescribing practice leading to better patient care and better use of available resources in the development of general practice. To assist in this process, doctors are provided with indicative drug targets each year for GMS patients on their panels. These targets are constructed on the basis of average prescribing costs weighted by age and sex criteria. As an incentive to doctors, the IDT scheme provides that a portion of the savings made would be made available to the individual doctor for practice development projects designed to improve the delivery of GP services. The balance of the savings made is allocated [1124] to the relevant health board and for investment in general practice projects within the board's area.

At every stage during the process of reaching agreement on the IDT scheme and in the subsequent implementation of that agreement, all of the parties to the review mentioned above clearly understood and accepted that it was the duty and obligation of doctors, individually and collectively, to provide the most appropriate management and to optimally utilise the available resources for patient care. I would emphasise that the IDT scheme is a voluntary scheme and the right of the doctor to prescribe for the patient as he-she considers necessary, remains absolutely in place.

I am satisfied therefore, that the IDT scheme places the utmost importance on patient care from the viewpoint of safe, rational and cost effective prescribing. It is important to point out that the IDT scheme does not provide the general practitioner with a personal remunerative advantage, rather it provides a means for investment in facilities, equipment and services in his-her own practice in the first instance and for other practices in the health board's area. Such investment is to the advantage of all patients of general practitioners.