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Audit Committee

3rd Report, 2004 (Session 2)

Supporting Prescribing in General Practice - A Progress Report

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SP Paper 84

Session 2 (2004)

 

Contents

REMIT AND MEMBERSHIP

THE REPORT

ANNEXE A - EXTRACT FROM THE MINUTES

Extract from the Minutes - 3rd Meeting 2003 (Session 2)

Extract from the Minutes - 5th Meeting 2003 (Session 2)

Extract from the Minutes - 2nd Meeting 2004 (Session 2)

ANNEXE B - ORAL EVIDENCE AND ASSOCIATED WRITTEN EVIDENCE

5th Meeting 2003 (Session 2), 30 September 2003

ORAL EVIDENCE

Mr Trevor Jones, Head of Health Department, Scottish Executive and

Chief Executive, NHS Scotland

Mr Bill Scott, Chief Pharmaceutical Officer, Health Department,

Scottish Executive

Dr Hamish Wilson, Head of Primary Care Division, Health Department, Scottish Executive

SUPPLEMENTARY WRITTEN EVIDENCE

Letter from the Convener to Trevor Jones, Head of Health Department, Scottish Executive and Chief Executive, NHS Scotland

Letter from Trevor Jones, Head of Health Department, Scottish Executive and Chief Executive, NHS Scotland to the Convener


Audit Committee

Remit and membership

Remit:

1. The remit of the Audit Committee is to consider and report on-

(a) any accounts laid before the Parliament;

(b) any report laid before or made to the Parliament by the Auditor General for Scotland; and

(c) any other document laid before the Parliament concerning financial control, accounting and auditing in relation to public expenditure.

2. No member of the Scottish Executive or junior Scottish Minister may be a member of the Committee and no member who represents a political party which is represented in the Scottish Executive may be convener of the Committee.

(Standing Orders of the Scottish Parliament, Rule 6.7)

Membership:

Mr Brian Monteith (Convener)

Rhona Brankin

Susan Deacon

Robin Harper

Margaret Jamieson

George Lyon

Mr Kenny MacAskill (Deputy Convener)

Committee Clerking Team:

Clerk to the Committee

Shelagh McKinlay

Senior Assistant Clerk

Joanna Hardy

Assistant Clerk

Christine Lambourne

 

Audit Committee

3rd Report, 2004 (Session 2)

Supporting Prescribing in General Practice - A Progress Report

The Committee reports to the Parliament as follows-

INTRODUCTION

1. In considering the report of the Auditor General for Scotland (AGS) entitled "Supporting prescribing in general practice - a progress report" (AGS 2003/5) the Committee took evidence on 30 September 2003 from Mr Trevor Jones, Head of Scottish Executive Health Department and Chief Executive, NHS Scotland; Mr Bill Scott, Chief Pharmaceutical Officer and Dr Hamish Wilson, Head of Primary Care Division, Scottish Executive Health Department.

2. In taking evidence, the Committee sought to examine:

· maximising the benefits of computerisation

· repeat prescribing and reducing waste

· The new General Medical Services Contract

· The patient experience

3. Our main findings and recommendations are as follows:

Summary of Findings and Recommendations

· The Committee notes the progress which has been made by NHSScotland since the 1999 baseline report both in improving the quality of prescribing and achieving savings. (Para 7)

· The Committee believes that the development and application of modern Information Management and Technology (IMT) systems to support effective and efficient prescribing practice within NHSScotland has been too slow and, at times, piecemeal. The Committee acknowledges that there are many local examples of good practice but is concerned that these have not been adopted more widely across the country. The Committee recognises also that the Scottish Executive Health Department (SEHD) has supported a number of innovative pilot projects but is concerned that many such projects remain in pilot phase for many years. It recognises that the process for national roll-out of technological change is complex and involves considerable investment as well as significant changes to clinical practice. Nonetheless the Committee believes that greater priority and impetus must be given to accelerating the process of evaluation and roll-out both to achieve best value and to provide a modern and effective service to patients. (Para 12)

· The Committee believes that the pace of technological change must be significantly advanced and recommends that SEHD sets out an explicit action plan, including timescales and targets, on how this will be achieved. (Para 13)

· The Committee is firmly of the view that a failure to embrace modern technology in areas such as repeat prescribing and the transfer of prescribing data will result in an inefficient use of NHS resources and a less than optimal service to patients. (Para 14)

· The Committee is concerned about the risk involved in moving from many local IT systems to national systems, given the substantial financial resources involved as well as the need to maintain continuity of service and to protect patient safety. (Para 15)

· The Committee therefore recommends that the risks involved in moving over to new national IT systems are properly evaluated through a formal risk assessment procedure which should be examined by the Executive's auditors. (Para 16)

· The Committee recommends that work to roll out successful pilots which have been shown to combat waste in repeat prescribing is given a much higher priority to ensure that improvements for patients and savings are generated at the earliest opportunity. (Para 21)

· The Committee requests that in responding to this report, the Executive sets out the progress being made in resolving a) the issue of electronic signatures on prescriptions and b) difficulties relating to current remuneration and reimbursement models. (Para 22)

· The Committee believes that the delay in delivering the benefits of pilot projects to patients throughout Scotland is unacceptable. The Committee considers that a clear structure for agreeing and adopting successful practices identified by pilot projects is urgently required and that this should be accompanied by definite timescales. (Para 25)

· While the Committee recognises the benefits of minimising the bureaucracy involved in the operation of the quality framework associated with the new General Medical Services (GMS) contract, it is essential that proper systems controls are in place in order that the Accountable Officer can ensure that public money is used with due regularity and propriety. (Para 30)

· The Committee has received no evidence of the risk assessment procedures which may have been carried out in relation to the operation of payments under the quality framework. The Committee therefore recommends that a comprehensive risk assessment is drawn up and applied. (Para 31)

· The Committee appreciates the complexities involved in estimating the financial impact of the new General Medical Services contract. However, it remains concerned that the Executive was not able to provide a more detailed assessment of the possible cost pressures which may arise. Despite the difficulties involved, the Committee believes that an evaluation of the impact of the contract on prescribing costs, including a margin for error as appropriate, is a fundamental of sound financial planning. (Para 34)

· The Committee would like an assurance that SEHD has measures in place to ensure that other services would not be adversely affected should the introduction of the new GMS contracts result in an unforeseen rise in prescribing costs. (Para 35)

· The Committee welcomes the developments in information management and technology across the Primary Care sector, which aim to improve the efficiency of prescribing, but feels there is a lack of focus on treating patients more effectively. SEHD is unable to say when systems will be capable of allowing a comparison to be made between diagnosis and prescription on a large scale. This is needed to facilitate improved clinical audit and allow the development of robust performance indicators. (Para 37)

· The Committee is concerned that many of the delays and repeat visits experienced currently by patients could be avoided through improvements to prescribing practice and more effective use of IMT. The Committee believes that patient safety and the overall quality of care depends upon effective sharing of prescribing data, particularly in the interface between primary and secondary care, and requests that SEHD review and report upon current progress in this area. (Para 38)

· The Committee welcomes the Executive's plans to launch more public awareness campaigns to equip patients with more information on the use and cost of medicines. It further welcomes the dump campaign which the Executive Health Department intends to run early in 2004 to encourage the return of unused medicines. (Para 40)

· The Committee is disappointed by the ad hoc manner in which patients gain access to alternative treatments and the lack of evidence gathering to evaluate the effectiveness of lifestyle prescriptions and herbal or homeopathic remedies against established treatments. (Para 44)

· The Committee considers that SEHD, in its consideration of best value, should ensure that the full range of possible approaches is considered alongside conventional treatments. (Para 45)

· The Committee recommends that SEHD support more studies to evaluate both the effectiveness and cost-effectiveness of alternative therapies, including lifestyle prescriptions and herbal and homeopathic remedies, compared with established therapies. (Para 46)

BACKGROUND

4. In September 1999, the Accounts Commission published a baseline report "Supporting prescribing in general practice" (AGS/2003/5). The report provided some broad comparative information about prescribing patterns with the aim of improving both the quality and cost-effectiveness of GP prescribing.

5. "Supporting prescribing in general practice - a progress report" (AGS/2003/5) records the progress which has been made by trusts in prescribing quality and effectiveness since the publication of the baseline report in 1999.

6. The follow-up report identifies the scope for making further savings although it is acknowledged that such savings represent a small proportion of the overall prescribing budget (some £14 million against a total budget, in 2001/02, of £760 million) and will be overshadowed by the rising costs of drugs1.

7. The Committee notes the progress which has been made by NHSScotland since the 1999 baseline report both in improving the quality of prescribing and achieving savings.

MAXIMISING THE BENEFITS OF COMPUTERISATION

8. In evidence to the Committee Trevor Jones, (Head of the Scottish Executive Health Department) stated that a range of new information systems are being developed by NHSScotland in primary and secondary care. A number of pilot IT projects and evaluation exercises have been or are being carried out to try to ensure that local successes are duplicated nationally. For example, the Executive estimate that a pilot project on the electronic transfer of prescriptions (ETP) which has been running since 2002 in Ayrshire and Arran will be rolled out across Scotland in 20052. (Cols 122-124)

9. However, Mr Jones also stated that in relation to the wider picture of improving electronic clinical communication between primary and secondary care, it was not possible for the Scottish Executive Health Department (SEHD) to give a completion date for what is an ongoing process.

10. Historically, IT solutions had been a matter for individual NHS bodies and, as a consequence, a large diversity of systems evolved. The NHS intended to move to national systems which would, once established, facilitate a more rapid roll-out of future developments. The development of national systems would involve a very large investment, with attendant risks. (Col 129)

11. Mr Jones stated that IT has, at times, assumed a lower priority than clinical needs when development funds became available to the Service and that this resulted in an underinvestment in the development and updating of IT systems in the NHS. (Col 130)

12. The Committee believes that the development and application of modern IMT systems to support effective and efficient prescribing practice within NHSScotland has been too slow and, at times, piecemeal. The Committee acknowledges that there are many local examples of good practice but is concerned that these have not been adopted more widely across the country. The Committee recognises also that the Scottish Executive Health Department (SEHD) has supported a number of innovative pilot projects but is concerned that many such projects remain in pilot phase for many years. It recognises that the process for national roll-out of technological change is complex and involves considerable investment as well as significant changes to clinical practice. Nonetheless the Committee believes that greater priority and impetus must be given to accelerating the process of evaluation and roll-out both to achieve best value and to provide a modern and effective service to patients.

13. The Committee believes that the pace of technological change must be significantly advanced and recommends that SEHD sets out an explicit action plan, including timescales and targets, on how this will be achieved.

14. The Committee is firmly of the view that a failure to embrace modern technology in areas such as repeat prescribing and the transfer of prescribing data will result in an inefficient use of NHS resources and a less than optimal service to patients.

15. The Committee is concerned about the risk involved in moving from many local IT systems to national systems, given the substantial financial resources involved as well as the need to maintain continuity of service and to protect patient safety.

16. The Committee therefore recommends that the risks involved in moving over to new national IT systems are properly evaluated through a formal risk assessment procedure which should be examined by the Executive's auditors.

WASTE

17. Medicines which are prescribed but not taken represent an estimated £15 million in wasted resources in Scotland each year3. SEHD did not consider that it is safe to re-use medicines which have been returned. In evidence to the Committee, Mr Scott stated that "We have no idea about the conditions under which the medicines that are returned from the community have been stored or whether they have been contaminated in any way". It is for this reason that SEHD felt that the issue of waste was best tackled by improvements to prescribing practices - for example by dispensing small amounts, particularly at the beginning of a new treatment. The Committee supports the efforts being made to give patients greater control over their own medication and to engage patients in decision making and concurs with the view that this will help to reduce waste as well as having wider benefits to patients. (Cols 126-127)

18. The Committee believes that the development of services such as pharmacy domiciliary visits will help to further reduce waste as well as enhance patient safety and the effective use of medication and recommends that SEHD works to expand such services in line with its commitment in "The Right Medicine" (Col 138)

Repeat dispensing

19. The AGS report records that 75% of medicines prescribed are on repeat prescription4. Pilot projects which were carried out in Grampian and Tayside in 2001 involved a system whereby a signed "master" prescription was created to authorise reimbursement to pharmacists while a series of "slave" prescriptions enabled small instalments of medicine to be dispensed at frequent intervals. The Grampian pilot showed that, with pharmacist involvement and frequent review of patient needs, wastage can be reduced and quality can be improved. The pilots also, however, revealed that the current remuneration and reimbursement models present an obstacle to such innovative dispensing practice5. (Cols 127-128)

20. Following these pilots and an extensive literature review, the Primary Care Division of the Scottish Executive recommended a model for repeat prescribing and dispensing based on a system of master and slave prescriptions. The model was being piloted in North East Fife at the time of the publication of the AGS's report. A resolution to some of the difficulties - for example, the use of electronic signatures which is governed by UK legislation - was still being sought. (Col 128)

21. The Committee recommends that work to roll out successful pilots which have been shown to combat waste in repeat prescribing is given a much higher priority to ensure that improvements for patients and savings are generated at the earliest opportunity.

22. The Committee requests that in responding to this report, the Executive sets out the progress being made in resolving a) the issue of electronic signatures on prescriptions and b) difficulties relating to current remuneration and reimbursement models.

MAINSTREAMING PILOT PROJECTS

23. Evidence on both computerisation and prescribing initiatives designed to reduce waste demonstrates the central role of pilot projects in the evaluation of new systems. The Committee considers that in both the AGS report and the Executive's evidence it is possible to discern a pattern of delay in capitalising on successful pilot projects by adopting them into mainstream practice6.

24. The Committee believes that the delay in delivering the benefits of such projects to patients throughout Scotland is unacceptable. The Committee considers that a clear structure for agreeing and adopting successful practices identified by pilot projects is urgently required and that this should be accompanied by definite timescales.

THE GMS CONTRACT

25. The General Medical Services (GMS) contract will come into use following the passage of the Primary Medical Services (Scotland) Bill in December 2003. The target date for implementation is April 20047. The contract has been developed with the aim of introducing a fairer and more flexible contract for general practitioners and will involve incentives for the delivery of quality patient care. The AGS's report8 did not refer directly to the new contracts but the Committee took evidence on the issue in order to discover how prescribing behaviour might be influenced by the introduction of the new contracts.

26. The Committee heard evidence that under the new contracts, a quality and outcomes framework would assess the quality of service delivered by Primary Care Practices and calculate the appropriate financial rewards. During evidence, Dr Hamish Wilson stated that the indicators within the framework would "encourage and incentivise prescribing that is in line with nationally accepted, good clinical practice". A complex scorecard9 would be used to assess a practice's performance against the framework. Robust information systems within the practice would therefore be necessary to ensure that the assessment was sound. (Col 138)

Systems controls

27. Following evidence-taking, the Committee wrote to Mr Jones seeking more information on the development of the information systems which will underpin the new contracts and asked what system controls and risk assessments had been carried out.

28. In his response, Mr Jones said that the upgrade of GP practice systems is a stated priority within NHSScotland's IMT strategy and that the upgraded systems, approaching completion, will "provide a robust base for the enhanced features necessary to deliver the requirements of the new contracts and the executive's wider strategy".10

29. Mr Jones also stated in his follow-up response that the quality framework will be measured within a "high trust/low bureaucracy" system implemented through "an annual review, including a practice report and a visit by the NHS Board".11

30. While the Committee recognises the benefits of minimising the bureaucracy involved in the operation of the quality framework, it is essential that proper systems controls are in place in order that the Accountable Officer can ensure that public money is used with due regularity and propriety.

31. The Committee has received no evidence of the risk assessment procedures which may have been carried out in relation to the operation of payments under the quality framework. The Committee therefore recommends that a comprehensive risk assessment is drawn up and applied.

Cost of implementing the new contracts

32. The Scottish Executive Health Department, during evidence, was unable to provide the committee with a view as to the impact of the new contracts on the cost of prescribing. During evidence, Mr Jones said "The measures...are not about reducing prescribing costs; they are about improving the quality of prescribing". (Col 140)

33. In his follow-up letter, Mr Jones expanded on the difficulties involved in costing accurately the impact of the new GMS contracts. He said "Evidence based prescribing may in some circumstances lead to increases in overall costs, for example, the increased prescribing on statins, but there are other initiatives that may reduce costs. These include the work of Area Drugs and Therapeutic Committees, Scottish Medicines Consortium Guidelines and NHS Board Prescribing Formularies". Mr Jones also reiterated that the primary purpose of the new contracts was to improve the quality of prescribing.12

34. The Committee appreciates the complexities involved in estimating the financial impact of the new GMS contract. However, it remains concerned that the Executive was not able to provide a more detailed assessment of the possible cost pressures which may arise. Despite the difficulties involved, the Committee believes that an evaluation of the impact of the contract on prescribing costs, including a margin for error as appropriate, is a fundamental of sound financial planning.

35. The Committee would like an assurance that SEHD has measures in place to ensure that other services would not be adversely affected should the introduction of the new GMS contracts result in an unforeseen rise in prescribing costs.

THE PATIENT EXPERIENCE

Clinical audit

36. As information systems currently stand, there is limited scope to link prescription with diagnosis. During evidence, Dr Wilson described clinical audit as "a peer-based system that allows others to check whether what is being prescribed by an individual GP for his or her patients is clinically appropriate". It is anticipated that the new systems being developed to provide evidence for payments made under the GMS contract will, one day, facilitate such clinical audit to a greater degree than is currently the case. (Col 135)

37. The Committee welcomes the developments in information management and technology across the Primary Care sector, which aim to improve the efficiency of prescribing, but feels there is a lack of focus on treating patients more effectively. SEHD is unable to say when systems will be capable of allowing a comparison to be made between diagnosis and prescription on a large scale. This is needed to facilitate improved clinical audit and allow the development of robust performance indicators.

38. The Committee is concerned that many of the delays and repeat visits experienced currently by patients could be avoided through improvements to prescribing practice and more effective use of IMT. The Committee believes that patient safety and the overall quality of care depends upon effective sharing of prescribing data, particularly in the interface between primary and secondary care, and requests that SEHD review and report upon current progress in this area.

Public awareness

39. The NHS in Scotland has run campaigns to inform patients on matters such as the use and overuse of anti-biotics and the safe storage and disposal of medicines and intends to run more, along with a dump campaign, in early 2004, which will encourage patients to return any unused, prescribed medicines. (Col 131)

40. The Committee welcomes the Executive's plans to launch more public awareness campaigns to equip patients with more information on the use and cost of medicines. It further welcomes the dump campaign which the Executive Health Department intends to run early in 2004 to encourage the return of unused medicines.

Achieving Best Value and the Consideration of Alternative treatments

41. In the context of achieving best value, the Committee took evidence on the range of alternative therapies and treatments which can be and are prescribed by GPs. It is becoming more common for doctors to prescribe lifestyle therapies such as diet and exercise programmes. Outside the GP's consultation room, work is being carried out to promote healthier lifestyles, often in partnership with Local Authorities and voluntary organisations. (Cols 136-137)

42. At present, access to alternative medicines such as homeopathic or herbal remedies can depend on the particular interests of GPs although it is possible to refer patients to another GP with an interest in this type of treatment. (Col 136)

43. Drugs trials on new medicines are undertaken by manufacturers with the co-operation of clinical staff. There is some doubt over whether an adequate academic infrastructure exists to support widespread proper clinical trials of alternative remedies. The Chief Scientific Officer is funding a small number of trials on alternative treatments and the Glasgow Homeopathic Hospital may also be conducting trials. (Cols 135-137).

44. The Committee is disappointed by the ad hoc manner in which patients gain access to alternative treatments and the lack of evidence gathering to evaluate the effectiveness of lifestyle prescriptions and herbal or homeopathic remedies against established treatments.

45. The Committee considers that SEHD, in its consideration of best value, should ensure that the full range of possible approaches are considered alongside conventional treatments.

46. The Committee recommends that SEHD supports more studies to evaluate both the effectiveness and cost-effectiveness of alternative therapies, including lifestyle prescriptions and herbal and homeopathic remedies, compared with established therapies.

ANNEXE A

AUDIT COMMITTEE

EXTRACT FROM THE MINUTES

3rd Meeting, Session 2 (2003)

Tuesday 2 September 2003

Members Present:

Rhona Brankin Susan Deacon

Margaret Jamieson George Lyon

Mr Kenny MacAskill (Deputy Convener) Mr Brian Monteith (Convener)

Apologies were received from Robin Harper.

Also present were Fergus Ewing and Ms Margo MacDonald.

The meeting opened at 10.03 am

GP Prescribing: The Committee received a briefing from the Auditor General for Scotland on his report on GP prescribing entitled `Supporting prescribing in general practice - a progress report' (AGS/2003/5).

GP Prescribing (in private): The Committee considered its approach to the report by the Auditor General for Scotland entitled `Supporting prescribing in general practice - a progress report' (AGS/2003/5). The Committee agreed to proceed with an inquiry into the report and to invite Mr Trevor Jones, Head of the Scottish Executive Health Department and Chief Executive, NHS Scotland and accompanying officials to give evidence.

AUDIT COMMITTEE

EXTRACT FROM THE MINUTES

5th Meeting, Session 2 (2003)

Tuesday 30 September 2003

Members Present:

Rhona Brankin Susan Deacon

Margaret Jamieson George Lyon

Mr Kenny MacAskill (Deputy Convener) Mr Brian Monteith (Convener)

The meeting opened in private at 9.49 am

Inquiry into AGS report on GP Prescribing: The Committee took evidence from -

Mr Trevor Jones, Head of Department and Chief Executive, NHS Scotland; Mr Bill Scott, Chief Pharmaceutical Officer; Dr Hamish Wilson, Head of Primary Care Division, Scottish Executive Health Department.

GP Prescribing (in private): The Committee considered the evidence taken at agenda item 5 and agreed to write to the Accountable Officer requesting further information on a number of issues.

AUDIT COMMITTEE

EXTRACT FROM THE MINUTES

2nd Meeting, Session 2 (2004)

Tuesday 20 January 2004

Members Present:

Rhona Brankin Marlyn Glen (Committee Substitute)

Robin Harper Margaret Jamieson

George Lyon Mr Kenny MacAskill (Deputy Convener)

Mr Brian Monteith (Convener)

Apologies were received from Susan Deacon.

The meeting opened at 9.36 am

Supporting Prescribing in General Practice (in private): The Committee considered a draft report on its inquiry into the AGS report entitled `Supporting Prescribing in General Practice: a progress report' (AGS/2003/5) and arrangements for its publication. The report, as amended, was agreed to.

 

SUPPLEMENTARY WRITTEN EVIDENCE

LETTER FROM THE CONVENER TO TREVOR JONES, HEAD OF HEALTH DEPARTMENT, SCOTTISH EXECUTIVE AND CHIEF EXECUTIVE, NHS SCOTLAND

SUPPORTING PRESCRIBING IN GENERAL PRACTICE

Thank you for attending the meeting of the Audit committee on 30 September to give evidence on the above report by the Auditor General for Scotland.

I am writing on behalf of the Committee to seek further information on the introduction of the new GMS contract. There were two particular areas of concern expressed by members. Please see the attached extract from the Official Report of the meeting which may assist you.

Cost (Cols 140-141)

The Committee would appreciate more detail on the impact the new contracts will have on the NHS budget. While the Committee appreciate the difficulty in making such predictions given uncertainties in the future of the drugs market, we would appreciate your best assessment of whether the new contracts will lead to an increase or decrease in the cost of prescribing, leaving aside inflationary costs.

Information systems and compliance (Cols 123-125, 138-139)

The Committee would like more information regarding the development of the information systems which will determine whether primary care practices comply with the requirements of the new contracts and qualify for the relevant extra payments. Can you tell us what system controls and risk assessments, if any, have been carried out in this context. On this issue, it would be helpful if you would provide a copy of the scorecard mentioned by Dr Wilson and any other information regarding the quality and outcomes framework you feel is relevant.

Should you require any further information please do not hesitate to contact either the Clerk, Shelagh McKinlay on 0131 348 5390 or the Senior Assistant Clerk to the Committee, Joanna Hardy on 0131 348 5237 or by email at audit.committee@scottish.parliament.uk.

Brian Monteith MSP

Convener

7 October 2003

LETTER FROM TREVOR JONES, HEAD OF HEALTH DEPARTMENT, SCOTTISH EXECUTIVE AND CHIEF EXECUTIVE, NHS SCOTLAND, TO THE CONVENER

SUPPORTING PRESCRIBING IN GENERAL PRACTICE

Thank you for your letter of 8 October requesting further information on the introduction of the new GMS contract.

I am pleased to provide further information on your queries below.

Cost (Cols 140-141)

The expectation is that the emphasis in the new GMS contract on quality will lead to more effective prescribing compared to the present baseline. As I said at the Committee hearing, this will help ensure that the most appropriate drugs are being prescribed in the most appropriate quantities. Evidence based prescribing may in some circumstances lead to increases in overall costs, for example, the increased prescribing of statins, but there are other initiatives that may reduce costs. These include the work of the Area Drugs and Therapeutic Committees, Scottish Medicines Consortium Guidelines and NHS Board Prescribing Formularies.

Information systems and compliance (Cols 123-125, 138-139)

In preparation for the new GMS contract and in accordance with a stated priority in our national IM&T strategy the Executive launched earlier this year a procurement exercise to upgrade the 150 or so remaining non-accreditated systems in use in GP surgeries in Scotland. This work on ensuring that all GP practices have an operating system that meets the standards laid down in the Requirements For Accreditation for Scotland (RFA Scotland) is approaching completion. These upgraded systems will provide a robust base for the enhanced features necessary to deliver the requirements of the new contract and the Executive's wider strategy.

Work is continuing in a 4 country (UK) context to implement the data processing requirements of the Quality and Outcomes framework. We are also working on an upgraded list of features which we expect GP systems in Scotland to start to deliver for the benefit of practices and the wider NHS during 2004.

The quality framework will be measured within a `high trust/low bureaucracy' system developed to strike a balance between monitoring and demonstrating that standards have been achieved. This will be implemented in normal circumstances through an annual review, including a practice report and a visit by the NHS Board. The quality framework will be reviewed and updated as necessary in the light of changes to the evidence base, advances in healthcare, changes in legislation or regulation and the need for further clarity, or so as to include new areas. These decisions will be based on a review of the quality framework and direct monitoring of the quality standards through NHS Boards and indirect monitoring through academic research and tracking studies. An independent UK-wide expert group will oversee the process. The group will consider the latest evidence available and make recommendations to the four Health Departments or their agents and the GPC.

Finally with regard to the `scorecard' I would refer you to page 17, Chapter 3 `Rewarding Quality and Outcomes' in `New GMS Contract 2003 - Investing in General Practice' a copy of which I enclose; a copy of the scorecard can be found at figure 2 on pages 20 - 22.

If you should require any further information please do not hesitate to contact me.

Trevor Jones

Head of Department and Chief Executive

October 2003

THE FOLLOWING EVIDENCE WAS ALSO RECEIVED BUT IS NOT PRINTED HERE. COPIES MAY BE OBTAINED FROM THE CLERK.

"NEW GENERAL MEDICAL SERVICES CONTRACT 2003 - INVESTING IN GENERAL PRACTICE"


Footnotes

1 Supporting prescribing in general practice - a progress report (AGS/2003/5)

2 The Right Medicine - a Strategy for Pharmaceutical Care in Scotland - Scottish Executive

3 Supporting prescribing in general practice - a progress report (AGS/2003/5)

4 Supporting prescribing in general practice - a progress report (AGS/2003/5) para 4.5.1, page 41

5 Supporting prescribing in general practice - a progress report (AGS/2003/5) para 4.5.2, page 44

6 "Master and Slave Prescriptions: A Model for Repeat Prescribing and Dispensing System" Exhibit 38, Supporting prescribing in general practice - a progress report (AGS/2003/5); Ayrshire and Arran pilot on Electronic Transfer of Prescriptions - The Right Medicine, Scottish Executive, page 17

7 Scottish Executive Press Release 20/06/2003 "GPs vote 'yes' to new contract"

8 Supporting prescribing in general practice - a progress report (AGS/2003/5)

9 "The New General Medical Services Contract" Chapter 3, page 17

10 Letter to Brian Monteith from Trevor Jones October 2003

11 Letter to Brian Monteith from Trevor Jones October 2003

12 Letter to Brian Monteith from Trevor Jones October 2003

 

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