The UK indicative prescribing scheme: background and operation

The cost of drugs in the UK has increased at a rate of 4% above inflation over the last ten years. Prescribing in general practice accounts for 80% of the total drugs bill. Within general practice, there is considerable variation in individual prescribing frequency and costs, reflecting demographic, morbidity and professional influences. Recognition that much prescribing is unnecessary and wasteful of resources which may be better used elsewhere in the NHS is a major force behind recent radical changes to the organisation of British general practice. This paper describes the background, implementation and first year of the Indicative Prescribing Scheme (IPS). The IPS is an initiative of the Department of Health in the United Kingdom that aims to introduce greater accountability for, and control over, the costs of prescribing in general practice. Previous attempts to control the costs of drugs to the NHS included efforts to control price, demand, availability; encouraging generic prescribing; and educational initiatives. The IPS was introduced to place downward pressure on expenditure on drugs by improving the quality of prescribing and by eliminating wasteful prescribing. The scheme hinges around the setting of 'indicative prescribing amounts' for each general practice. Practitioners are expected to operate within these guidelines and are provided with regular financial summaries to help them gauge their progress. Additionally, Family Health Service Authorities (the new administrative and managerial body with responsibility for the day-to-day running of primary care services) have engaged medical and pharmaceutical advisers to provide support and information to assist general practitioners with their prescribing. The first year of the scheme has been one of establishment and consolidation. It is too early to judge whether it will be a success. After initial resistance, many doctors are adopting the principles of the scheme and are critically reviewing their prescribing. Greater awareness of the content and influences on prescribing in primary care and of the resource implications for the rest of the NHS of rational prescribing has encouraged dialogue between hospital clinicians, managers and general practitioners.