Sir - O'Connell and Feely's article (IMJ December 1997;90:298) highlights the poor knowledge of drug costs among Hospital Doctors. Interestingly seven of the thirteen proprietary drugs listed have even less expensive generic equivalents ranging from 50% cheaper in the case of Frumil to 25% cheaper in the case of Capoten. Doctors working in Primary Care are forced to be aware of drug costs because of the Indicative Drug Budgeting Scheme (lDBS). This scheme is currently the principle method of funding infrastructure development in Primary Care. Primary Care Doctors are measured against two standards under this scheme; - their historical prescribing pattern which determines their target and their potential to make Savings and
- their relationship to the National Age Related Average (NARA) which determines their group and potential to receive a Grant.
As the scheme has developed, NARA has become the more important measure. Doctors who are 5% below NARA (Group C) receive a grant. In 1996 70% of the total pay out under IDBS was made in grants to Group C Doctors and only 15% of the pay out to Doctors was from savings. Hospital initiated prescribing has always been a concern for Primary Care Doctors especially because Hospital Doctors' poor knowledge of drug costs. The GMS Payments Board publish NARA values for each age group and it would be most helpful if Hospital Doctors not only knew the cost of drugs but also the NARA values for each age groups. The NARA values are listed below. NARA cost of medicines by gender within Age Groups per annum. Age Group | Male | Female | Total | | | | | <5 Years | 36.86 | 34.15 | 35.54 | 5-15 Years | 30.56 | 30.06 | 30.32 | 16-44 Years | 79.72 | 86.42 | 83.39 | 45-64 Years | 193.20 | 185.35 | 189.04 | 65 + Years | 279.32 | 252.74 | 263.05 | Total | 129.561 | 137.20 | 133.72 |
Primary Care Doctors must achieve budgets 5% below NARA if they are to fund Practice Development. As only 30% of doctors practice from purpose built premises and the majority of doctors are single handed such development is urgently required. Frequently a patients hospital prescription for one months treatment will exceed the yearly NARA allowance for that patient. From the Primary Care Doctors viewpoint, therefore, the message for Hospital Doctors is two fold; - know the cost of drugs,
- know the NARA values.
Garrett Igoe, Deerpark, Virginia, Co. Cavan. |