A prescription for improvement Towards more rational prescribing in general practice

The Audit Commission became responsible in 1990 for the external audit of National Health Service (NHS) bodies in England and Wales, including family health services authorities (FHSAs) and district health authorities (DHAs). The Commission's auditors are required to examine arrangements made by these authorities for securing economy, efficiency and effectiveness in areas of expenditure for which they are responsible. FHSA responsibilities include oversight of primary care delivered by general medical practitioners (GPs) and their staff and of dispensing by community pharmacists. Prescribing by GPs is the largest item in their budgets. Two of the reports published by the Commission in 1993, Practices make perfect: the role of the FHSA (Ref.1) and Their Health, Your Business: the new role of the DHA (Ref.2), looked at recent structural changes in the way patient care, including prescribing, is commissioned. They pointed the way towards more co-ordination between purchasing of primary and secondary care. The former report recommended development of the internal management of FHSAs. It pointed to ways in which FHSAs were promoting the development of GP practices and strengthening their infrastructure. FHSAs should now, it said, tailor these efforts more to local circumstances. They should set priorities which reflect assessed needs and give added prominence to the development of quality assurance frameworks and monitoring of practice performance. This report takes forward those recommendations, focusing on GP prescribing. It recognises that this can not be considered in isolation from other GP activities and services, or from prescribing and dispensing in other sectors of health care. All have faced major new pressures, demands and opportunities in recent years. PREFACE This report is based on a detailed study at 10 FHSAs and interviews with doctors and staff at 54 GP practices. Findings were confirmed and developed during pilot audits at nine further FHSAs. Many other organisations and individuals gave views and information. Practice in other countries, in particular the Netherlands, was also examined. The Audit Commission is most grateful to all who contributed (a list is appended), especially to members of our Advisory Group, and to the Prescription Pricing Authority for provision of data. This study was carried out by Ian Jones and Sara Griffiths, with medical advice from Professor Philip Reilly and under the direction of Ken Sneath. Philip Blake and Christine Hogg compiled and edited the associated audit guide. Patrick Graydon, John Russell and Brian Coverley assisted with the preparation and analysis of data. Dr. Frans Van Andel and Geoffrey Jenkins undertook supporting studies.