Office of the Comptroller and Auditor General - Press release VFM examination report on Prescribing Practices in the GMS

Press release issued on 26 January 1998

Office of the Comptroller and Auditor General
Press Release
Value for Money Report on Prescribing Practices and the

Development of General Practitioner Services

The Comptroller and Auditor General, Mr. John Purcell, has carried out an examination on prescribing practices and the development of general practitioner services in the General Medical Services Scheme. A report on the examination is being presented to Dáil ?reann today and a copy is enclosed for your information.


Under the General Medical Services (GMS) Scheme medical card holders are entitled to a comprehensive range of health services free of charge, including general practitioner services and prescribed drugs and medicines. In 1996 the scheme provided for the health care needs of 1.25 million people at a cost of ?264 million, including ?130 million in respect of drugs and medicines.

In a review of the scheme in 1991 the Department of Health and Children and the Irish Medical Organisation agreed that the level of prescribing could be reduced without adversely affecting patient care. It was subsequently agreed to introduce an incentive scheme known as the Indicative Drug Target Scheme with effect from 1993 to encourage more rational and economic prescribing.

In 1994 the Department published a strategy document which identified organisational and service problems in the health service and set out a number of steps to develop the service over the period 1994 to 1997.

Overall Finding

The examination revealed that there was scope for further considerable savings in the prescribing of drugs and medicines and that it was not possible to establish whether the investment in developing GP services represented good value for money as no evaluation had been carried out by the Department or the health boards.

The main findings of the examination are summarised overleaf.

Publication Details

VFM Report No. 19: Prescribing Practices and the Development of General Practitioner Services (Publication reference: Pn. 4477) will go on sale in the Government Publication Sales Office, Sun Alliance House, Molesworth Street, Dublin 2 on 26 January 1998

For further information about the report contents, please contact:

Derrick Rapple at (01) 6793122

Main Findings

Indicative Drugs Target Scheme

Over the four year period to 1996 GPs whose prescribing costs were under target achieved savings of ?18.3m while GPs who exceeded their targets overspent by ?43m. Only 5% of GPs achieved savings in each of the four years while 27% did not achieve savings in any year.

Economy in Prescribing Practices

An analysis of prescribing data revealed that

  • the maximum possible savings achievable if every item prescribed was at its lowest unit cost would be ?460,000 per month or ?5.5m per year
  • the full substitution of generic drugs for more expensive proprietary drugs could provide savings of ?1.3m a year.

The potential for further significant savings was also identified in the following areas

  • a switch to less expensive but equally effective first line treatment for depression could save ?640,000 per annum
  • a minor shift in some expensive therapies for stomach ailments would achieve significant savings
  • in the absence of good scientific evidence as to their effectiveness the use of mucolytics which cost some ?700,000 annually should be reviewed
  • a switch to less powerful antibiotics would have long term benefits in medical care and reduce costs. For example, a 10% shift could save ?100,000 a year.
  • the prescription of medical foods which cost ?3.8m in 1996 should be subject to regular review.

Improvement in General Practitioner Services

Between 1993 and 1996, ?64m was paid from savings under the Indicative Drugs Target Scheme and from the GP Development Fund towards the development of GP services. The efficiency and effectiveness of the developments have not been evaluated by the health boards. Each health board should carry out an overall assessment of its programme of investments and a national review should be considered by the Department.

Health boards are not receiving data on the incidence of illness from GPs nor has a patient registration system been introduced, both of which work against better planning of the health service.

A target of 80% for computerising GP practices by 1997, set in the 1994 Strategy document, had not been achieved with only 58% of practices computerised by February 1997.

Therapeutic committees which were set up to bring together hospital doctors/consultants and GPs to define and implement therapeutic regimes for specific ailments have not been as successful as envisaged.

The contents of this page were last updated on 26/09/03