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Primary care prescribing and budget-setting

  • Last modified date:
    14 February 2008

This guidance is intended to inform PCTs in making decisions, as part of the capacity planning process, about the deployment of their unified allocations.

Contacts for queries on this guidance are:

 Ming Liu (Finance & Investment) 0113 254 5066
Colin Pearson (MPIG-CCE) 0113 254 5975

1. This guidance should be read in conjunction with two documents recently issued by the Department of Health. First, the planning and priorities guidance for 2003-2006 Improvement, Expansion and Reform: the Next Three Years. Second, the Health Service Circular 2002/012 issued on 18 December 2002 which notifies PCT revenue resource limits for the same three years 2003/04 to 2005/06.

2. This guidance is intended to inform PCTs in making decisions, as part of the capacity planning process, about the deployment of their unified allocations. It is important to earmark realistic amounts to underpin primary care prescribing by GPs and nurses (commonly referred to as the "drugs bill"). PCTs should factor into their planning the best forecast prescribing costs associated with meeting the PPF priorities over the next three years, taking into account any scope to target prescribing more effectively and potential efficiency savings.

CALCULATION OF RESOURCES FOR PRESCRIBING

3. PCT finance directors and prescribing advisors should consider and agree the advice to be provided to their PCT Boards about the resources to underpin prescribing in primary care. This discussion should involve other stakeholders within PCTs, eg, those responsible for specialist commissioning, to ensure that all interests are properly taken into account.

4. We recommend that the starting point for discussions should be the current rate of growth of the drugs bill. The Prescribing Support Unit web site www.psu.ppa.nhs.uk provides monthly national in-year forecast updates which should be viewed in conjunction with PCTs' monthly forecasts included in the PPA Prescribing Monitoring Documents. The PSU web site contains a forecasting utility to facilitate local comparisons with national data.

5. Additional factors to consider include:

  • The National Institute for Clinical Excellence (NICE): PCTs are reminded that they are under a statutory obligation to provide funding for clinical decisions within recommendations from NICE contained in Technology Appraisal Guidance. It is important that mechanisms are in place to assess the impact of NICE guidance on both primary and secondary care. The National Prescribing Centre's handbook "Implementing NICE Guidance" is available on www.psu.ppa.nhs.uk . Additionally, PCTs are reminded about the statutory requirements to fund the provision of disease modifying therapies for Multiple Sclerosis in accordance with HSC 2002/004
  • National Service Frameworks (NSFs) are clearly leading to additional expenditure as more patients are treated. For instance, national expenditure on statins continues to increase by around 30% year on year. The financial implications of NSFs have been factored into unified allocations and PCTs should ensure adequate provision in primary care budgets. Additionally, PCTs should consider the feasibility of arrangements to monitor patients' compliance with and benefit from the treatment prescribed for them.
  • Newly licensed drugs: Most significant new drugs will be referred to NICE for appraisal, but plans should recognise the scope for prescribing during the interim period between the reference and NICE providing their guidance [see para 5 of HSC 1999/176]. Underlying trends of new drugs are picked up in the drugs bill forecast but any large spends may need to be factored in. To help with these assessments, the National Prescribing Centre has distributed the document "On the Horizon" to all PCTs. This document provides information about potentially significant new developments to aid the capacity planning round.
  • Primary care/secondary care collaboration: It is important to ensure a common understanding between primary and secondary care about a consistent approach to clinical responsibilities and funding. For example, it is probable that patients (and their GPs) will benefit if Hospital Pharmacy Services supply greater quantities on discharge. Such arrangements can only be facilitated by a re-alignment of funding between primary and secondary care.
  • Audit Commission Bulletin "Primary Care Prescribing": This bulletin is likely to be published early this year. It provides information on the management of prescribing.

PRESCRIBING BUDGETS FOR PRACTICES

6. It is for the PCT to agree strategies for setting practice prescribing budgets that meet the need of patients and represent the most efficient use of resources. The general principles in last year's guidance for setting and monitoring practice budgets continue to apply. PCTs are still required to notify PPA about the budgets allocated to GP practices and other organisations such as PMS pilots and Walk-in Centres, whose expenditure will be monitored via PPA's Prescribing Monitoring Documents (PMD).

7. PCTs should note changes to nurse prescribing and out of hours prescribing:

  • All nurse prescribing costs should be included within the practice budget. Prescribing costs of nurses directly employed by the practice or PCT are charged to GP practices, as nurses prescribe on prescriptions endorsed with the appropriate practice identifier.
  • PCTs should agree Out of Hour provider budgets and hold them locally (i.e. not notify PPA of them like other practice budgets). For monitoring purposes, PPA will allocate a unique FP10 identifying code to the OOH provider and spend will be reported as a separate line on the PMD.

8. PCTs should be aware that from 2003/04 onwards "elements of which resources have been retained centrally" forms part of their unified allocation. Sufficient provision should be set aside to meet these costs.

9. The Prescribing Support Unit has enhanced its budget setting utility which can be accessed on www.psu.ppa.nhs.uk. This utility, together with local knowledge, should be used to produce final practice prescribing budgets.

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