Brennan Report - Department of Health and Children

Report of the Commission on Financial Management and Control Systems in the Health Servicerecovered by setting it against payments due to the GP in the following year.Recommendations in respect of the General Medical Service (cont’d)R6.8 GPs should be assigned responsibility for reporting to the health board on the accuracy of their list ofregistered medical cardholders annually.R6.9 Health boards should introduce new verification and audit procedures to ensure their lists of medicalcardholders are accurate.R6.10 Based on an evaluation of the reports at R6.8 by the health board, overpayments made in a previous year (forexample, where a patient dies or moves to another GP) should be automatically netted off by the health boardagainst that GP’s Practice Budget for the following year.6.4 COMMUNITY DRUG SCHEMESThe main community drugs schemes are prescriptions under the medical card scheme, asdescribed in the preceding section, and the Drugs Payment Scheme (DPS). There are morespecialised schemes namely the Long Term Illness Scheme (for certain defined illnesses/conditions) and High Tech Medicines Scheme (for certain high cost drug products).Medical Card Scheme: provision of drugs, medicines and appliancesA medical cardholder is entitled to free drugs, medicines and appliances, as prescribed byhis/her GP, chosen from a list of 4,536 licensed drugs, medicines and appliances, agreed betweenthe Department of Health and Children and the Irish Pharmaceutical Healthcare Association.This list includes products of similar content but of (sometimes substantially) varying cost.The retail pharmacist filling a prescription is entitled to a dispensing fee andreimbursement for the drugs, medicines and appliances dispensed on a cost of ingredients basis.We understand that, in accordance with normal commercial practice, retail pharmacies routinelynegotiate discounts (in the form of rebates) with wholesalers in relation to the products theyprovide under the medical card scheme.In all health board areas, on a voluntary basis, GPs are participating in initiatives designed tocontain prescribing costs. In the case of the Indicative Drug Target Savings Scheme, operatingsince 1993, this has involved setting a nominal drugs budget for the GP practice based on his/hernumber of patients with medical cards and average prescribing rates for the country as a whole.Savings made under the scheme are made available by the health board for investment in thedevelopment of general practice (including infrastructure, equipment and computer costs).In at least one health board area, we are aware that savings under this initiative have been usedto co-fund the construction and equipping of a number of local health centres owned by thehealth board where the GP is a central figure within the team providing services from thecentre. Significant investment in medical equipment, communications and computer systems forprimary care has also been achieved. This is fully in accordance with Government strategy onprimary care. The use of resources under the scheme may offer important lessons for use in awider context.80