Brennan Report - Department of Health and Children

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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
Chapter 6 Accountability – General Medical Services and Community Drug SchemesDrugs Payment SchemeUnder the Drugs Payment Scheme, individuals and families pay only the first ¤ 70 per calendarmonth of expenditure on approved items. Under the scheme, GPs, Consultants and Dentistsmay prescribe approved medicines of their choice from a list of licensed drugs, medicines andappliances, agreed between the Department of Health and Children and the IrishPharmaceutical Healthcare Association. This list includes the 4,536 items from themedical card list above plus a further 3,673 items. It should, however, be noted that, in 2002,only 2.4% of the drugs prescribed/dispensed under the Drugs Payment Scheme (at a cost of¤ 5.8 million) were from this supplementary list.The retail pharmacist facilitating this service is entitled to a dispensing fee and a 50% mark upon the ingredient costs of the products dispensed. Again, it is understood that, in accordancewith normal commercial practice, retail pharmacies routinely negotiate discounts (in the formof rebates) with wholesalers in relation to the drugs, medicines and appliances they supply underthe Drugs Payment Scheme.As Figure 6.1 below suggests, the cost of operating these publicly-funded drugs schemes hasincreased significantly in recent years.Figure 6.1: Comparative Costs of Publicly-Funded Pharmacy Services, 2001 - 2003Cost of Services (£ m)800700600200120022003 (est)5004003002001000GMS:DoctorsGMS:PharmacyClaimsGMS:HighTechDPS:PharmacyClaimsLTI:PharmacyClaimsDPS:HighTechSource: GMS (Payments) BoardAccording to the 2001 Annual Report of the GMS (Payments) Board, the national averagepharmacy cost per medical card holder was ¤ 371. The national average pharmacy cost perclaimant under the Drugs Payment Scheme (DPS), was ¤ 890, not including the co-paymentcontribution per claimant (the gross figure is ¤ 1,314). As such, the pharmacy costs of the twomain publicly-funded schemes, the medical card and the Drugs Payment Scheme, varyconsiderably.81
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Commission onFinancial Managementan
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TABLE OF CONTENTSEXECUTIVE SUMMARY
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6.4 COMMUNITY DRUG SCHEMES 80Medica
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Executive SummaryEXECUTIVE SUMMARYT
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Executive SummaryWe do not underest
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Executive Summary"demand-led" schem
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Terms of ReferenceTERMS OF REFERENC
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GlossaryEstimates for Public Servic
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Chapter 1 Introduction and Backgrou
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Chapter 1 Introduction and Backgrou
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Chapter 2 Overview and Issues2.2 OR
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Chapter 2 Overview and IssuesAppend
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Chapter 2 Overview and IssuesFigure
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Chapter 2 Overview and Issuesother
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Chapter 2 Overview and IssuesTable
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Page 35 and 36: Chapter 2 Overview and IssuesIn 200
Page 37 and 38: Chapter 2 Overview and IssuesThe an
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Page 41 and 42: Chapter 2 Overview and IssuesProble
Page 43 and 44: Chapter 3 Managing the Health Servi
Page 59 and 60: Chapter 4 Service Planning, Budgeti
Page 65 and 66: Chapter 5 Accountability - Hospital
Page 79 and 80: Chapter 6 Accountability - General
Page 81: Chapter 6 Accountability - General
Page 89 and 90: Chapter 7 Accountability - Employme
Page 101 and 102: Chapter 8 Audit ReformCHAPTER 8AUDI
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Page 105 and 106: Chapter 8 Audit Reformoutsourcing)
Page 107 and 108: Chapter 8 Audit Reformaudit reports
Page 109 and 110: Chapter 8 Audit Reformas relating t
Page 111 and 112: Chapter 8 Audit Reform●●Penalti
Page 113 and 114: Chapter 9 External Reporting Proced
Page 119 and 120: Chapter 10 Information SystemsStrat
Page 121 and 122: Chapter 10 Information SystemsRecom
Page 123 and 124: Chapter 11 ImplementationRecommenda
Page 125 and 126: Chapter 11 Implementationbeing brou
Page 127 and 128: Appendix 1Appendix 1COMMISSION MEMB
Page 129 and 130: Appendix 1He has held this position
Page 131 and 132: Appendix 2SIPTU*South Eastern Healt
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Appendix 3Name of AgencyBord na Rad
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Appendix 3Name of AgencyIrish Blood
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Appendix 3Name of AgencyWomen’s H
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Appendix 4Department of Health and
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Appendix 4collated and assessed by
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Appendix 4The most detailed element
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Appendix 4Ratifying and Submitting
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Appendix 4changes to the Service Pl
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Appendix 4advised of their existenc
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Appendix 4Approvals Required in lin
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Appendix 5Appendix 5DIAGNOSIS RELAT
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Appendix 5Figure: Ax.1 Casemix Adju
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Appendix 6Appendix 6AUDIT OF STRUCT
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Appendix 7(vii)(viii)(ix)participat
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Appendix 8Appendix 8 - Integrated M
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ADDENDUMNumber Recommendation IT Ti
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Number Recommendation IT TimeframeR
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Brennan Report - Department of Health and Children

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