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1. Expenditure on GP prescribing covers the costs incurred by GPs in prescribing drugs to their patients. Last year this programme accounted for 12% (£577m) of the total Health budget
2. The GP prescribing budget is not addressed by SHARE and its distribution was based entirely on historical spend until the introduction of a weighted capitation formula in 1996. This formula has been gradually phased in and currently applies to some 12% of the total GP prescribing spend. The other 88% continues to be driven by historical spend. The formula will be superseded by whatever is agreed as a result of this Review
3. Under the current formula age-sex cost weights for GP prescribing are derived from information on the average annual cost of dispensed prescriptions across nine female age bands and eight male age bands. These are based on an annually updated random sample of 1,000 prescriptions per month collected over 2 years, which are based wherever possible on generic drug costs.
4. The average annual costs by age and sex are shown in Table 13.1. These highlight the significant differences in GP prescribing costs across the age bands. The increased costs of GP prescribing for the elderly population are particularly noteworthy:
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Table 13.1: GP Prescribing Costs Per Head of Population by Age and Sex, 1996/97 |
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GP Prescribing |
Age Bands |
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0-1 |
2-4 |
5-15 |
16-24 |
25-44 |
45-59 |
60-64 |
65-74 |
75+ |
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Cost per Male head £ Female |
22 |
22 |
29 |
22 |
41 |
108 |
108 |
199 |
251 |
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21 |
21 |
26 |
46 |
58 |
134 |
191 |
184 |
235 |
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Note:
1. Table shows costs per head of the total population in each age group, not
costs per patient.
2. There is only one age band for males between the ages of 45 and 64
5. The Steering Group has been advised that the sampling approach on which these weights are based is statistically sound. It has noted that the weights offer precise age bands and the attraction of being annually updateable to reflect changes in national average GP prescribing costs by age.
6. The Steering Group has also decided to add two refinements to improve the robustness of the evidence base for this age-sex adjustment:
7. In addition the Steering Group has decided that for reasons of transparency an adjustment for temporary residents should be made an explicit element of the age-sex weighting. Temporary residents can impose considerable additional prescribing cost burdens on particular GP practices in areas where there are large influxes of holiday-makers. There are substantial differences between Health Boards in the numbers of temporary residents treated by GPs. This additional source of demand therefore needs to be allowed for in the GP prescribing adjustment
8. The Steering Group has agreed to make an adjustment for these extra costs by adding to the age-sex weights a demographic category to reflect the numbers of temporary residents treated in each Board. A judgement was taken (based on the value of temporary resident costs adopted within the English formula) to fix the cost of prescriptions for temporary residents at 0.5 of the average cost of prescriptions for males under 5
9. It is therefore proposed that the age-sex weights used by the current GP prescribing formula be retained and updated, with extra adjustments to increase the sample size and to account explicitly for temporary residents
10. Figure 13.1 shows Health Boards' relative GP prescribing requirements (compared to the national average) resulting from these age-sex weightings
11. The chart shows a range of relative costs, from 5.7% below the national average in Shetland to over 10% above the national average for Borders. Lanarkshire, where prescribing costs are over 4% below the national average, is also noteworthy. Other Boards with below average costs are Grampian, Greater Glasgow and Lothian. The below-average Boards have an age-sex structure which places a less than average burden on GP prescribing costs because they have a lower proportion of elderly people in their populations. As will be seen later in this chapter these differences in age-sex structures can have a significant effect on each Board's overall GP prescribing needs.
12. The current GP prescribing formula already adjusts for relative morbidity and life circumstance needs using the same statistical methodology as that adopted by this Review. The index applied by the formula comprises one indicator - the proportion of the population under the age of 75 reporting a limiting long-term illness in the Census. As explained above, this index is applied to only 12% of the total GP prescribing budget, the remaining 88% being distributed on a historic basis without any morbidity and life circumstances adjustment
13. Chapter 5 describes the decision tree within which adjustments for morbidity and life circumstances across all the care programmes have been developed. This underpins all the morbidity and life circumstance needs adjustments with a consistent evidence-based rationale running throughout the formula, based on the links between patterns of health service use and indicators for health need derived from population characteristics. At the same time the model developed for each care programme can reflect the different indicators that influence the need for services, allowing each programme to follow the particular path which available knowledge and evidence suggest is best for that element of care
14. The route taken through the decision tree by the GP prescribing programme is highlighted below in bold italics. For GP prescribing the only option which passed all the statistical tests was a disease-specific model using the full set of available indicators.
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