§ Mr. Hickmetasked the Secretary of State for Social Services (1) what assessment he has made of the effect of inducements offered by drugs manufacturers to general practitioners and dispensing doctors on the level of prescribing of particular drugs under the National Health Service; and if he will quantify that cost;
(2) what information he has as to inducements offered by drugs wholesalers and manufacturers; what other methods are used by drugs wholesalers and manufacturers to persuade general practitioners and dispensing doctors to prescribe particular drugs on the National Health Service; and if he will make a statement;
(3) how much he estimates drugs manufacturers spend on general practitioners in persuading them to prescribe particular drugs on the National Health Service; and what information he has as to the manner in which such money is spent;
(4) what arrangements he has to claw back excess discounts on National Health Service prescribed drugs received by dispensing doctors; and if he will make a statement;
(5) pursuant to his reply of 19 February, Official Report, column 447, whether there is any evidence to suggest that discounts offered to dispensing doctors by drugs wholesalers and manufacturers result in the unnecessary prescription of particular drugs on the National Health Service; and if he will make a statement;
(6) pursuant to his reply of 19 February, Official Report, column 447, in what manner and by what system dispensing doctors receive additional income from the varying levels of discount on the drug cost offered to them by wholesalers and manufacturers; to whom, and by whom, the discounted price is paid; to whom, and by whom, the full price is paid; and if he will make a statement;
(7) pursuant to his reply of 19 February, Official Report, column 447, whether additional income is received by doctors from the varying levels of dicount on the drug cost offered to them by wholesalers and manufacturers in relation to drugs contained in the provisional limited list which he announced on 8 November 1984; and if he will quantify that income;
72W(8) pursuant to his reply of 19 February, Official Report, column 447, what is the average amount of additional income which each dispensing doctor receives from the varying levels of discount on the drug cost offered to them by wholesalers and manufacturers.
§ Mr. Kenneth ClarkeIn 1982, the latest year for which complete returns are available, companies within the pharmaceutical price regulation scheme with sales exceeding £2 million declared sales promotion expenditure amounting to £155 million (UK), not all of which was accepted as an admissable expense in the pricing of NHS medicines. About 46 per cent. was spent on representatives, 21 per cent. on advertising, 11 per cent. on literature and the remainder on administrative and other expenses. The companies also spent some £12 million on "information" items such as data sheets, material for medical symposia and samples. They were not allowed under the scheme to reflect any expenditure on gifts and similar inducements in the prices of NHS medicines and we have no information about expenditure on such matters.
General medical practitioners' remuneration arrangements are designed to pay them on average the net income which the Government (having regard to the Review Body's recommendations) have decided is due to them and the expenses actually incurred providing general medical services. We carried out an inquiry in 1983 which established that dispensing doctors obtained discounts. As the reimbursement which they then received for the cost of the drugs which they dispensed was not adjusted to take account of discounts, a disproportionate share of the expenses incurred by general medical practitioners was paid to dispensing doctors. With the profession's agreement, from 1 July 1984 the reimbursement prices paid to dispensing doctors were adjusted to take some account of the discounts the inquiry had revealed. Discount will be completely offset from 1 April 1985 when the full discount adjustment comes into effect.
No information is available about the discount obtained in relation to specific drugs. We have no evidence to suggest that the availability of discounts results in the unnecessary prescription of any drug.
In 1983–84, the last year before discount was taken into account, it is estimated that dispensing doctors in Great Britain received on average additional income from discounts of about £1,200.