§ Mr. Clifton-BrownTo ask the Secretary of State for Health what assessment he has made as to the extent to which the system of a fee per item for general practitioner dispensings is conducive to cost-effective prescribing.
§ Mr. MaloneThere is no ready measure of the cost-effectiveness of prescribing. I am aware of evidence that the costs of prescribing by dispensing doctors tend to be higher than those of non-dispensing doctors. I am keeping this matter under review.
§ Mr. Clifton-BrownTo ask the Secretary of State for Health by what percentage difference generic drugs are more or less likely to be prescribed, based on the ratio of the number of prescriptions for one drug to another comparing prescribing patients to those on dispensing lists.
§ Mr. MaloneIn 1993 the proportions of prescriptions dispensed by community pharmacist and dispensing doctors which were prescribed generically were 49.6 per cent. and 21.6 per cent. respectively.
§ Mr. Clifton-BrownTo ask the Secretary of State for Health (1) what would be the impact on the NHS budget if all prescriptions were to be dispensed by pharmacists;
(2) what is the average total cost and the cost of drugs of a general practitioner-dispensed prescription compared to a pharmacist and what is the percentage change of each category over the last two years for which figures are available.
§ Mr. MaloneInformation, published by the Prescription Pricing Authority, on comparative drug costs for 1992–93 is as follows:
Dispensing Doctors£ Pharmacists£ Average total cost (excluding Value Added Tax) 7.48 7.68 Net ingredient cost 6.35 6.77 The percentage changes over the previous two years were:
Year-on-year increase percentage pharmacists Percentage 1992–93 over 1992–92 1991–92 1990–91 Average total cost (excluding Value Added Tax) 5.6 8.0 Net ingredient cost 7.3 7.5
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Year-on-year increase percentage dispensing doctors Percentage 1992–93 over 1991–92 1991–92 over 1990–91 Average total cost (excluding Value Added Tax) 7.0 6.9 Net ingredient cost 8.6 8.1 It is difficult, however, to draw any meaningful inferences from these figures about the relative costs to the national health service of dispensing by community pharmacists and dispensing doctors. There are significant differences between the two systems of payment. Pharmacists only receive payments for their NHS dispensing whereas, in the case of dispensing doctors, such dispensing payments form an integral part of the system whereby the profession as a whole is reimbursed for the actual costs of providing general medical services, including any practice expenses relating to the dispensing function.