(Capitation based prescribing budgets will not work) (Effective prescribing at practice level should be identified and rewarded)

General practice prescribing costs have risen rapidly in recent years and there are wide variations between practices in rates and costs of prescribing. In this week's BMJ, Majeed and Head argue that capitation based formulas for prescribing are very crude tools and that health authority pharmaceutical and medical advisers should use their knowledge of local factors when setting budgets. They also underline that GPs need to ensure that their prescribing is appropriate and cost effective.

To the contrary Greenhalgh argues that Majeed and Head fail to take into account the reality of the variability of prescribing costs between practices, even when local factors are accounted for. She concludes that it is theoretically possible for health authorities to identify a range of bands within which a practice's prescribing costs should fall and calls for a pilot study to test the feasibility of such a notion.

Contact:

Dr Azeem Majeed, Senior Lecturer in General Practice, Division of General Practice and Primary Care, St George's Hospital Medical School, London
[email protected]

Dr Trisha Greenhalgh, unit for Evidence Based Practice and Policy, Joint Department of Primary Care and Population Sciences, UCLMS/RFHSM, Whittington Hospital, London
[email protected]