Many practices will probably have experienced an instruction to change all patients on drug X to drug Y because it would have saved the PCO a said amount of money.
This form of wholesale drug switching is both an inconvenience and interference that practices would not normally choose. The change may be clinically appropriate and in certain cases it may be financially appropriate (i.e. if there are significant savings to be made as opposed to simply switching from month to month to save a few pennies here or there).
Where it is reasonable to switch a patient then practices may agree to do so. However, GPs must always use their clinical judgement and, where they can make a clinical case for not switching a patient, they have every right to continue to prescribe as they feel is clinically appropriate.
GPs are responsible for anything they sign and, even if they feel they are being coerced to change by the PCO, they should only change prescribing if they believe it to be correct for an individual patient.
Practices should also be able to decide on the most appropriate method of switching, e.g. bulk switching, where a whole of a practice’s relevant population are switched to the new drug en masse, or switching at routine review.
Where a bulk switch is made at the request of the PCO they should provide adequate resource to facilitate the switch including the input of the PCO pharmacy advisor and resources to inform patients of the change.
Computer software integrated into the clinical system may suggest alternative, more cost-effective options for prescribing for an individual patient. Where clinically appropriate, GPs should try to be mindful of prescribing costs but there is no contractual obligation for clinicians to adhere to all such software suggestions.