Controversies in primary care Setting prescribing budgets in general practice Capitation based prescribing budgets will not work

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# Controversies in primary care Setting prescribing budgets in general practice {#article-title-2} General practice prescribing costs have risen rapidly in recent years, and there are wide variations between practices in rates and costs of prescribing. Setting general practice prescribing budgets with a capitation based formula seems to offer a solution to these problems. However, capitation based formulas may unfairly penalise legitimate variations and increases in prescribing costs. We therefore asked Azeem Majeed and Trisha Greenhalgh to give their views on the subject. # Capitation based prescribing budgets will not work {#article-title-3} Many health authorities are considering introducing capitation based prescribing budgets for their general practices.1 There are two important factors driving this process. The first is cost containment. Drugs prescribed by general practitioners now account for 11% of all NHS spending (see table). Furthermore, general practice prescribing costs have been rising more quickly than both the average rate of inflation and the total NHS budget.2 Many NHS managers and treasury officials are unhappy with this rapid rate of increase and see considerable scope for savings in general practitioners' prescribing costs. For example, the Audit Commission estimated that prescribing costs could be reduced by about £425m if all general practitioners prescribed like the doctors in 50 general practices which the commission identified as being “good” prescribers.3 View this table: Table 1 Cost of drugs prescribed by general practitioners in United Kingdom from 1985 to 1995 The second factor behind the increasing interest in capitation based budgets is the belief that such budgets will help to ensure that resources are allocated more fairly among general practices. There are wide variations in prescribing costs between general practices, and it is not clear whether these variations are clinically justified. To many people, these variations suggest that the prescribing of general practitioners is either inefficient or inappropriate. Capitation based budgets seem to offer a solution to tackling the dual problems of unacceptable variations in prescribing costs and increasing …