The Merrison and Greenfield reports and the Limited List

Abstract

In his paper, MrGravelle argued that GPs had little incen-tive to keep drug costs down because anysavings that they generated were spreadover all taxpayers, so that individual prac-titioners received insignificant benefitsfrom even very large savings. Moreover,a reduction in the number of scripsissued would probably have requiredsome family doctors to spend more timewith each patient, thus increasing theirworkloads. Given the range of policy instrumentsthat could have been introduced, MrGravelle asked:• Should patients pay for the whole or aproportion of their prescriptions or shoulda limited list be introduced?• Should GPs or family practitioner com -mittees (FPCs) be given prescribingbudgets and how should they be deter-mined?• Would controls on prescribing repre-sent an unacceptable reduction in GPs’clinical freedom?• Would controls be preferable to a vol-untary system based upon improved infor-mation and peer review?• What forms might control take?In response to the first of MrGravelle’s questions, the Merrison Reportsuggested that the introduction of a lim -ited list ‘should lead to improvement inthe quality of prescribing by the elimina-tion of ineffective and unnecessarilyexpensive drugs’. Against the backgroundof the remaining questions, the commit-tee did not suggest any further reductionsin prescribing freedoms. As plans to computerise prescribingdata suggested by the Tricker Reportwere still underway, the recommenda-tions of the Merrison Committee suggestthat voluntary peer-review was favouredover limitations of the freedom to pre-scribe.