More staff training needed to promote breast feeding when babies leave neonatal care.

1253 Andrew Jack FiNaNcial TiMes UK doctors will be drawn into new efforts to boost cost effective prescribing in the next few months as part of a deal agreed this month between the government and industry. The newly revised pharmaceutical price regulation scheme (PPRS), designed to cut the overall NHS drug bill by about 5% in its five year life, will result in two initiatives to change current prescribing practice. The first initiative, to be phased in by 2010, introduces generic substitution, which is designed to save costs directly by ensuring that pharmacists switch from any branded drugs named on prescriptions to cheaper generic alternatives unless a doctor ticks a box to insist on the branded drug. The second initiative, to be tested in pilot programmes from next year, will experiment with paying doctors to encourage them to prescribe newer, more effective drugs even when they are more expensive, in line with the latest guidance from the National Institute for Health and Clinical Excellence (NICE). Industry estimates that about 17% of prescriptions cite a specific drug by brand, with the result that 17% of dispensed drugs are branded. But with generic substitution, whereby a pharmacist can substitute the generic equivalent, the proportion should fall. In negotiations with the government, industry preferred substitution to the originally proposed idea of imposing a flat 1.1% price cut on branded drugs for which the patent had expired as well as a cap on the price of these drugs at 50% more than their generic equivalents. More importantly, industry has reached agreement for measures designed to stimulate and reward innovative drug development through “prescribing incentive schemes”; payment by results; and publication of the uptake of “clinically and cost effective medicines,” locally, nationally, and internationally. The new PPRS is staggered, with an initial 3.9% cut to the price of patented drugs due to start in February 2009. Cite this as: BMJ 2008;337:a2699 Generic substitution of drugs is set to be introduced in 2010 UK NEWS Scotland sets six week target for diagnostic tests, p 1254 World NEWS Uninsured people get poor deal from organ donation in the US, p 1256 bmj.com one third of diagnoses of asthma in Canada are wrong, study finds news For the full versions of articles in this section see bmj.com