The origins of the National Prescribing Service (NPS) lie in the Australian National Medicinal Drug Policy, particularly the policy on the quality use of medicines.1 The work of the Australian Pharmaceutical Advisory Council and the Pharmaceutical Health and Rational Use of Medicines (PHARM) Committee has placed the quality use of medicines firmly on the national agenda. Many successful projects have been funded. Some of these identified interventions which influenced prescribing. The problem was that, when the projects ended, there was no mechanism for continuing effective interventions. To translate the benefits of this research into national action clearly required a new strategy.

On several occasions, the idea of a national prescribing centre to support prescribers was proposed. The proposals did not become reality until last year's Federal Budget when approximately $22 million was allocated to establish a national prescriber service.

One of the important features of the policy on the quality use of medicines is the partnership approach. This involves health professionals, consumers, the Government and the pharmaceutical industry coming together to solve problems. If the national prescriber service was to be a success, the health professions and consumers would need to feel a sense of ownership and it would have to operate at 'arm's length' from government control. Accordingly, the original idea of having the service designed by a panel of experts was abandoned. Instead, an advisory group was formed made up of representatives of organisations such as the Australian Medical Association (AMA), the Royal Australasian College of Physicians, the Royal Australian College of General Practitioners (RACGP) and the Consumers' Health Forum. One of the group's first recommendations was to change the title of the service from 'prescriber' to 'prescribing' to recognise that pharmacists, nurses and consumers all have a role in the prescribing process.

At the end of 1997, a series of consultations began. These ranged from written submissions to meetings in capital cities and, finally, discussions in local areas co-ordinated by Divisions of General Practice. The views expressed in these consultations were considered by the advisory group in its deliberations.

The advisory group decided that the NPS would be controlled by a board of up to 10 directors. The members of the board are nominated by groups of organisations. The 3 general practitioner members of the board are nominated by the AMA, the RACGP, the Australian Divisions of General Practice and the Rural Doctors Association of Australia. The single pharmacist is nominated by the Pharmacy Guild, the Pharmaceutical Society of Australia and the Society of Hospital Pharmacists of Australia. As members of the board, these representatives will have to act with the best interests of the NPS in mind, rather than those of their own constituencies. Their remuneration reflects their responsibilities for deciding how the NPS will spend its money. Part of this year's budget has already been spent on establishment costs and paying the Health Insurance Commission for the latest round of prescriber feedback. The next financial year will be different. Several core strategies have been proposed.

The NPS will need to co-ordinate all the activities that currently influence prescribing, e.g. encouraging the different sources of drug information to provide consistent advice. If new initiatives to improve prescribing are to be developed, the NPS will need to see that appropriate research is carried out. This may include identifying incentives and disincentives for good prescribing. Its major role is likely to be supplying doctors with information about their own prescribing.2

As prescribing information is an area of interest to the NPS, it will need to work in close collaboration with Australian Prescriber. Before the NPS was announced, a rigorous review of Australian Prescriber was commissioned. This was to find out what role, if any, Australian Prescriber should have in encouraging the quality use of medicines. After considering the results of a readership survey and the opinions of peak bodies, it was clear that there is a need for Australian Prescriber. Health professionals want reliable independent information about the drugs they use. The review, therefore, recommended that the journal be published more frequently. Australian Prescriber will continue to be independently produced with editorial control remaining with the Executive Editorial Board of practising clinicians.

The NPS will have to monitor its own effect on prescribing. Its funding was based on savings in the cost of prescribed medicines. Good prescribing, however, can involve higher drug costs, but lead to savings elsewhere in the health system. The long-term viability of the NPS will depend on it being able to show a beneficial effect on the cost of health care. If the evaluation of the NPS finds that, after 4 years, the savings targets have been exceeded, who should benefit?

The key to the long-term survival of the NPS may lie in devolution. If the philosophy of partnership is extended to the local level, such as Divisions of General Practice, the NPS will be more likely to create its own momentum. Instead of a national centre, there will be many local centres encouraging and helping health professionals and consumers to improve the quality use of medicines. The cumulative effect of locally developed initiatives may exceed the response to imposed interventions.

The NPS has a great potential to promote quality prescribing. There is research available to help plan its strategies and adequate resources to implement them. By co-ordinating the activities which are already operating to encourage good prescribing, the NPS will be able to claim some of the savings it is required to make. Adding its own strategies, particularly if implemented at the local level, should increase the chances of success.


John S. Dowden