• abdominal supports.

As with many of the prescribable accessories that can be used by the stoma patient, if good stoma care is taught, patients do not routinely need accessories to supplement their stoma appliances.

The cost of caring for the stoma patient in the community takes a large proportion of the GP's budget, especially as stoma appliances are low-volume, high-priced goods. Since the formation of primary care trusts (PCTs) there are unified budgets for prescribing hospital and community health services and therefore it is vital that prescribing costs are kept down. Stoma care products are an area that GPs find difficult to assess; they normally rely on the stoma care nurse or discharging nurse on the ward to supply the correct information for the patient's prescription. If a patient just requests stoma bags from a GP it is unlikely that the GP would be able to prescribe the appropriate appliance unless the patient had the full and correct information.

In 1997, stoma goods accounted for 1.3 million prescription items costing £89 000 000 - 2% of prescribing costs in England for that year. After the first prescription for stoma appliances is provided by the GP, the following prescriptions are done on a repeat request programme and the prescription is automatically signed by the GP. In the face of escalating practice costs, GPs start to look at prescribing and search for areas where money can be saved and stoma appliances are often targeted.

Sometimes, accessory products are needed by the patient for short-term or one-time use, but unless the product is removed from the prescription after the need has finished the product will go on being prescribed and the patient will often stockpile the accessory. For GPs the use of prescribing analysis and cost data (PACT) can be a useful tool to audit stoma appliance prescribing within their PCT. Prescribing data are kept by the Prescribing Prescription Authority (PPA) and include the name, cost and number of items dispensed. This information is available at national, health authority and practice levels and can allow the GP to examine a specific therapeutic area such as stoma care. Armed with this information the GP can highlight his or her spend on stoma appliances. It seems that GPs find the large and constantly changing number of stoma products that become available bewildering, and many do not have the expertise to identify the inappropriate or excessive usage of certain products (Majeed, 1998).

If GPs undertook regularly to audit stoma patients in their practice, either in conjunction with their stoma care nurse or by seeing the patient at least once a year to rewrite the patient's prescription and remove appliances or accessory products that are not currently needed, considerable savings could be made within the PCT.

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