Background to Prescribing Management
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- Theodore Summers
- 5 years ago
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1 Background to Prescribing Management Inverclyde CHP population 80,780 Medical Prescribers 63 GPs Dental Prescribers - 26 Non Medical Prescribers 46 (42 nurses, 3 pharmacists, 1 podiatrist) Community Pharmacies 19 GP Practices /09 in Scotland billion on prescription drugs million in primary care (72%) Inverclyde CHP 09/10 drug budget 17.2M Medicines - common intervention a third of over 75 year olds on 4 or more meds ADRs implicated in 5 17% of hospital admissions Waste estimated at 10% of medicines prescribed Need to support safe, clinically effective and cost effective prescribing by medical and non-medical prescribers
2 Prescribing Influences NHS Formularies / National or Local GGC Guidelines Education/ CPD Pharmaceutical Companies Health Board Prescribing Targets for GPs General Medical Services(GMS) Rational Prescribing Scheme Practice Demographics Patient Expectations Drug Cost Hospital Advice Standardised via MCNs
3 Cost per patient (GIC) December November 2009 Health Board Name Cost (GIC) / Patient Cost (GIC) / Weighted Patient NHS Ayrshire & Arran NHS Borders NHS Dumfries & Galloway NHS Fife NHS Forth Valley NHS Grampian NHS Greater Glasgow & Clyde NHS Highland NHS Lanarkshire NHS Lothian NHS Orkney NHS Shetland NHS Tayside NHS Western Isles
4 Inverclyde Primary Care Prescribing Budget 17.2 million 09/10 Expenditure 11.29% over April % over October % over November % over December % over March 2010 Volume + 3.3% annually Offset by drop in cost of drugs through improved cost effectiveness
5 CH(C)P Cost /Patient (GIC) Dec`08 Nov`09 CH(C)P Cost (GIC) / Patient Cost (GIC) / Weighted Patient East Dunbartonshire Community Health Partnership East Glasgow Community Health & Care Partnership East Renfrewshire Community Health & Care Partnership Inverclyde Community Health Partnership North Glasgow Community Health & Care Partnership North Lanarkshire Community Health Partnership Renfrewshire Community Health Partnership South East Glasgow Community Health & Care Partnership South Lanarkshire Community Health Partnership South West Glasgow Community Health & Care Partnership West Dunbartonshire Community Health Partnership West Glasgow Community Health & Care Partnership
6 Prescribing Budget Setting Baseline - Final year end expenditure 1. National adjustments 2. Potential cost savings RPI GMS Technical savings 1. Practice list size adjustment Cost / patient -anomalies 1. NRAC - Demographics
7 Budget Setting Process BASELINE Spend 1. Adjusted for shifts in tariff prices, phasing (Easter), Prescription Price Regulatory Scheme (PPRS), erythropoietin
8 Budget Setting Process 2. Adjusted for prescribing initiatives Savings from RPI indicators Savings from top 3 GMS indicators Savings from remaining Indicators Targeted Therapeutic Interventions (technical) SIP Feed Proposal Nursing Home Dressing Formulary Switch from Tubigrip /Tubifast Medication Waste Campaign** Targeted COPD Medication Reviews** ** applied where current spend > predicted by NRAC
9 Budget Setting Process 3. Adjusted for list size anomalies 4. Uplift (6%) applied to adjusted baseline
10 SCOT-PU Age-sex cost weights for GP prescribing Cost per head ( )
11 18.00
12 East Dun Edinburg North Lan
13 Inverclyde CHP Prescribing Team Role: To promote and support safe, high quality, cost effective prescribing
14 Prescribing Lead GP Hector MacDonald Lead Clinical Pharmacist Margaret Maskrey 3.4 WTE Prescribing Support Pharmacists 2.8 WTE Pharmacy Technicians 0.4 WTE Dietitian 1 WTE Admin Support
15 Working with GPs Working with Community Pharmacies Feedback reports/visits Work with nursing homes Staff training Patient medication review Awareness raising with GDPs
16 Prescribing Indicators Performance indicators which are set at HB level which reflect high quality cost effective prescribing
17 Simvastatin should account for 65% or over of all Statin prescribing
18 100%
19
20
21 Inverclyde CHP - Top 10 Non Formulary Drugs by Cost Per Patie Inverclyde Community Health Partnership NHS Greater Glasgow & Clyde CLOPIDOGREL PREGABALIN ESOMEPRAZOLE ESCITALOPRAM PANTOPRAZOLE RISEDRONATE METFORMIN MR OLMESARTAN IBANDRONIC ACID MODAFINIL
22 GGC Management of Infection Guidance Guidance for Adults Summary
23 Community Pharmacy Schemes Minor Ailments Scheme Public Health Scheme Acute Medication Scheme Chronic Medication Scheme
24 Analysis of GDP Prescribing Per Prescriber Number of Prescriptions Prescribed Items Cost of Prescriptions
25 No of Prescriptions Per GDP (May 09 - Apr 10) A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
26 Prescribing Cost Per GDP (May 09 - Apr 10 10,000 9,000 8,573 8,000 7,000 6,000 5,000 4,425 4,000 3,000 2,000 1, , ,077 1,086 1, A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
27 To p 10 Dru gs By Co 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 SODIUM FLUORIDE AMOXICILLIN CHLORHEXIDINE GLUCONATE BENZYDAMINE HYDROCHLORIDE PHENOXYMETHYLPENICILLIN METRONIDAZOLE ERYTHROMYCIN DOXYCYCLINE MICONAZOLE ARTIFICIAL SALIVA
28 The Future Continued engagement with Prescribers Continued advice and feedback on prescribing to multidisciplinary team Improving links with secondary care Awareness raising with multidisciplinary team Public Engagement e.g. regarding waste management
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