Prescribing and Medicines Optimisation Strategy

Transcription

1 Prescribing and Medicines Optimisation Strategy - for consultation Dr Robin Jackson Executive Lead Dr Kamlesh Sidhu GP Prescribing Lead

2 The Challenge Medicines the most common health intervention delivered by the NHS, BUT... Treatment with a medicine is not always the answer, and may not be what the patient wants 30-50% of medicines not taken as intended Extensive waste of medicines, circa 300million nationally per year Medicines implicated in 5-8% of preventable hospital admissions Unacceptable levels of medication errors Variable uptake of evidence-based medicines (NHS Atlas of Variation) The financial context do more with less

3 Medicines Optimisation a paradigm shift Not just about the 24 million prescribing budget (but managing the cash non-negotiable) Meaningful patient encounters and involvement in shared decision making Consider the patient experience Patients empowered to manage their medicines and self care Provide support where needed Deliver better value from the CCG investment in medicines Improve patient outcomes Improve the patient experience Reduce medicines waste Improve medicines safety Prevent hospital admissions Integrated working across providers of care

4 Improved patient outcomes Delivery of QIPP a Enhanced patient experience and satisfaction Improved standards of care Medicines optimisation - Medicines within care pathways - Patient empowerment and support for medicines taking Improve prescribing efficiency and reduce medicines waste Minimise patient harm associated with the use of medicines Use of medicines to reduce preventable deaths and minimise the burden of disease Clinical leadership and engagement a Quality, Innovation, Productivity, Prevention Infrastructure to support medicines optimisation Partnership working with stakeholders

5 Strategic Priority 1: Reduce preventable deaths and minimise the burden of disease Earlier identification of unmet health need and initiation of evidence-based medicines Pilot an electronic audit tool to systematically interrogate the GP clinical system and identify those patients whose treatment may be optimised Agree a joint primary-secondary care prescribing formulary compliant with NICE guidance, and support implementation via EMIS-Web Practice Pharmacist supported prescribing reviews in asthma, COPD and diabetes

6 Strategic Priority 2: Minimise patient harm associated with medicines CCG and Practice Pharmacists to provide advice and support for proactive implementation of patient safety advice relating to medicines Medication reviews prioritised for patients taking high risk medicines, care home residents and those on multiple medicines supported by Practice Pharmacists Take action to improve medicines safety and reduce risks when patients transfer between care providers e.g. Primary care to hospital, and vice versa Targetted therapeutic prescribing / medication reviews e.g. NSAIDs, antibiotics Ongoing maintenance of RAG lists for prescribing responsibility

7 Strategic Priority 3: Improve prescribing efficiency and reduce medicines waste 1.0 Inhaled Corticosteroids (Cost per Average Daily Quantity) QIPP Prescribing Profile : OCT 12-DEC 12 (All) Practice : LANCASHIRE NORTH Selected Practice Selected CCG Other CCGs

8 Strategic Priority 3: Improve prescribing efficiency and reduce medicines continued... Generic prescribing and optimising for efficiency treatment choices e.g. Sildenafil first-line PDE5 inhibitor, citalopram in preference to escitalopram Review repeat prescribing systems to ensure good governance and reduce medicines waste (specific focus on care homes) Increase the proportion of electronic repeat prescription requests from patients, and the number of prescriptions generated electronically Targetted work on specific areas of prescribing including: wound management, dermatological specials and emollients, infant formula milk, oral nutritional supplements and gluten free foods

9 Strategic Priority 4: Optimise medicines use through integration with care pathways and patient empowerment Clinicians to empower patients in the management of their medicines through engagement in shared decision making and utilisation of self-management plans Signpost those patients requiring additional support to other services e.g. Community pharmacy provided Medicines Use Review (MUR) or New Medicines Service (NMS) Optimise the use of inhaled medicines in respiratory disorders through improved inhaler technique

10 Strategic Priority: Structural Enablers Clinical leadership and engagement Clarify roles of CCG and GP Practice Prescribing Leads Clinicians and Practices to be encouraged to critically review their prescribing performance CCG to seek GP and Practice engagement in the delivery of the strategy and its objectives Local Pharmacy Network (LPN) to be invited to identify a representative to work with the CCG in engaging the community pharmacy sector in CCG priorities for medicines optimisation

11 Strategic Priority: Structural Enablers Robust infrastructure to support medicines optimisation Establish a CCG Prescribing and Medicines Optimisation Forum (encompassing the Practice Pharmacists Group) Review and clarify CCG governance arrangements for Local Decision Making in respect of medicines e.g. formulary Review and evaluate GP practice requirements for pharmacy support to assist in the delivery of CCG objectives In consultation, develop a standard Practice Pharmacist job description for those roles and functions resourced by the CCG and intended to support the delivery of CCG objectives Consider benefits and potential investment requirements for pharmacy support as part of a bespoke service to care home Embrace innovation and IT; education underpinning

12 Strategic Priority: Structural Enablers Partnership working with stakeholders Joint work with other commissioners: CCGs, NHS England, Lancashire County Council (Public health), Health and Wellbeing Boards Work across providers of care and care pathways to do the right thing in relation to prescribing and medicines Partnerships with patients and the public seeking to consider the patient experience in its work on prescribing and medicines optimisation A more sophisticated model of joint working with the pharmaceutical industry that is ethical and transparent where this supports CCG objectives and priorities

13 Summary CCG to build on the very positive practice already evident in Lancashire North on prescribing and medicines optimisation Managing the money non-negotiable, but now need a greater emphasis than ever on the use of medicines to deliver improved patient outcomes, reduce waste and enhance patient experience seeks to provide a roadmap to improving the health and experience of people of Lancashire North through the optimal use of medicines