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 - 16 08/09 in Scotland - 1.3 billion on prescription drugs - 933 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
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
Cost per patient (GIC) December 2008 - November 2009 Health Board Name Cost (GIC) / Patient Cost (GIC) / Weighted Patient NHS Ayrshire & Arran 192 175 NHS Borders 165 169 NHS Dumfries & Galloway 193 177 NHS Fife 199 199 NHS Forth Valley 198 202 NHS Grampian 159 176 NHS Greater Glasgow & Clyde 180 173 NHS Highland 183 180 NHS Lanarkshire 199 202 NHS Lothian 144 164 NHS Orkney 165 166 NHS Shetland 157 168 NHS Tayside 182 181 NHS Western Isles 205 177
Inverclyde Primary Care Prescribing Budget 17.2 million 09/10 Expenditure 11.29% over April 2009 5.29% over October 2009 4.53% over November 2009 3.61% over December 2009 1.97% over March 2010 Volume + 3.3% annually Offset by drop in cost of drugs through improved cost effectiveness
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 162 169 East Glasgow Community Health & Care Partnership 196 173 East Renfrewshire Community Health & Care Partnership 157 169 Inverclyde Community Health Partnership 204 178 North Glasgow Community Health & Care Partnership 198 182 North Lanarkshire Community Health Partnership 155 168 Renfrewshire Community Health Partnership 177 170 South East Glasgow Community Health & Care Partnership 156 165 South Lanarkshire Community Health Partnership 178 171 South West Glasgow Community Health & Care Partnership 178 165 West Dunbartonshire Community Health Partnership 177 162 West Glasgow Community Health & Care Partnership 154 160
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
Budget Setting Process BASELINE 2008-09 Spend 1. Adjusted for shifts in tariff prices, phasing (Easter), Prescription Price Regulatory Scheme (PPRS), erythropoietin
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
Budget Setting Process 3. Adjusted for list size anomalies 4. Uplift (6%) applied to adjusted baseline
SCOT-PU Age-sex cost weights for GP prescribing Cost per head ( ) 75+ 619 625
18.00
East Dun 60.00 Edinburg North Lan
Inverclyde CHP Prescribing Team Role: To promote and support safe, high quality, cost effective prescribing
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
Working with GPs Working with Community Pharmacies Feedback reports/visits Work with nursing homes Staff training Patient medication review Awareness raising with GDPs
Prescribing Indicators Performance indicators which are set at HB level which reflect high quality cost effective prescribing
Simvastatin should account for 65% or over of all Statin prescribing
100%
Inverclyde CHP - Top 10 Non Formulary Drugs by Cost Per Patie Inverclyde Community Health Partnership NHS Greater Glasgow & Clyde 6.00 5.00 4.00 3.00 2.00 1.00 0.00 CLOPIDOGREL PREGABALIN ESOMEPRAZOLE ESCITALOPRAM PANTOPRAZOLE RISEDRONATE METFORMIN MR OLMESARTAN IBANDRONIC ACID MODAFINIL
GGC Management of Infection Guidance Guidance for Adults Summary
Community Pharmacy Schemes Minor Ailments Scheme Public Health Scheme Acute Medication Scheme Chronic Medication Scheme
Analysis of GDP Prescribing Per Prescriber Number of Prescriptions Prescribed Items Cost of Prescriptions
No of Prescriptions Per GDP (May 09 - Apr 10) 900 800 803 700 600 500 400 494 397 362 384 433 394 300 253 280 281 200 100 0 186 153 160 170 123 116 120 94 61 2 2 9 1 2 1 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
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 1,000 0 1,885 937 1,077 1,086 1,154 856 581 633 252 298 440 511 491 2 118 3 18 1 2 135 1 279 125 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
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
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