Introduction: The Prescribing Quality Review Scheme (PQRS) has been designed to reflect the four key principles of medicines optimisation: Understanding and improving patient experience. Evidence based choice of medicines. Ensuring medicines use is as safe as possible. Making medicines optimisation part of routine practice. It also aims to support the cost-effective use of medicines within the principles of local decision making. The delivery will be via increased collaborative working between GP practices and CWS Medicines Management Team and will consist of 3 sections: 1. Attendance by the nominated prescribing lead for each practice at the FOUR quarterly prescribing leads meetings. 2. Attendance at TWO medicines managers workshops by the nominated Medicines Managers for each practice. 3. Practice prescribing review work. With THREE themes: a. Improving quality of prescribing. b. Improving safety of prescribing and medication related process. c. Improving cost effectiveness. Aims of the scheme: To promote high quality, safe and cost-effective prescribing. To promote multidisciplinary engagement in line with local and national guidelines and priorities. Develop and maintain effective relationships between CWS Medicines Management Team and practices. Principles of the scheme: The funding for the scheme will support improved outcomes in patients through improved prescribing practice; these improved outcomes are linked to local and national priorities to achieve high quality, safe and cost effective prescribing. This will be achieved through collaboration between practices and CWS Medicines Management Team. Eligibility: The scheme is open to all practices within CWS. Participation is voluntary; practices are not obliged to take part. All practices wishing to participate in the scheme must complete the sign-up form by 27 th June 2016 and return the completed form electronically to cwsccg.medicinesmanagement@nhs.net (Appendix 1). Prescribing Quality Review Scheme 1
Payment: The maximum payment that each practice can achieve is: 800 for attendance at the quarterly locality prescribing meetings ( 200 per attendance at meeting x 4). 400 for nomination of Medicines Manager (attendance at two workshop sessions provided by the Medicines Management Team and provision of support for the GP practice Prescribing Lead) as well as for supporting the work as detailed in Section 3. 10p/patient for successful completion of each element of the Quality Improvement section of the scheme (Section 3a). 8p/patient for successful completion of the Improving Best Practice section of the scheme (Section 3b). 5p/patient for participation in the cost effectiveness section of the scheme (Section 3c). Total available payment available across Coastal West Sussex = 280,000. For all relevant markers the registered patient numbers will be based on the NHS Business Services Authority Prescription Pricing Division (PPD) practice list size data for March 2016. Changes in list size during the course of 2016/17 greater than 3% will be taken into consideration upon request. Use of savings: Payments are to be used for the direct benefit of patients of the practice, as required by Department of Health guidelines. Examples of the way that the monies may be spent are set out in Appendix 2. Payments for Section 1 and 2 will be made in year to practices following successful attendance at Locality Prescribing Meetings or Medicines Managers workshop sessions and the relevant payment criteria being met for each section. Payment for Section 3 will be made to practices by 1 st May 2017. Achievement: Achievement will be assessed upon: 1. Attendance by a GP prescribing lead (or deputy) at Locality Prescribing Meetings and return of feedback forms. 2. Written confirmation that the practice has nominated a Medicines Manager and attendance at two Medicines Managers workshop sessions. 3. Return of relevant paperwork by date outlined in this document or the relevant detail aid for each element of the scheme. Engagement with the CWS Medicines Management Team at practice level: The role of the Medicines Management Team will be to support the practice to complete the work outlined in the Prescribing Quality Review Scheme. This may take the form of undertaking searches, reviewing patients identified, feeding back findings and recommendations from the review to appropriate clinical staff within the practice and at clinical meetings. The payments for each section of this scheme will include sign up to this engagement with the Medicines Management Team. Prescribing Quality Review Scheme 2
Feedback to practices: Practices are required to work with the Medicines Management Pharmacist to facilitate feedback of the work done by the pharmacist in practice at practice clinical meetings. It is preferred that the pharmacist will feedback outcomes and actions from the review work to the practice team. Practices will be asked to share the learning points from the areas of work completed during 2016/17 with other GP prescribing leads at a locality prescribing meeting. This aims to encourage sharing of good practice leading to positive changes. Paperwork linked to the scheme: All forms referred to in this scheme will be made available via the medicines management section of the CWS CCG website. These include the following: Locality prescribing meeting feedback forms. Feedback forms. Detail aids. Data sets. 1. Locality prescribing meetings supporting effective prescribing: Payment: One GP attendee/practice AND completion of feedback form - Maximum payment 800 per practice To qualify for payment, practices must attend the meeting AND complete the feedback form and return it to the Medicines Management Team. Practices will receive payment on a pro-rata basis. Maximum payment 200 per meeting per practice. Frequency of meetings to be determined locally. GP to provide feedback to the practice (to include 3 key learning and action points) and the Medicines Management Team using the feedback form provided. Feedback forms to be returned to the Medicines Management Team after discussion in practice and within 6 weeks of the locality prescribing meeting attended. As part of the support programme to GP practices in CWS, the CWS Medicines Management Team will Provide up to four locality prescribing meetings on key aspects of prescribing during 2016/17. Provide feedback form template following each meeting. Record receipt of all feedback forms received. 2. Medicines Manager: Maximum payment 400 per practice The practice has the opportunity to nominate a Medicines Manager. The Medicines Manager will normally be a nonclinical member of the practice (i.e. suitable member of the practice that is able to effect change / audit or support delivery of QIPP savings) who will be able to support the practice Prescribing Lead and Medicines Management Pharmacist on medicines management issues within the practice. Payment is dependent on the Medicines Manager attending up to two workshop sessions provided by the Medicines Management Team and meeting the requirements as outlined below. Prescribing Quality Review Scheme 3
The Medicines Manager will: Attend up to two workshop sessions facilitated by the Medicines Management Team. Payment of 200/session will only be made if the following requirements are also met: o Support the practice Prescribing Lead and Medicines Management Pharmacist on medicines management related issues within the practice. These may be highlighted internally within the practice, by the Medicines Management Pharmacist, via the Locality Prescribing Meetings or via communication from the Medicines Management Team. o Ensure feedback forms from the locality prescribing meetings are returned to the Medicines Management Team after discussion in practice and within 6 weeks of the locality prescribing meeting attended. o Support the practice and the Medicines Management Pharmacist to deliver the work laid out in the practice prescribing review work section of the scheme. The Medicines Management Team will: Work in collaboration with the Medicines Manager to achieve the work outlined in the scheme. Provide two Medicines Manager workshop sessions for nominated Medicines Managers. These sessions will be up to two hours in duration. 3. Practice prescribing review work: a. Quality improvement Payment of 10p per patient per element if completed as laid out in the detail aids. Undertake in collaboration with the Medicines Management Team reviews of prescribing practice outlined below: Compulsory elements: Antimicrobial stewardship to improve the quality of antibiotic prescribing through the promotion of selfcare and management minor infections, the use of back up prescriptions or no prescribing strategies, patients education and education programmes delivered through online course and at prescribing leads meeting. Atrial fibrillation Review of treatment for patients with AF in line with new guidance for the management of AF. Including identifying unmet need, changes in co morbidities, time in therapeutic range those prescribed warfarin, inappropriate treatment. Choose EITHER i or ii below: i. Diabetes Review of self-monitoring of blood glucose in Type 2 diabetic patients in line with NICE guidance and local formulary. ii. Dementia Review of patients on low dose anti psychotics with behavioural symptoms of dementia. Prescribing Quality Review Scheme 4
b. Safety improvement Payment of 8p per patient if both elements are completed as laid out below and in the detail aid for methotrexate. Reporting medication related safety incidents: Practice to develop processes to identify and report medication related safety incidents via the National Reporting and Learning System (NRLS). Feedback the findings of those incidents to the practice team as part of the reporting process. Payment will be received if there is evidence of the practice uploading 5 medication related incidents to NRLS. Reports can be made online via: https://report.nrls.nhs.uk/gp_eform Once a report has been submitted, you will have the option to print and save a copy, we recommend you do so for your records. However, there is no need to submit these reports to the Medicines Management Team as we can monitor submissions directly (providing he practice organisational code has been entered using the online system). Review of methotrexate prescribing: Ensuring safe prescribing of methotrexate in primary care and compliance with the NPSA guidance Towards the safer use of oral methotrexate. Further details of this safety improvement work including requirements to receive payment can be found on the specific detail aid for each element of the scheme. c. Cost effectiveness improvement Payment will be 5p per patient to the practice for the Medicines Management Team to undertake this work and engage with the practice. The Medicines Management Team has developed a cost savings Programme which identifies savings in prescribing of around 300k. The cost savings programme consists of medication swaps, dose optimisations, generic prescribing savings and drugs which are considered to be limited clinical value. The work will be led by the Medicines Management Technicians who will identify individual practice savings. These will be implemented following discussions and agreement by the practice. Savings will be monitored on a monthly basis by the Medicines Management Team. Further details of the cost effectiveness improvement work including requirements to receive payment can be found on the specific detail aid for this this element of the scheme. Performance monitoring: Progression of work will be monitored as per the detail aid for element of the scheme. Dispute resolution: In the event of any dispute over a practice s entitlement, an appeals process will be put in place. Please see Appendix 3 for further details. Prescribing Quality Review Scheme 5
Contact details: For further information Please contact: Phil Foster or Chirag Patel Deputy Heads of Medicines Management Tel: 01903 708485/ 01903 708448 Email: phillip.foster@nhs.net or chiragpatel4@nhs.net Version No. Status Author Date 1 Draft v1 Phil Foster May 2016 2 Draft v2 Chirag Patel June 2016 3 Draft v3 Sue Carter June 2016 4 Final v4 Chirag Patel June 2016 Prescribing Quality Review Scheme 6
Appendix 1 Sign-up form - to be completed by 27 th June 2016 Practice Name: Practice Address: Date: GP prescribing Lead (print name) GP prescribing Lead (signature) Practice Manager (print name) Practice Manager (signature) Sections of the scheme Yes No 1. Locality prescribing meetings 2. Medicines Manager workshops Please provide the details of your nominated Medicines Manager*: Name Email 3. Practice prescribing review work a. Quality improvement (please confirm which elements you intend to participate in): - Antimicrobial Stewardship (Mandatory) - Atrial Fibrillation (Mandatory) Choose EITHER i or ii; - Diabetes - Dementia b. Safety improvement c. Cost effectiveness improvement * The Medicines Manager should be a suitable member of the practice that is able to effect change / audit or support delivery of QIPP savings and who has the capacity to carry out this role. Contact details: The completed form should be submitted electronically by 27 th June 2016 to the Medicines Management Team, Email : cwsccg.medicinesmanagement@nhs.net Tel. 01903 708606 Prescribing Quality Review Scheme 7
Appendix 2 Use of Prescribing Quality Review Scheme Monies 1 Approved uses of Prescribing Quality Review Scheme monies: 1. Purchase of material or equipment which is to be used for the treatment of patients of the members of the practice including diagnostic equipment, ECG machines, spirometers, BP monitors etc. 2. Payments to dieticians or counsellors providing advice on diet, lifestyle, alcohol consumption, smoking etc. 3. The purchase of material or equipment which will enhance the comfort or convenience of patients registered with the practice including, furniture, furnishings, security features, heating/air-conditioning etc. 4. The purchase of computers including hardware and software relating to improving patient care. 5. Non-recurring staff costs. 6. Initiatives to improve prescribing. 7. The purchase of material or equipment relating to health education including televisions, videos, leaflets, posters etc. Items on which Prescribing Quality Review Scheme monies may not be spent 1. The purchase of services or equipment which are unconnected with healthcare. 2. To reduce a practice s contribution to the employment costs of existing practice staff. 3. The purchase of land or premises. 4. To pay off pre-existing loans taken out by members of the practice. 5. The purchase of drugs, medicines or appliances. 6. The purchase of hospital services. 1 Derived from national guidance: Strategies to achieve cost-effective prescribing. Guidance for Primary Care Trusts and Clinical Commissioning Groups. Department of Health Gateway reference 14802, 2010 Prescribing Quality Review Scheme 8
Appendix 3 Appeals Panel The panel will consist of senior members of the CWS Medicines Management Team and the Prescribing Lead for CWS. The panel will consider appeals from practices submitted by 31 st July 2017. Appeals will be considered on the basis of change in list size as detailed in the scheme. The panel will also consider whether there have been any extenuating circumstances relating to the practice. The decisions from the appeal panel will be passed on to the CWS Head of Medicines Management for sign off and whose decision will be final. The panel will arrange for letters to be sent to practices informing them of the decision of the panel. The panel will arrange for any additional payments to be made via colleagues in Finance. Payment will be made by 1 st September 2017. Prescribing Quality Review Scheme 9