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Prescribing Update

Prescribing Update. Sara Wilds Primary Care Prescribing Lead Oxfordshire PCT sara.wilds@oxfordshirepct.nhs.uk. Financial Overview. Financial Overview. Costs per ASTRO PU (weighted Population) significantly below SHA and PCT average

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Prescribing Update

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  1. Prescribing Update Sara Wilds Primary Care Prescribing Lead Oxfordshire PCT sara.wilds@oxfordshirepct.nhs.uk

  2. Financial Overview

  3. Financial Overview • Costs per ASTRO PU (weighted Population) significantly below SHA and PCT average • Areas of significant increase in cost for Oxfordshire: Lipids, Diabetes, Respiratory Corticosteroids

  4. High Growth Cost Areas

  5. Prescribing Budgets • The total prescribing financial envelope for 2009/10 is £78,335k. • Increase of 2.5% after efficiencies • £5,300k efficiencies taken out – of this £2.5million to the Community Pharmacy Contract.

  6. Practice Budgets • Forecast outturn at month 8 (November 2008) was used as a baseline • Based upon 50:50 allocation. 50% Historic: 50% capitation • Capitation based upon January 2009 ASTROPUs added extra weighting for care home patients in line with PSU guidance. • Maximum uplift 8% & minimum 1% uplift • Adjustments: centrally allocated drugs, expensives, Scriptswitch

  7. Prescribing Incentive Scheme • 85% of all statin prescribing should be for simvastatin or pravastatin • 90% of all PPI prescribing should be for omeprazole or lansoprazole CAPSULES • 80% of all bisphosphonate prescribing should be for generic alendronate 70mg • 75% of all Renin Angiotensin prescribing should be for ACE inhibitors • Percentage generic savings less that 0.25%

  8. Prescribing Incentive Scheme

  9. Practice Prescribing Meeting • Discuss practice prescribing report • Updates of national and local guidance • Agree 3 QOF priorities 2009/10 • Agree prescribing team support

  10. QOF Priorities • Quality / Safety Priorities e.g. Clopidogrel, Glitazones, NSAIDs, Antimicrobials • Local Priorities e.g Sip Feeds, Dressings, Appliances

  11. Prescribing Team Support • Clinical Audit • Medication Review • Care Home Review • Educational Support to Care Homes • Support to Case Review Managers • Independent Prescribers

  12. Scriptswitch • Software tool which allows the presentation of prescribing support messages and recommendations. • Promoting cost-effective, consistent, quality prescribing.

  13. Scriptswitch – Key Benefits • Implementation of NICE and other guidelines • Spread of better practice • Increased formulary adherence • Improved safety around the use of high risk medicines • Reduced influence of the pharmaceutical industry • Monitoring of change in prescribing behaviour

  14. Scriptswitch Savings

  15. Top Rejected Switches

  16. Inappropriate Prescribing Requests • Medicines Management Standards in the 2009/10 contract with the ORH & NOC. • All secondary care recommendations to be in line with Oxfordshire Traffic Light System & local guidance. • Feedback via ‘inappropriate prescribing requests form’ to Medicines Management Team

  17. Traffic Light Classification for Prescribing • Classification of drugs via Area Prescribing Committee • Quarterly monitoring via EPACT • Inappropriate Prescribing Request feedback to ORH/NOC via PCT Contracting Team & ORH Commissioners.

  18. Monitored Dosage Systems • Community Pharmacy Contract, includes some funding meet their obligation under the Disability Discrimination Act (DDA) • Different systems were set up across the county to deal with requests for patients who required an MDS but who did not fall under the DDA e.g. carer support • Oxfordshire Health and Social Care currently allow their carers to administer one medicine from a bottle or blister pack. • Patients on two or more medicines however must have their medicines dispensed into an MDS if the carer is to administer (i.e. give to the patient to take or put in the patients mouth). • Carers are however allowed to remind or prompt patients to take their medicine and this does not need an MDS.

  19. PCT Commissioned MDS Service • For the small number of patients where there is no local provision of MDS the PCT commissioned service may be used. In this case the practice should contact Continuing care on 01235 205480 who will: • Check that the patient has a carer administering their medicine • Check that the local pharmacy is not able to take on additional patients • Provide the Practice with details of the commissioned service • Request that prescriptions are sent to the PCT commissioned service.

  20. 7 Day Prescriptions 7 day prescriptions should only be used when: • flexibility is required to change the medication at short notice • the patients’ medicine needs are unstable and liable to change • there may be a risk to the patient or others from having too much medicine in the home • weekly provision of MDS is required • 7 day prescriptions should not be requested as a way to fund MDS

  21. Thank you • Any questions?

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