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A Fist Full of Scottish Pound Notes Medicines optimisation without GP Commissioning
Dr Simon B Hurding
Clinical Lead Therapeutics Branch Scottish Government
Commissioning
Securing the highest quality healthcare services
to meet the needs of a population within
available resources
Medicines Optimisation
Helping patients to make the most of medicines
Pressures
Prescribing Trends
Complex system
Complex system
Of interest
'Thyroid' Medicine Volume (items) change CH(C)P by year
0
10 0 0
2 0 0 0
3 0 0 0
4 0 0 0
5 0 0 0
6 0 0 0
7 0 0 0
8 0 0 0
2 0 0 6 / 0 7
( £ 6 . 8 5 )
2 0 0 7 / 0 8
( £ 6 . 8 5 )
2 0 0 8 / 0 9
( £ 5 . 0 0 )
2 0 0 9 / 10
( £ 4 . 0 0 )
2 0 10 / 11
( £ 3 . 0 0 )
2 0 11/ 12
( £ 0 . 0 0 )
Fiscal Year 2006/07 to 2011/12
Th
yro
id Ite
ms C
han
ge
East Lothian
Edinburgh
Midlothian
West Lothian
Free Prescriptions
Percentage cost and volume change OTC Medicines by year
- 10
- 5
0
5
10
15
2 0
2 0 0 6 / 0 7
( £ 6 . 8 5 )
2 0 0 7 / 0 8
( £ 6 . 8 5 )
2 0 0 8 / 0 9
( £ 5 . 0 0 )
2 0 0 9 / 10
( £ 4 . 0 0 )
2 0 10 / 11
( £ 3 . 0 0 )
2 0 11/ 12
( £ 0 . 0 0 )
Fiscal Year 2006/07 to 2011/12
Perc
en
tag
e C
han
ge
Volume
Cost
Interlude
Policy-making
The translation of government’s political
priorities and principles into programmes and
courses of actions to deliver desired change
Orange vegetable and wooden object
Quality Outcomes Framework
QOF
Medicines management
36 23
QP QOF Prescribing
28
Better value better care
ARB
PPI
Statins
National Prescribing Programme
WS1 Develop National prescribing indicators
WS2 Develop network for sharing best practice (SPAA)
WS3 Primary and secondary care interface
WS4 Polypharmacy, medicines waste and repeat medicines
WS5 Review of incentive schemes
WS6 Difficult decisions: Gluten Free, ONS, diabetes, respiratory, wound
management
National Therapeutic Indicators
Comparative data
0
50
100
150
200
250
A&
A
BO
RD
ER
S
D&
G
FIF
E
FV
GR
AM
PIA
N
GG
C
HIG
HLA
ND
LA
NA
RK
SH
IRE
LO
TH
IAN
OR
KN
EY
SH
ET
LA
ND
TA
YS
IDE
WI
SC
OT
LA
ND
Proton Pump Inhibitors: DDDs/1,000patients/dayD
DD
s p
er
10
00
pa
tie
nts
pe
r d
ay
Report Period: Oct-12 to Dec-12
Audit Scotland
National Therapeutic Indicators
4C antibiotics
SQPI
6
£800K
SQPI
SQPI
NTI 04 Dipyridamole DDD per 1,000 patients per day
• 719 eligible practices and 314 signed up
• Target shift achieved by 93.9% of SQPI practices
• Target shift achieved by 92.3% of non-SQPI practices
SQPI
NTI 03 Ezetimibe as a percentage of ezetimibe and all statins (DDD)
• 728 eligible practices and 31 signed up
• Target shift achieved by 90.3% of SQPI practices
• Target shift achieved by 53.1% of non-SQPI practices
SQPI
NTI 05 High strength inhaled corticosteroids as a percentage of all inhalers
• 725 eligible practices and 119 signed up
• Target shift achieved by 36.1% of SQPI practices
• Target shift achieved by 24.1% of non-SQPI practices
Respiratory
Respiratory
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
A&
A
BO
RD
ER
S
D&
G
FIF
E
FV
GR
AM
PIA
N
GG
C
HIG
HLA
ND
LA
NA
RK
SH
IRE
LO
TH
IAN
OR
KN
EY
SH
ET
LA
ND
TA
YS
IDE
WI
SC
OT
LA
ND
High Strength Steroid inhalers as a percentage of all Steroid inhalers (items)
Pe
rce
nt
Hig
h S
tre
ng
th S
tero
id In
ha
lers
Report Period: October 2012 to December 2012
Diabetes
Diabetes
40%
50%
60%
70%
80%
90%
100%
A&
A
BO
RD
ER
S
D&
G
FIF
E
FV
GR
AM
PIA
N
GG
C
HIG
HLA
ND
LA
NA
RK
SH
IRE
LO
TH
IAN
OR
KN
EY
SH
ET
LA
ND
TA
YS
IDE
WI
SC
OT
LA
ND
Established oral hypoglycaemics (metformin & sulphonylureas) as percentage of all anti-diabetic drugs (excluding insulin) (DDDs)
Perc
en
t E
sta
blish
ed
ora
l h
yp
og
lycaem
ics (
metf
orm
in &
su
lph
on
ylu
reas)
Report Period: Oct-12 to Dec-12
National Prescribing Programme
Interlude
My Vision
Polypharmacy
Self-Management
Prescription for excellence
Scottish Therapeutics Utility (STU)
Multifactorial
Total antimicrobial use
The more Scottish GP contract
A Fist Full of Scottish Pound Notes Medicines optimisation without GP Commissioning
Dr Simon B Hurding
Clinical Lead Therapeutics Branch Scottish Government
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