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 adjustments2. 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

Cost per head (£)

75+ £619 £625

Ag

e-se

x co

st w

eig

ht s

fo

r G

P p

res c

rib

ing

CH(C)P Cost / Patient (GIC) April to November 2009

£16.77£16.52

£17.48 £17.46

£17.05£17.31

£16.81£17.06

£14.52 £14.49£14.78

£15.29

£14.51 £14.61

£15.65

£14.32

£13.69 £13.57

£14.22

£12.81 £12.84

£12.41

£13.84

£12.12

£10.00

£11.00

£12.00

£13.00

£14.00

£15.00

£16.00

£17.00

£18.00

Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09

East Dun East Glasgow East Renfrewshire Inverclyde North Glasgow

Renfrewshire South East Glasgow South West Glasgow West Dunbartonshire West Glasgow

GGC & Lothian Weighted Cost / Patient

£30.00

£35.00

£40.00

£45.00

£50.00

£55.00

£60.00

2004Q4

2005Q1

2005Q2

2005Q3

2005Q4

2006Q1

2006Q2

2006Q3

2006Q4

2007Q1

2007Q2

2007Q3

2007Q4

2008Q1

2008Q2

2008Q3

2008Q4

2009Q1

2009Q2

East Dunbartonshire East Glasgow East Lothian East Renfrewshire Edinburgh Edinburgh North Edinburgh South Inverclyde Midlothian North Glasgow North Lanarkshire Renfrewshire South East Glasgow South Lanarkshire South West Glasgow West Dunbartonshire West Glasgow West Lothian

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

Simvastatin as a % of all Statins (by prescriptions)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Jan-Mar2005

Apr-Jun

2005

Jul-Sep2005

Oct-Dec2005

Jan-Mar2006

Apr-Jun

2006

Jul-Sep2006

Oct-Dec2006

Jan-Mar2007

Apr-Jun

2007

Jul-Sep2007

Oct-Dec2007

Jan-Mar2008

Apr-Jun

2008

Jul-Sep2008

Oct-Dec2008

Jan-Mar2009

Apr-Jun

2009

Jul-Sep2009

Oct-Dec2009

Inv CHP GG&C Scotland Baseline (65%)

Inverclyde CHP - Top 10 Non Formulary Drugs by Cost Per Patient

£0.00

£1.00

£2.00

£3.00

£4.00

£5.00

£6.00

CLOPID

OGREL

PREGABALIN

ESOMEPRAZOLE

ESCITALO

PRAM

PANTOPRAZOLE

RISEDRONATE

METFORMIN

MR

OLMESARTAN

IBANDRONIC

ACID

MODAFINIL

Inverclyde Community Health Partnership NHS Greater Glasgow & Clyde

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)

494

153

397

253

123

2

280

160

116

170

120

2

281

362

9

384

1 2

433

94

394

1

186

803

61

10

100

200

300

400

500

600

700

800

900

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)

£1,885

£252

£937 £856

£298£2

£581 £633£440 £511

£118 £3

£491

£1,077

£18

£4,425

£1 £2

£1,086

£135

£1,154

£1£279

£8,573

£125 £1£0

£1,000

£2,000

£3,000

£4,000

£5,000

£6,000

£7,000

£8,000

£9,000

£10,000

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

Top 10 Drugs By Cost

£0

£2,000

£4,000

£6,000

£8,000

£10,000

£12,000

£14,000

£16,000

£18,000

SODIUM F

LUORID

E

AMOXIC

ILLIN

CHLORHEXID

INE G

LUCONATE

BENZYDAMIN

E HYDROCHLO

RIDE

PHENOXYMETHYLPENIC

ILLIN

METRONID

AZOLE

ERYTHROMYCIN

DOXYCYCLINE

MICONAZOLE

ARTIFIC

IAL S

ALIVA

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