Background to Prescribing Management - NHS Greater Glasgow ...
Transcript of Background to Prescribing Management - NHS Greater Glasgow ...
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
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 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
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