Prescribing in the Future

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Prescribing in the Future..

• Sara Wilds, Primary Care Prescribing Lead

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Therapeutics Team What we have always done..

• Clinical support to enable evidence based and
  cost effective prescribing
• Prescribing spend always under budget always
  achieve significant savings targets annually
• Support practices in achievement of QOF
• Trusted clinical team
• Clinicians with strong respected relationships
  with clinicians in both primary secondary care

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Tools for delivery
Prescribing guidance Prescribing Points,
Shared Care protocols, Scriptswitch etc
Data Benchmark against national and local
prescribing achievements, Dashboard
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• Integrated within Primary Care / Clinical
  Commissioning Group
• Established valued clinical support to
  practices
• Established and effective working relationship
  with Acute Trust to influence appropriate primary
  care prescribing.

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Financial Achievements

• Based upon December 2011 prescribing data
  forecast outturn for year end is 950k underspend
  on budget
• Break even position would release 2.5 million
  efficiency target
• (therefore total savings 2.5 million plus
  950k)
• Practice Support Team (3.67 WTE Pharmacists and 1
  WTE Dietician) direct savings to date 2011/12
  620,000

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Clinical Achievements

• Support to improve outcomes and quality of care
  to patients through safe and appropriate use of
  medicines, e.g. anticoagulation in Atrial
  Fibrillation review, NSAID audits, anti platelet
  antipsychotic in dementia reviews.
• Difficult to quantify, however one stroke
  prevented significant individual patient
  benefit and cost benefit to health economy.

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Area of Significant Risk to CCG Oxfordshire
Practices

• Current proposed structure for Oxfordshire
  Clinical Commissioning Group no local team to
  support practices.
• Team can demonstrate significant cost effective
  return on investment

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Opportunities for the Future to improve
effectiveness

• Further locality engagement
• Further develop clinical role of team
• Medicines Managers

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Eclipse data - CHD
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Vision

• High quality, evidence-based, and safe
  patient-centred care.

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Challenges

• Population approach versus individual care
• Health care budgets are finite
• We have to make choices in healthcare
• It is legitimate to take cost effectiveness into
  account
• Barbers boxes give a good framework for those
  choices

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Align with Clinical Commissioning Group Aims

• Lower elective referral and admission rates
• Reduced emergency related bed days
• Lower waiting times for non-emergency treatment
• Improved co-ordination of care across interfaces
• Improved financial risk management
• Better collaboration between practices
• Engagement of clinicians in commissioning process
• Increased patient satisfaction
• Appropriate use of prescribing resources

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Support at Clinical Commissioning Group level

• Help your practices deliver cost-effective and
  safe prescribing
• Reduce inter-practice variation
• Work across primary / secondary care interface to
  ensure consistency
• Challenge non-formulary hospital prescribing
• Advice to Boards, Directors, Programme Boards
• Budgets, QIPP
• Care and Control of Medicines
• Understanding and implementing medicines
  legislation
• Managed introduction of new drugs
• Pharmaceutical Public Health
• Service development, innovation
• Education and Training
• Audit, performance management
• Supporting Priorities Panel

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Support at practice level

• Establishing practice formularies
• Repeat prescribing systems review help to set up
  repeat dispensing
• Dose optimisation streamlining supply
• Generic and therapeutic switches
• Concordance checks with patients
• Medication review
• Care and control of medicines within the practice
• Supporting patients after discharge, patient
  information support material
• Reviews of prescriptions and processes for
  medication in care homes
• Updates on therapeutic areas
• ePACT analysis and commentary
• Maintaining Scriptswitch profile

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• But the future is really now over to you!