Prescribing Incentive Scheme
Prescribing Incentive Scheme 2018-19
The Oxfordshire Prescribing Incentive Scheme is offered to all of its member GP practices as encouragement and reward to improve the quality, safety and cost effectiveness of prescribing.
The objectives are to:
- Increase value for money by improving the quality and cost effectiveness of use of health care resources by practices in the CCG;
- Enable individual practices to realise benefits for patient care;
- Incentivise practices for changing practice in prescribing to improve the health of the Oxfordshire population.
Resources for 2018-19 can be found below.
Prescribing Data Report 2018-19
Prescribing Incentive Scheme Resources for 2018-19
A number of resources have been produced:
- Suggested Items for Cost Saving:
- Resources for Repeat Prescribing
- Resources for Antibiotics
- Suggested Items for Clinical Audits:
The ScriptSwitch dashboard is available to show the top missed opportunities for the practice and therefore where the greatest potential for savings is available using the system. Please see the How To Guide.
Ensure maximum use of ONPOS and only prescribe dressings outside ONPOS/formulary where recommended by specialists if appropriate. Ensure all practice staff are aware of the local Wound Management Formulary and process for non-ONPOS/formulary prescribing. Identify any repeat prescribing using the EMIS search available in the resource link below.
Review liothyronine patients for appropriate discontinuation or switch to levothyroxine in line with local liothyronine prescribing guidance. Identify patients on liothyronine using EMIS search which can be found in the resource link below. Specialist advice is available via email@example.com.
Prescribing of infant formula should be reviewed regularly and discontinued when no longer appropriate. Prescribers can use the new Infant Formula Guidelines to ensure appropriate prescribing of specialist infant formulas and quantities. The updated commissioning policy on Specialist Infant Formulas will also help support prescribing decisions. For support with allergy related queries, clinicians can contact the consultant led email allergy advice service commissioned from OUH. The service can be accessed by emailing firstname.lastname@example.org. The Medicines Optimisation Team has also employed a dietitian, who will be available over the next few months to assist practices with reviewing their infant formula patients and will provide an email advice service via email@example.com. Patients prescribed all types of infant formula can be identified using the Emis Web search which can be found in the resource link below.
The recently published Commissioning Policy Statement 277 clarifies our position on oral nutritional supplements. Resources are available below to support clinicians with reviewing their patients e.g. patient information leaflets, a template letter and a Prescribing Points newsletter with suggestions as to how to implement the policy etc. Our dietitian can also help review our sip feed patients and will provide an email advice service via firstname.lastname@example.org.
Gluten Free products such as bread, flour and bread mixes should only be prescribed as per the commissioning policy on Gluten Free Foods, quantities should be no more than 8 units per month regardless of age or gender. Biscuits, pasta, cake mix, crackers, etc. are low priority for funding and should no longer be prescribed.
The Therapeutic use of probiotics in adults and children Commissioning Policy Statement 125b does not support the use of probiotics due to insufficient evidence in adults or children. Consider reviewing prescribing of probiotics in your practice.
Consider switching appropriate patients on to meters with cost effective glucose and ketone strips (if required) and review quantities. The following resources may help;
- Ketone Testing and Sick Day Rules guideline can be used. This summarises which patients should receive ketone testing strips, the most cost effective options and sick day rule advice. Also see Prescribing Points for a summary table comparing meters.
- Choosing a Blood Glucose Monitor – summarises different monitors available and important considerations in different groups
- Guide to Self-Monitoring of Blood Glucose in Type 2 Diabetes – flow chart of which patients should be monitoring blood glucose and how often.
The GLP-1 Receptor Agonists in Type 2 Diabetes guideline has been updated, and lixisenatide is now first line. Lixisenatide is significantly more cost effective than the other options, so should be used where appropriate. GLP-1 Receptor agonists should only be given for a 6 month trial, and should only be continued beyond 6 months if certain criteria are met. The Patient agreement form can be used to gain patient agreement and monitor the treatment success.
The Medicines Optimisation Team will consider producing protocols on switching DPP4i to Alogliptin in the near future. Further information can be found in the Prescribing Data Report and searches can be found in the resources below.
The complexity of the DOACs various doses, indications and durations of therapy can result in patients inadvertently being left on treatment long term. An audit can be conducted to ensure DOACs are being prescribed at the correct dose and duration for short term licensed indications. The OCCG guideline on DOACs for Treatment and Secondary Prevention of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) in Primary Care contains more information.
The recently published Commissioning Policy Statement 88c clarifies the OCCG commissioning policy on prescribing OTC products. There are a number of resources that you can use to promote the Over the Counter Medicines Campaign. The ‘How to manage your conditions’ slides for practice waiting room screen display offer a very effective method of communication to your patients. A poster on 'How to manage your conditions' and a printable leaflet on 'Treating minor conditions' have been developed for practices to use. A number of importable EMIS searches can be found in the resource link below.
The search is based on the ePACT2 dashboard which is designed to provide insight into the savings that could be achieved by changing from proprietary to generic prescribing. The dashboard/search looks at the top 20 drugs identified at a national level as having the greatest potential to release additional resources through increased generic prescribing. This search is based on Oct-Dec 2017.
NICE Guideline SC1 Managing Medicines in Care Homes recommends that care home residents should have a medication review at least annually. There are multiple benefits of regular medication reviews including a reduction of the pill burden for the individual, reduced side effects, a decrease in hospital admission and financial savings. Please contact Jane Bennett (Jane.Bennett@oxfordshireccg.nhs.uk) if you require support.
The ‘DROP’ list is an accumulation of medicines that are considered as low priority, poor value for money or for which there were safer alternatives.
Repeat prescriptions represent approximately 60-75% of all prescriptions written by GPs. The sheer volume of repeat prescribing in general practice is a vast amount of work and also a source of potential risk to patient safety. As a result, practices will be invited to take part in a project to review repeat prescribing processes as part of the Prescribing Incentive Scheme. A free e-learning package can be downloaded for all healthcare professionals in our commissioning area.
The incentive scheme focuses on reducing total antibiotic prescribing, high risk antibiotic prescribing and trimethoprim in the over 70 year olds.
Patients on opioids for chronic pain should be reviewed for appropriateness. Opioids Aware is a useful resource for both patients and healthcare professionals. At least 0.5% of practice population should be included in this audit.
Complex multimorbidity is often associated with polypharmacy and optimising medicines, through targeted prescribing review, is a vital part of managing long term conditions. This may involve starting new medicines or stopping inappropriate treatments. The deprescribing element can involve tapering, withdrawing, or discontinuing medications with the aim of reducing adverse drug effects, reducing the use of ineffective medicines and improvement of outcomes.
Evidence-based tools are available and can be used in the medication review process e.g. The STOPP/START toolkit can be downloaded as a PDF file from the North of England CSU website. Patients for review may be identified on an ad-hoc basis during routine medication reviews, by reviewing patients in care/nursing homes or the EMIS Web search in the polypharmacy resource link below will identify patients on 8 or more medications (the search can be easily adapted to identify patients prescribed different numbers of medications). Details of medications which have been altered, including associated cost-savings, should be recorded on the audit template.
This audit reviews patients with heart failure to ensure dosage titration is optimised using The Management of Heart Failure in Primary Care Guideline. At least 0.5% of practice population should be included in this audit.
The respiratory audit reviews patients with either COPD or Asthma and aims to optimise inhaler use, device selection and technique. At least 0.5% of practice population should be included in this audit. Prescribers should ensure that the new formulary choices are considered when starting a patient on new treatment or when reviewing existing treatment. The Maintenance Management of Asthma guideline and COPD guideline summarise the formulary inhaler choices in a clear pathway.