Prescribing Incentive Scheme
Prescribing Incentive Scheme 2017-18
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.
Prescribing Incentive Scheme Resources
A number of resources have been produced:
- Practice Population Information
- Eclipse Potential Savings
- Suggested Menu Items:
- Chronic Obstructive Pulmonary Disease (COPD)
- Infant Formula
- Oral Nutritional Supplements (ONS)
- Over the Counter (OTC) Products
- Proton Pump Inhibitors (PPI)
- Rationalising Prescribing in the Frail and Elderly
- Stoma and Continence
- Travel Vaccines
- Waste Reduction
- Wound Management
The Practice Population and Savings Targets Spreadsheet details the practice populations at 1st April 2017, associated target savings, and summarises the spend highlighted in the baseline ePACT charts listed below.
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.
Eclipse Potential Savings Report is available to highlight some straightforward switches for consideration by the practice. This is an excel spreadsheet which enables practices to manipulate the report to suit their needs. The document can be filtered to view individual practice information.
The data is gathered from December 2016 to February 2017 data and generates annual savings estimates for the practice.
Please note that due to the delay in third party processing of this data any recent practice mergers are not reflected and affected practices will need to interpret with caution.
To review asthma patients on high dose inhaled corticosteroids (ICS) for step-down in line with national guidance (BTS/SIGN 2016) (high dose > 800mcg beclomethasone equivalent per day). There is no ideal single method to identify spend and potential savings for this option. The High Strength Corticosteroid Inhalers Chart (spend for March 2016-February 2017) shows spend on high strength (equal to or more than 800mcg/day of beclomethasone equivalent) ICS. It is not possible to differentiate for COPD or asthma use from the data, although many products are only licensed for one indication, see the inhalers included in the ePACT tag for the chart. The chart is therefore intended to give an approximate indication of high strength ICS use. An importable EMIS search and audit template can be found in the resource link below.
Optimise prescribing and outcomes for COPD patients through patient reviews in line with the new local COPD guidance. Aim to:
- Optimise patients inhalers based on inspiratory flow in line with local prescribing guidance for COPD – prescribe according to inspiratory flow rate i.e. low <30L/min MDI/soft mist: ‘Long and Slow’ or high >30L/min DPI: ‘Quick and fast’
- Review and give careful consideration to appropriate prescribing of high-dose inhaled corticosteroids (ICS)/long acting beta agonist (LABA) combination inhalers (high dose > 800mcg beclomethasone equivalent per day)
- Implement inhaler technique training for all device types for appropriate healthcare professionals.
A number of importable EMIS searches for different types of inhaled treatment (e.g. triple therapy, dual therapy, monotherapy) and an audit template can be found in the resource link below.
Reducing waste through rationalising the use of needles, strips and lancets and aligning with prescribing of insulin and oral diabetes medication. Identify patients, using EMIS search, with needles, glucose strips, ketone strips and lancets on repeat. Review patients for appropriate rationalisation of prescribing quantities/frequency and/or switching to cost-effective options. A number of importable EMIS searches and related guidelines can be found in the resource link below.
Prescribing of infant formula should be reviewed regularly and discontinued when no longer appropriate. Updated CCG guidelines will be available from October 2017. 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 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.
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 firstname.lastname@example.org.
The Sip feeds chart (spend for March 2016-February 2017) shows spend on all ONS (sip feeds). 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. The Medicines Optimisation Team has also employed a dietitian, who will be available over the next few months to assist practices with reviewing their sip feed patients and will provide an email advice service via email@example.com.
The Over the Counter Products chart (spend for March 2016-February 2017) shows spend on a number of products available over the counter. This includes products for analgesia, antihistamines, cold sore, colic, conjunctivitis, cough and cold, eczema, fungal infection, haemorrhoid, head lice & scabies, heartburn and indigestion, skin rash, sleep problems, threadworm, travel sickness and upset stomach.
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. The poster may be printed for display, shared on your website, published in your patient newsletter or used as an alternative leaflet. If you require printed posters for display in your practice, please email firstname.lastname@example.org, and we will consider how best to support you.
A number of importable EMIS searches can be found in the resource link below.
The Proton Pump Inhibitors chart (spend for March 2016-February 2017) shows spend on all PPIs of all strengths, as consideration of stepping down or discontinuing long term treatment is recommended. Resources are available below, this includes an importable EMIS search and a patient information leaflet.
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 10 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.
Review prescribing for repeat request frequency, rationalisation of quantities and inappropriate retrospective script requests. Local Stoma guidance and Continence guidance are available to support this review. An importable EMIS search for stoma products and a letter to appliance contractors are also available in the resource link below.
Ensure non-NHS commissioned travel vaccines are NOT prescribed. CombinedHepA/B should not be prescribed (only hep A on NHS). Combined Hep A/typoid should not be prescribed (prescribe separately). Ensure all practice staff are aware. Non-NHS items should be prescribed on a private script. There will be a Prescribing Points article to follow shortly.
Mechanisms can be identified to reduce the inappropriate over-ordering of prescribed medicines including reviewing repeat prescribing policies and education/training for prescription clerks. Specific measures can be adopted to reduce waste in care homes. The Prescqipp Bulletin - Reducing waste information for care home staff provides useful information. Practices would be required to demonstrate savings in this area. Details of individual savings can be recorded on the audit template.
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.