requesting information regarding prescribing incentive schemes in Canterbury and Coastal Clinical Commissioning Group

Transcription

1 requesting information regarding prescribing incentive schemes in Canterbury and Coastal Clinical Commissioning Group Canterbury and Coastal Clinical Consortium Group Medicine Management plans 2013/14 During 2013/14, medicines management plans for practices will be aligned to two frameworks: 1. The Management sections 6 and 10 of the Quality and Outcomes Framework (QOF) 2. The C4G Prescribing Incentive Scheme The Management sections 6 and 10 of the Quality and Outcomes Framework (QOF) 6 4 points 10 4 points The practice meets the PCO prescribing adviser at least annually and agrees up to three actions relating to prescribing The practice meets the PCO prescribing adviser at least annually, has agreed up to three actions relating to prescribing and subsequently provided evidence of change NB The practice is required to have at least one PRACTICE meeting with the prescribing advisor Additional meetings may be required with the GP prescribing lead or other prescribers responsible for specific therapeutic areas. To ensure consistent adoption of cost effective strategies for more complex areas of prescribing, practices in C4G will be asked to all agree to work on the following three areas of prescribing. However if practices cannot identify three appropriate measures, they will be asked to select alternative measures from section B of the Prescribing Incentive Scheme or provide an alternative area of prescribing to review.

2 MM10 action Action required Evidence of change 1. Medication changes following discharge or outpatient appointment Practices will be required to conduct an audit of the medication changes requested following discharge from hospital or outpatient appointment for a one week period with an emphasis on addition of information to patient records on medication which requires special monitoring and medication which is being supplied direct from acute trusts or homecare companies. If accuracy is less than 100%, an action plan and further audit will be required Management team by 31 September 2013 and If necessary, an action plan and a further audit template on 31 March Repeat Prescribing Procedures Practices will be required to conduct a survey of requests for repeat prescriptions for a one week period. Practices may chose to focus on repeats being submitted from a specific area e.g. from care homes, pharmacies or direct from patients. If areas are identified where change is necessary, an action plan and further survey will be required. Practices will be able to nominate a reasonable sample size A template is provided as a guide but not all fields need to be completed depending on the area selected for review anonymised survey Management team by 31 September 2013 If necessary an action plan and a further survey template on 31 March Cost effective from Community Pharmacies Practices will be required to conduct a review on how for cost effective use of medicines are received and actioned from local Community Pharmacies (maximum of 3 pharmacies) and how feedback on these is provided to the pharmacies anonymised survey Management team by 31 September 2013 and If necessary an action plan and a further survey template on 31 March 2014 The C4G Prescribing Incentive Scheme Summary The Prescribing Incentive Scheme is intended to encourage practices to consider both cost and quality, and hence cost-effectiveness of their prescribing and reward practices appropriately. In 2013/14 practices will be asked to agree to: work on all eight of the prescribing Indicators in section A

3 select three out of the seven prescribing indicators in section B. (Practices will not normally be able to chose a measure in which was selected in ) Provide a summary in the quarterly report of CCG reports, Prescribing+ and Eclipse Live reports, to explain or provide actions to address: 1) Areas of spend above local or national average 2) Where high levels of recommended switches are being declined Payment schedule-maximum payment per 1000 population= 500 Population based on list size 1 st April 2013 Measure Payment per 1000 population Section A1 (Blood Glucose meters) Practices will be paid a maximum of 100 per 1000 patients for this element of the scheme. Payments will be made as follows, based on the % of test strips which are GlucoRx Nexus (based on epact data) 20-40% 50 per 1000 patients 41-60% additional 25 per 1000 patients 61%+ additional 25 per 1000 patients Payments will be made quarterly, based on Q1, Q2, Q3 and Q4 epact data Section A2 to 8 (inclusive) Section B (3 measures) 100 for all 7 measures as an all or nothing payment 100 per measure Section A Incentive scheme measure Action required Evidence required A1 Blood Glucose Meters All practices will be required to implement the East Kent blood glucose meter recommendation for the use of blood glucose test strips (BG test strips). All type 2 diabetics using BG test strips should be reviewed to ensure their usage is in line with East Kent All type 2 diabetics using BG test strips should be switched to a GlucoRx Nexus or GlucoRx Nexus mini blood glucose meter unless there is an exceptional clinical reason why one of these meters is not suitable for the patient epact data Target as above A lower may be considered for practices with higher than national average of type 1 diabetics. (To be agreed prior to signing practice agreement) A2 Consider Seretide Accuhalers

4 500/50 in preference to Seretide Evohalers 250/25. provided, to demonstrate that patients, reviewed in clinic between 1May 2013 and 28 February 2014, who are currently prescribed Seretide Evohalers 250/25, are considered for a change to Seretide Accuhalers 500/50 or provide documented reasons why alternatives were continued or selected. The same spreadsheet is used for measures A2, B4 and B5 It is intended that this template will be completed as patients are reviewed in clinic. Produce an action plan on process to manage treatment for those who have declined to attend review A3 Stop prescribing drugs with insufficient evidence to justify NHS prescribing 1. Glucosamine 2. icaps and similar vitamin preparations for AMD Stop all prescribing of glucosamine ad vitamins for AMD Measured by epact data from July 2013 onwards Target-No prescribing A4 Prescribing within SLS criteria provided to demonstrate that all patients prescribed medication for erectile dysfunction are prescribed in line with SLS criteria 31 st July 2013 Target-all prescribing to be within SLS criteria (100%) A5 Appropriate use of flat priced medication Pregabalin capsules are the same cost per capsule irrespective of the dose contained. Reducing the frequency of administration and the number of capsules included in each dose will improve the cost effectiveness of treatment and benefit the patient by reducing provided to demonstrate that all patients receiving more than 2 capsules of pregabalin per day have had their regimen reviewed and where possible adjusted to ensure that the lowest practical number of capsules per day is prescribed 31 st July 2013 Target- in line with C4G average

5 the number of capsules they need to take on a daily basis. A6 Prescribing of Oramorph to be reviewed in patients with chronic pain with Sevredol tablets considered as a preferred option provided to demonstrate that all patients with chronic pain prescribed oramorph have been reviewed with a view to consider sevredol tablets. 30 th September 2013 A7 A8 Buccal Midazolam in Epilepsy Use of dapagliflozin in line with NICE criteria (if approved) provided to demonstrate that all prescribing of buccal midazolam for patients with epilepsy is in line with East Kent Prescribing Group Audits to demonstrate compliance with NICE Criteria to be provided following release of NICE guidance 30 th September 2013 Eclipse data- No 1 st February 2014 Section B Incentive scheme measure Action required Evidence required B1 Ensure NPH insulin used first line for type 2 diabetics in accordance with East Kent Prescribing Group (EKPG) recommendation. (For practices who are insulin initiating only ) Audit all new type 2 diabetic patients initiated on insulin between1 May 2013 and 28 February 2014, against current EKPG recommendation. B2 To ensure DPP-4 inhibitors (gliptins) are used in accordance with NICE provided to demonstrate that all patients prescribed gliptins

6 guidance. have been reviewed and treatment only continued if the HbA1c level has reduced by 0.5% within 6 months of initiation. It is intended that this template could be completed as patients are reviewed in clinic. B3 To ensure GLP 1 analogues are used in accordance with NICE guidance. provided to demonstrate that: 1. all patients initiated on GLP 1 analogues meet the NICE initiation criteria. 2. all patients prescribed GLP 1 analogues have been reviewed and treatment only continued if the HbA1c level has reduced by 1% within 6 months of initiation and if part of triple therapy the weight has reduced by 3%. It is intended that this template could be completed as patients are reviewed in clinic. B4 Ensure all new prescribing of combined inhaled corticosteroids and long acting beta 2 agonists (ICS/LABAs) for adult asthma patients is in accordance with East Kent Prescribing Group (EKPG) recommendation to demonstrate that the prescribing for all adult asthma patients initiated on combined ICS /LABA inhalers, between 1 May 2013 and 28 February 2014, is in line with EKPG, or provide documented reasons why alternatives were selected. The same spreadsheet is used for measures A2, B4 and B5 It is intended that this template will be completed as patients are reviewed in clinic. Produce an action plan on process to manage treatment for those who have declined to attend review B5 Ensure all prescribing of combined inhaled corticosteroids and long acting beta 2 agonists (ICS/LABAs) for provided, to demonstrate that all adult asthma patients on combined ICS/LABA inhalers,

7 adult asthma patients is reviewed and where possible considered for stepped down or a more cost effective preparation in accordance with East Kent Prescribing Group (EKPG) who are reviewed in clinic between 1 May 2013 and 28 February 2014, are considered for step down or preferred cost effective inhalers in line with EKPG, or provide documented reasons why alternatives were continued or selected. Produce an action plan on process to manage treatment for those who have declined to attend review The same spreadsheet is used for measures A2, B4 and B5. It is intended that this template will be completed as patients are reviewed in clinic. B6 Use of Long acting Muscarinic Antagonists (LAMAs) s in line with East Kent recommendation. provided, to demonstrate that all COPD patients prescribed LAMAs are reviewed as part of annual check to ensure in line with East Kent recommendation or document reasons why alternatives were continued and/or selected. Produce an action plan on process to manage treatment for those who have declined to attend review B7 Use of buprenorphine patches in line with East Kent Review patients on buprenorphine patches as part of the annual medication review to ensure this is still an appropriate medication to achieve pain control for that patient. The review should include a discussion with the patient or carer. If pain relief is inadequate consideration should be given to a change in medication. All patients newly commenced on buprenorphine patches

8 should be in line with East Kent unless there is a specific clinical reason for exception. Have difficulty with compliance/concordan ce with oral opioids Concerns regarding substance abuse For long term use- not suitable for patient requiring dose titration Weaning off opioids Cannot tolerate codeine and suffer from osteoarthritis or skeletal pain Measure Prescribing Issue Rationale for inclusion Potential saving 1 Medication safety issue 0 changes following discharge or outpatient appointment 2 Repeat Prescribing Significant drug 0 Procedures waste returned to pharmacies - need to identify collaborative action A1 A2 3 Cost effective from Community Pharmacies Diabetes Blood glucose test strips ICS/LABA combination inhalers to address. Develop or strengthen relationship between community pharmacy and GP practices Policy to switch type 2 diabetics to glucose Rx approved. East Kent implementation plan being developed Consider Seretide 500/50 Accuhalers in preference to Seretide 250/25 Evohalers. 0 Rationale for saving 251,400 40% of test strips changed - type 2s only 63,000 5% reduction Comments Use East Kent recommendation to change current practice

9 A3 Stop prescribing drugs with insufficient evidence to justify NHS prescribing 1. Glucosamine 2. icaps and similar vitamin preparations for AMD A4 Prescribing within SLS criteria A5 Appropriate use of flat priced medication- Pregabalin 25mg capsules A6 Prescribing of Oramorph to be reviewed in patients with chronic pain with Sevredol tablets considered as a preferred option A7 Buccal Midazolam in Epilepsy A8 Use of dapagliflozin in line with NICE criteria (if approved) B1 Insulin analogues East Kent guidance for use now approved so good basis against which to audit B2 Gliptins audits identified that patients not always reviewed in line with NICE - as costs for diabetes increase need to ensure cost effective use B3 GLP1 analogues audits identified that patients not always reviewed in line with NICE - as costs for diabetes increase need to ensure cost effective use 48, % reduction from current costs 54,000 20% reduction 115,000 75% reduction 0 Follow up from Prescribing Leads meeting Nov Use East Kent guidance % of national average Difficult to change patients but may be able to review where ineffective. Aim to change initiation practices. 0 No savings anticipated but work required to contain growth 0 No savings anticipated but work required to contain growth

10 B4 B5 B7 Ensure all new prescribing of combined inhaled corticosteroids ICS/LABA for adult asthma patients is in accordance with East Kent Prescribing Group (EKPG) recommendation Ensure all prescribing of ICS/LABA) for adult asthma patients is reviewed and where possible considered for stepped down or a more cost effective preparation in accordance with East Kent Prescribing Group (EKPG) Use of LAMA is in line with East Kent recommendation Buprenorphine patches Incentive scheme payment Use still significantly higher than national - concerns re. initiation by ICATs, hospice & EKHFT Total potential savings ,000 39,799 25% of national average - 110, ,199 Difficult to change patients but may be able to review where ineffective. Aim to change initiation practices.