August 2015 Our Ref: FOI.15.ASH0102 requesting information regarding Referral target schemes for GPs in NHS Ashford Clinical Commissioning Group a) Does the CCG currently operate any schemes for GPs which include a maximum number of referrals as a target? (Please list all relevant, including schemes to be implemented in the next year) I can confirm NHS Ashford Clinical Commissioning Group (CCG) currently have a Trauma and Orthopaedic triage scheme; however, whilst this is aimed at reducing referrals there is no set target for practices. a. Which procedures does this scheme target? (Please list all relevant) I can confirm the procedure targets all NHS Ashford CCG Trauma and Orthopaedic elective pathways. b. Are there any incentives or sanctions linked to achieving these targets? (Please give details. This could include a payment per patient for achieving targets, or loss of payments for exceeding them, but does not have to be financial) I can confirm NHS Ashford CCG does not have any incentives or sanctions linked to achieving these targets. b) Does the CCG have similar targets for prescribing, excluding schemes to switch from branded drugs to generics? (Please list all relevant, including schemes to be implemented in the next year) a. Which conditions or medicines does this scheme target? (Please list all relevant) I can confirm the following table shows the NHS Ashford CCG s list of cost effective options, which is revised regularly and changes throughout the year. The information below is current as at 11 th August 2015.
Project BNF 01.03.05 Cost effective use of Proton Pump Inhibitors (May 2015) BNF 01.03.05 Cost-effective use of Omeprazole (May 2015) BNF 01.05.01. Cost effective mesalazine (March 2015) BNF 01.06.04 Macrogol 3350-Cost effective options-cosmocol (first choice) or Laxido (March 2015) BNF 02.05 Angiotensin-II receptor antagonist optimisation BNF 02.05.04 Doxazosin Optimisation BNF 02.05.05 Perindopril arginine (Coversyl Arginine and Coversyl Arginine DROP list (DRugs of LOw Priority) BNF 02.06.01 Glyceryl Trinitrate sprays BNF 02.06.01 Isosorbide Mononitrate MR 60mg optimisation BNF 02.06.02 Amlodipine cost effective prescribing BNF 02.09 Clopidogrel / Dipyridamole Optimisation (Safety) BNF 02.09 Clopidogrel optimisation (May 2015) BNF 02.12 Ezetimibe Optimisation BNF 02.12 Omega-3 fatty acid compounds BNF 02.12 Rosuvastatin (Note for analyst - Double counts) BNF 02.12 Statin Optimisation BNF 03.01.01 Salbutamol DRY POWDER inhalers- cost effective preparations BNF 03.01.01 Salbutamol pmdi inhalers- cost effective preparations BNF 03.01.02 LAMA Optimisation BNF 03.02 ICS/LABA Project 1 Options for pmdi preparations (2000mcg BDP daily ) (Updated July 2015) BNF 03.02 ICS/LABA Project 1a Options for pmdi preparations (800-1000mcg BDP daily) (Updated July 2015) BNF 03.02 ICS/LABA Project 2 Options for DRY POWDER preparations ( 800mcg BDP daily) (Updated July 2015) BNF 03.02 ICS/LABA Project 2a Options for DRY POWDER preparations ( 800mcg BDP daily) (Updated July 2015 BNF 03.02 Seretide 125/25 Evohaler impact of using branded generic Sirdupla (Added Aug 2015) (Note for analyst - Double counts) BNF 03.02 Seretide 250/25 Evohaler impact of using branded generic Sirdupla (Added Aug 2015) (Note for analyst - Double counts) BNF 03.02 Symbicort 400/12 and 200/6 Turbohaler impact of using branded generic DuoResp Spiromax (Note for analyst - Double counts) BNF 03.03.02 Montelukast cost effective prescribing (May 2015) BNF 03.04.01 Antihistamines DROP topic (DRugs of LOw Priority) BNF 03.08 Decongestants, aromatic inhalations, cough mixtures. DROP list (DRugs of LOw Priority) BNF 04.02 Antipsychotics optimisation-olanzapine BNF 04.02 Antipsychotics optimisation-risperidone
BNF 04.02.01 Amisulpride optimisation BNF 04.02.01 Aripiprazole dose optimisation BNF 04.02.01 Quetiapine immediate release vs Modified release (Note for analyst - Double counts) BNF 04.02.01 use of branded generics for Quetiapine 150mg XL preparations. BNF 04.02.01 use of branded generics for Quetiapine 200mg XL preparations BNF 04.02.01 use of branded generics for Quetiapine 300mg XL preparations BNF 04.02.01 use of branded generics for Quetiapine 400mg XL preparations BNF 04.02.01 use of branded generics for Quetiapine 50mg XL preparations BNF 04.02.01 use of generic quetiapine 100mg BNF 04.02.01 use of generic quetiapine 150mg BNF 04.02.01 use of generic quetiapine 200mg BNF 04.02.01 use of generic quetiapine 25mg BNF 04.02.01 use of generic quetiapine 300mg BNF 04.03.03 Escitalopram cost effective prescribing (May 2015) BNF 04.03.03 Sertraline cost effective prescribing (May 2015) BNF 04.03.04 Venlafaxine optimisation BNF 04.04 Modafinil cost effective prescribing BNF 04.05.01 Orlistat BNF 04.07.01 Analgesia for minor/common ailments. DROP list (DRugs of LOw Priority) [Some overlap with Paracetamol project] BNF 04.07.01 Co-proxamol DROP list (DRugs of LOw Priority) BNF 04.07.02 Fentanyl lozenges DROP list (DRugs of LOw Priority) BNF 04.07.02 Fentanyl optimisation 100 micrograms (Added Aug 15) BNF 04.07.02 Fentanyl optimisation 12 micrograms (Amended Aug 15) BNF 04.07.02 Fentanyl optimisation 25 micrograms (Amended Aug 15) BNF 04.07.02 Fentanyl optimisation 50 micrograms (Amended Aug 15) BNF 04.07.02 Fentanyl optimisation 75 micrograms (Amended Aug 15) BNF 04.07.02 Oxycodone immediate release preparation-optimisation BNF 04.07.02 Oxycodone Modified Release Preparations-Optimisation 10mg BNF 04.07.02 Oxycodone Modified Release Preparations-Optimisation 120mg BNF 04.07.02 Oxycodone Modified Release Preparations-Optimisation 15mg BNF 04.07.02 Oxycodone Modified Release Preparations-Optimisation 20mg BNF 04.07.02 Oxycodone Modified Release Preparations-Optimisation 30mg
BNF 04.07.02 Oxycodone Modified Release Preparations-Optimisation 40mg BNF 04.07.02 Oxycodone Modified Release Preparations-Optimisation 5mg BNF 04.07.02 Oxycodone Modified Release Preparations-Optimisation 60mg BNF 04.07.02 Oxycodone Modified Release Preparations-Optimisation 80mg BNF 04.07.02 Oxycodone/ Naloxone (Targinact ) DROP list (DRugs of LOw Priority) BNF 04.07.02 Tramacet DROP list (DRugs of LOw Priority) BNF 04.07.02 Tramadol Immediate release optimisation 50mg BNF 04.07.02 Tramadol Modified release optimisation 100mg BNF 04.07.02 Tramadol Modified release optimisation 150mg BNF 04.07.02 Tramadol Modified release optimisation 200mg BNF 04.07.02 Tramadol Modified release optimisation 50mg BNF 04.07.04.01 Triptans-Cost-effective use BNF 04.08.01 Pregabalin 25mg BNF 04.09.01 Pramipexole cost effective prescribing (May 2015) BNF 04.10.03 Buprenorphine sublingual cost effective prescribing (May 2015) BNF 04.11 Galantamine optimisation BNF 05.01.03 Minocycline. DROP list (DRugs of LOw Priority) BNF 06.01.01.02 Intermediate and long acting Insulins- Use NPH insulin first line BNF 06.01.01.03 Pen needles (Revised measure Oct 2014) BNF 06.01.02 Gliclazide MR 30mg. DROP list (DRugs of LOw Priority) BNF 06.01.06 Blood Glucose Test strips BNF 06.01.06 Lancets BNF 06.03.02 Prednisolone 5mg Optimisation BNF 06.05.02 Desmopressin cost effective prescribing of nasal spray (May 2015) BNF 06.05.02 Desmopressin cost effective prescribing of tablets (May 2015) BNF 06.06.02 Bisphosphonate optimisation (May 2015) BNF 07.03.01 COC (Project 1) Gedarel 20/150 in place of Mercilon BNF 07.03.01 COC (Project 2) Millinette 20/75 in place of Femodette or Sunya 20/75 BNF 07.03.01 COC (Project 3) Gedarel 30/150 in place of Marvelon BNF 07.03.01 COC (Project 4) Lucette in place of Yasmin BNF 07.03.01 COC (Project 5) Millinette 30/75 in place of Femodene or Katya 30/75 BNF 07.03.01 COC (Project 6) Rigevidon in place of Microgynon 30, Ovranette or Levest BNF 07.03.01 COC (Project 7) TriRegol in place of Logynon BNF 07.03.01 POP Cerelle in place of Ceravette BNF 07.04.02 Tolterodine MR to Neditol XL BNF 07.04.05 Drugs for erectile dysfunction- generic sildenafil vs high cost alternatives (Amended Dec 2014)
BNF 07.04.05 Sildenafil cost effective prescribing (May 2015) (Note for analyst - Double counts) BNF 08.03.04 Anastrazole Optimisation (May 2015) BNF 08.03.04 Gonadorelin analogues (May 2015) (Preparations for one month duration of treatment) BNF 08.03.04 Gonadorelin analogues (May 2015) (Preparations for three months/12 weeks duration of treatment) BNF 09.04 Appendix 02.02 Nutritional supplements-ensure Cans BNF 09.04 Appendix 02.02.01.02 Nutritional supplements-aymes Shake is more cost effective than Complan Shake (March 2015) BNF 09.04.01 A02.05.01 Colief DROP list (DRugs of LOw Priority) BNF 09.04.01 A02.05.01 VSL#3 DROP list (DRugs of LOw Priority) BNF 09.06 Vitamins and minerals-unlicensed BNF 09.06.04 Calcium and Vitamin D -DROP list (DRugs of LOw Priority) BNF 10.01.01 Ibuprofen and naproxen as % of all NSAIDs (Safety) BNF 10.01.05 Glucosamine BNF 10.03.02 Ibruprofen gel 10% switch to branded generic BNF 10.03.02 Ibuprofen gel 5% to branded generic BNF 10.03.02 Movelat to Algesal BNF 11.06 Dorzolamide (and combination products) optimisation BNF 11.06 Latanoprost (and combination products) optimisation BNF 12.02.01 Mometasone nasal spray cost effective prescribing (May 2015) BNF 12.03.01 Dental products DROP list (DRugs of LOw Priority) BNF 12.03.03 Nystatin suspension optimisation BNF 13.02.01 Cost effective emollients - ZeroAQS (Aqueous Cream Alternative) BNF 13.02.01 Cost effective emollients - Zerobase (Diprobase Cream Alternative) BNF 13.02.01 Cost effective emollients - Zerocream (E45 Cream Alternative) BNF 13.02.01 Cost effective emollients - Zeroderm (Epaderm alternative) BNF 13.02.01 Cost effective emollients - Zerodouble Gel (Doublebase Gel Alternative) BNF 13.02.01 Cost effective emollients - Zeroguent Cream (Unguentum M Cream Alternative) BNF 13.02.01.01 Emollient bath and shower - cost effective preparations BNF 13.10 Fflornithine (Vaniqa) DROP list-drug of Low Priority BNF 13.10.02 Topical Antifungals DROP list (DRugs of LOw Priority) BNF 13.6.1 Cost effective Lymecycline Preparation BNF 14.04 Vaccinations for Hepatitis B and Meningitis ACWY BNF 14.04 Travel vaccines b. Are there any incentives or sanctions linked to achieving these targets? (Please give details. This could include a payment per patient for achieving targets, or loss of payments for exceeding them, but does not have to be financial)
I can confirm the NHS Ashford CCG prescribing quality scheme has three entry requirements as an entry point based on returning reports on the following: 1. Audit of antimicrobials 2. Audit of Non-steroidal anti-inflammatory drugs (NSAIDs) use 3. Regular review of safety alerts using Eclipse RADAR tool Support for GP practices to deliver safe and cost effective prescribing is funded by calculating the difference in prescribing spend per practice (adjusted for size, demographics, prevalence of high cost areas of prescribing and unusual patient groups) and the national spend. There is no target for any of the above measures listed in the table above. Practices are encouraged to engage with measures to address waste and processes in addition to considering cost effective preparations where available. Please include documents or details of these schemes that would be sent to GPs. Please see the attached documents. Some information has been redacted from the documents as the CCG considers that this information is commercially sensitive in nature and therefore exempt under section 43(2) of the FOI Act: Commercial Interests. The redacted sections contain detailed pricing information, effectively providing a unit cost for the service which, if released into the public domain, is likely to result in prejudice to the commercial interests of the Clinical Commissioning Group and its providers. Releasing the information will enable bidders to adjust their prices accordingly, undermining the competitive nature of the procurement process and the Clinical Commissioning Group s ability to secure the most advantageous price for the service.