nGMS Prescribing indicators and the future of prescribing

Dr Mike Bainbridge

‘Resting’ GP

Technical Director PRIMIS

Chairman PHCSG The British Computer Society

Clinical Application Design NPfIT

nGMS Basic Principles

1. Practice based contract 2. Emphasis on Quality 3. Control of workload 4. High trust / low bureaucracy

MODERNISED INFRASTRUCTURE IM&T

100% Funding

PCO Ownership and liability

Choice of systems

Development, implementation, support

Education & training

Implementation

Practice based contract

• Capitation based funding • Formula intended to reward workload • Carr-Hill formula:

– Age-sex + residential care – List turnover – ‘Standardised’ Illness Rates and ‘morbidity’ – Costs (rurality, market forces)

• Guaranteed funding for IT and ETD

2 - Emphasis on Quality

• Clinical indicators (550 points) – 9 exclusion criteria

• Organisational indicators (184) • Additional services (36) • Patient experience (100) • Holistic care (100) • Quality practice (30) • Access (50)

3 - Control of workload

• Essential Services • Enhanced Services

– National, Local

• Additional Services – Minor surgery, Imms & Vaccs,

• Out-of-Hours • Allocations

4 – “Low bureaucracy”

• Items of Service “abolished” • No separate staff budgets / rules • Automated reporting of quality indicators • IM&T support provided by the Primary

Care Organisation

IM&T organisational markers for practices 1

• Legal • Backups • Capacity • Business continuity • Security • ePR transfer

IM&T organisational markers for practices 2

• Clinical Coding • Entering data and summarising • Extracting data • Training • Development plan

Benefits for GPs

• 33% increased resources over 3 years • Fairer resource allocation • All NHS income pensionable • Improved seniority pay • Control over workload • Salaried options

The Carr-Hill Formula

Contract Meltdown!

Prescribing Indicators

• CHD – Aspirin / Antiplatelet – ACE Inhibitors post MI – Beta Blockers for CHD – Flu vaccination

Prescribing Indicators

• Left Ventricular Dysfunction – ACE Inhibitors

• Stroke – Aspirin / Antiplatelet – Flu vaccination

• Hypertension

Prescribing Indicators • Diabetes • COPD

– ‘Flu vaccination • Epilepsy

– ‘on drug treatment’ • Hypothyroidism • Cancer • Mental Health

– Lithium

Prescribing Indicators

• Asthma – ‘On drugs’ – Flu Vaccination

Over-arching Implications • Across all indicators • Monitoring

– Blood pressure – HbA1C – Microalbumin – Cholesterol – Retina

• ‘Compliance’ • Excellence in patient care

– Implied shared responsibility

NHS Care Record

• Mull the previous slides over • Consider IT and organisational changes • New Community Pharmacy Contract • Changes implied

‘Joined up’ care

• Increased mobility of service users • Increasing needs of care • Ageing population • Safety in practice across boundaries

Changes in care delivery

• Examples – Out of hours – NHS direct – Walk-in centres

• European working time directive

• High quality care demands high quality patient information as well as the latest information to support decisions

The National Programme

• Focus on the four key developments : – NHS care record – electronic booking – electronic transfer of prescriptions – infrastructure

• Output Based Specification published www.doh.gov.uk/ipu/programme/index.htm

The NHS on any given day

• Activity – 1 million people visit their family doctor – 130,000 dental visits – 8000 ‘999’ admissions – 1.5 million prescriptions – 100,000 district nurse visits

• Users – 90,000 doctors – 500,000 nurses – 1.2 million in total

Or in a year…..

• 13m outpatient visits • Over 5.3m people admitted to hospital • 624m prescription items issued • Approximately 300m office visits in primary

care • England already spends £850M on NHS IT

each year

The Five NPfIT Clusters (NPfIT’s geographic grouping of Strategic Health Authorities in England)

Procurement

• NPfIT is one of the largest single IT procurement programmes in the world

• The National Programme aims to conduct procurement: – rapidly, with solutions that are responsive to

business needs – to provide value for money – to optimise the cost of participation in the

procurement by suppliers – following the process outlined in the Procurement

Approach document http:/www.doh.gov.uk/ipu/programme/ issued in January 2003

• Budget £2.3 bn • 17 Bidders took part

Local Service Providers (LSPs)

• Provide IT systems and services, in the five geographic clusters dividing England

• LSPs will manage multiple partners / vendors

– Ensure that the national applications can be delivered locally – “Ruthless application of standards” – Ensure that national standards are met

• HL7 v3 • SNOMED CT • Decision support / Knowledge Management framework

– Ensure local business needs are met

Context

• This didn’t happen overnight – 25 year lead in

• Information Strategy 1992 • ‘Information for Health’ document

September 1998 • Vendor Standards started 1994 (RFA) • ‘Building the Information Core:

Implementing the NHS Plan’ January 2001 • ‘Delivering 21st Century IT, Support for

the NHS’ June 2002 • NPfIT October 2002

Computerisation in UK General Practice

• Only 70 practitioners (out of 30,000) are not computerised

• 95 % of all prescriptions are produced electronically from clinical information systems

• We are in the position to transfer the record between systems with semantic integrity

• Implementation in late planning stage • Not the same in other sectors

Our Aim

To deliver a 21st century health service through the efficient use of information technology • To improve the quality and convenience of care by

ensuring that those who receive care have the right information, at the right time

• To implement projects vital to the NHS

modernisation programme using IT to directly improve the patient experience and clinical care

NHS Care Record

• “Will facilitate the sharing of electronic patient records to provide clinical support across all care settings”: – providing a national set of standards and a

national repository of information (NHS Spine) – aiding delivery of patient-centred care – facilitating the sharing of electronic patient records – aiding clinical support across traditional boundaries

Prescribing in the 21st Century NHS

• Single record - PSIS • Single drug database – DM+D • Single set of products for decision support and advice • Standardisation

– Warnings – Behaviour

• National Patient Safety Agency – Increasing role

• Within 2 years

Community Electronic Prescribing / Dispensing

• 2005 – 50% • 2007 – 70 % • Paper chase • Reimbursement capacity • ‘Token’ • 2 Legal documents – back and front • Same Authentication model

– Audit trail / Approved and consented uses for information

Community Pharmacy Role

• New contract • Supplementary prescriber

• Connectivity • Clinical systems / Clinical Information

– Access – Confidentiality

• Enhanced role – Repeat dispensing

Hospital Pharmacy

• Electronic prescribing will be the norm • Same drug database • Complex Prescribing • Robots / Barcodes / Electronic Patient

Identification • ‘Administration’ event • Patient safety focus

– Very real weight behind it

What does this mean ?

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Females 37.0 20.0 42.1 49.1 44.9 38.6 41.2 31.0 45.3 37.2 49.6 38.2 48.3 40.5 37.2 34.2 41.7 43.1 40.9 32.7 27.6 43.7 33.8

Males 55.0 35.1 56.7 58.2 53.9 54.2 50.6 46.9 54.7 57.1 59.5 49.4 52.5 47.7 43.0 46.8 55.9 51.8 53.1 42.9 32.6 48.7 38.3

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nGMS Prescribing indicators and the future of prescribing

mike.bainbridge@npfit.nhs.uk mike.bainbridge@nottingham.ac.uk