Influencing Prescribing in Primary Care in the NHS

Janice SteelePrimary Care Pharmacist

Croydon Primary Care Trust

� 150 PCTs in England

� Population of Croydon 340,000� 65 GP surgeries

� 66 community pharmacies� Primary care drugs budget £45million

Local Health Issues

� Inequalities gap in life expectancy

� High black and minority ethnic group population

� 3 biggest killers – Circulatory disease– Cancer– Respiratory disease

History

� Prescribing advice pilot 1998� Team expanded 1999� Dual quality and cost effective prescribing

agenda� IT developments� Relationship building� Infrastructure� National Initiatives NICE , NPSA, QuOF

Key factors for success

� Strategic co-ordination

� Tailored implementation� Clinical engagement at all levels

� Communication� Well trained workforce

Strategic co-ordination

� Area prescribing committee– Clinical representatives from acute hospitals– Chaired by public health consultant– Members of the public– Links to networks and sectors

� Primary Care Prescribing Group– Agree practical implementation of annual

workplan

Tailored implementation

� 9 pharmacists provide tailored support� Annual visits - present data, discuss issues,

agree priorities to work on +/- support� Quarterly data provided to monitor progress� Comprehensive information packs developed

for each therapeutic area� Query answer service on individual patient

medicine management issues

Clinical Engagement

� Prescribing lead� Clinical opinion leaders� Peer pressure/ use of comparative graphs� Incentive scheme� Consistent use of the evidence base� Long term issues not just quick financial wins� Supportive� Look at prescribing processes as well as drugs

Communication

� Newsletters

� Reinforcement at practice meetings� Teaching sessions

� Website� Prescribing support tools

� Patient information material

Example- Statin switch programme

� Horizon scanning� Extensive review of the evidence� Explicit about risks as well as financial gains� Agreement by key committees� Presented to group of opinion leaders-consensus� Prepared support pack� Anticipated common questions/concerns � Patient information leaflet� Looked at clinical outcomes as well as financial

Statins continued

� Intervention form- standard approach� Communication with community pharmacists� Contact number for queries� Replicated pharmaceutical industry approach� Trained workforce� Piloted material� Incentive scheme� Targeted outliers � Messages reinforced regularly- newsletters , visits

Current Issues

� Structural reform of the NHS

� GP commissioning consortia� New initiatives + old ones to maintain

– Waste– Reducing patient admissions– Improving patient compliance– QIPP quality, innovation, PRODUCTIVITY,

prevention