Nottingham West CCG
Prescribing Team
Beth Carney/ Dawn Gajree / David
Sharpe
September 2014
Who we are…
• Beth Carney and Nayna Zuzarte – Prescribing
Advisor
• Dawn Gajree – Primary Care Pharmacist
• Kate Morris – Primary Care Pharmacist
• David Sharpe – Care Homes Pharmacist
• Total 2.5WTE
And the wider team
• Shared team across the five Nottinghamshire
county CCG’s:
– Area Prescribing Committee / Interface team
• Nicky Bird, Amanda Rawlings, James Sutton
– Clinical Governance and Care Homes Lead
• Coral Osborn
– Data Analyst
• Tim Oxley and Chris Day
What do we do?
“Promote evidence based cost effective
prescribing”
£12 million prescribing budget
£323,000 QIPP
A day in the life of a Primary Care
Pharmacist
• Read/ respond to emails
– Data analyst EPACT reports, meeting requests, request for
comments.
• GP practice
– read/respond to queries from emails and tasks, MI query, red
drugs, alternatives for specials.
– run report, identify patients, collect data for each individual,
summarise , agree changes, make changes.
– Medication reviews, formulary implementation, epact analysis
• Office/ meeting
– CCG service reviews, team meetings, write work streams, next
years work, MMF
Helping us with our prescribing plan
• Pain
– Practices have been asked to review of patients
taking high dose opioids for non-cancer pain
– Locally what is the maximum recommended dose
of morphine for non-cancer pain
• 60mg every 12 hours
• 100mg every 12 hours
• 200mg every 12 hours
Helping us with our prescribing plan
• Pain
– Practices are reviewing the prescribing of
pregabalin for neuropathic pain
– In local guidelines what is 1st line for neuropathic
pain after conventional analgesics?
• Gabapentin
• Pregabalin
• Amitriptyline
Respiratory
• COPD
– Ensure patients who have previously exacerbated are
issued with rescue packs (NNT =5)
– Patients with an FEV1>50% on an inhaled
corticosteroid (ICS) should be reviewed to deem if
treatment is appropriate.
– Formoterol easyhaler should be used as the 1st line
treatment option for long acting therapy in patients
with FEV1>50%
– Patients receiving oral steroid courses have the
number recorded in the last year and those receiving
3 or more courses are considered for bone protection
Asthma
• Responding to the National Review of
Asthma Deaths
• 39% of patients who died during the
monitoring period had >12 SABA reliever
inhalers issued in the year prior to their
deaths.
• 4% of patients had more than 50 inhalers
issued in the year prior to their deaths.
Respiratory
INHALER TECHNIQUE
Repeat prescribing processes
• Review of practices repeat prescribing
processes
• Printing of “duplication” on re-printed
prescriptions to aid identification of a
duplicated prescription to prevent the risk of a
patient receiving a double quantity of
medicines
The Care Homes Pharmacist
• Review all care home patients registered with
GP practices within CCG.
• All patients reviewed twice a year
• Indication, Dose, Quantity, Suitability
• Recommendations to GP
• Resolve issues with community pharmacies
Helping us with our prescribing plan
• Prescribing of Generics / Brands
– Promotion of generic prescribing
– But some exceptions to the rule…..
– Gatalin, sinemet, fenbid, laxido, nystan
• Prescribing the cost effective formulation
– Nitrofurantoin Caps
– Azithromycin Caps
Drug Tariff
Cost
Original Brand
Cost
Alternative Brands
Cost
n/a
Mercilon®
£7.67
Gedarel® 20/150
£5.98
Ethinylestradiol
20 micrograms/Gestodene 75 micrograms n/a
Femodette®
£8.85
Millinette® 20/75
Sunya 20/75®
£6.37
£6.62
Ethinylestradiol
30 micrograms/Desogestrel 150
micrograms
Marvelon®
£6.45
Gedarel® 30/150
£4.93
Ethinylestradiol
30 micrograms/Gestodene 75 micrograms n/a
Femodene®
£6.73
Millinette® 30/75
Katya 30/75®
£4.85
£5.03
Ethinylestradiol
30 micrograms/Levonorgestrel 150
micrograms
£2.82
Microgynon 30®
£2.82
Levest®
Rigevidon®
Ovranette®
£1.80
£1.89
£2.20
Ethinylestradiol 30/40/30 micrograms
Levonorgestrel 50/75/125micrograms
n/a
Logynon®
£3.82
TriRegol®
£2.87
Cilest®
£7.16
Lizzina®
£5.37
Cerazette®
£8.68
Cerelle®
Zelleta®
£3.50
£3.51
Generic
Ethinylestradiol
20 micrograms/Desogestrel 150
micrograms
n/a
Ethinylestradiol 35 mcg / norgestimate
250 mcg
Desogestrel 75 micrograms
£3.51
Where to find local guidelines and
formulary
http://www.nottsapc.nhs.uk/
ANY QUESTIONS?
Practices and Pharmacists
• Dawn Gajree:
– Church Street Medical Centre
– Hama Medical Centre
– Hickings Lane Medical Centre
– Linden Medical Centre
– Saxon Cross Surgery
– Abbey Medical Centre
Practices and Pharmacists
• Kate Morris
– The Valley Surgery
– Manor Surgery
– The Oaks Medical Centre
– Bramcote
• David Sharpe
– West End Surgery
– Church Walk Surgery