Medicines Optimisation Team
Daniel Watts – Medicines Management Pharmacist
July 2014
Engagement Scheme 2014-15 - draft
Prescribing element (70p per patient)
Practices in partnership with the MMT will be required to identify key areas of work in
order to promote the safe and efficient use of medicines and budgetary management.
In addition, the practices will also be required to utilise ScriptSwitch ® and familiarise
themselves with the GMMMG Formulary.
The Medicines Management Scheme is intended to provide a more holistic approach
to optimising the medicines use for patients within the CCG.
It will comprise of 3 main areas which will be supported by the Medicines Management
Team (MMT).
Medicines optimisation of an agreed high risk patient group
Practice to work with the MMT to review a mutually agreed high risk patient group identified within
care homes or where this is not applicable could include housebound patients or QOF
exempted patients.
Quality areas focusing on Respiratory and Atrial Fibrillation (AF)
Respiratory will be a key CCG theme and the MMT will continue to work with the practices to share
the learning identified.
AF – each practice to work with the MM pharmacist to identify patients with AF who should be
considered for anticoagulation and ensure the safe introduction of the newer oral anticoagulant
agents where appropriate.
QIPP medicines management initiatives
Practices to continue to work with the MMT on outlying MM QIPP areas. These will include:
 Diabetes and the safe introduction of new drugs, appropriate BGT usage and choice of
meters/strips and a review of insulin analogue prescribing.
 National MM QIPP areas
 Waste campaign
Achievements
Scriptswitch – South practices saved £312k in 13-14 as a direct result of switches accepted
and information messages being adhered to e.g. Red drug & Do Not Prescribe messages.
“Hands on support” – The Medicines Management team realised £161k in 13-14 by
working with practices and offering hands on support to implement cost savings and switches
missed by Scriptswitch.
Minor Ailment Scheme
•
•
•
•
The Greater Manchester scheme is designed to allow patients registered with a GP in a
participating CCG to access the scheme from any pharmacy in GM that provides the scheme.
This helps to eliminate cross border issues and provides a consistent service for patients in
Greater Manchester.
All medications included in the formulary are evidenced based and align to the Greater
Manchester Medicines Management Group Formulary.
Patients can self refer into the scheme which eliminates the need for the patient to visit the
practice initially.
The scheme will be live from end July 2014.
Conditions treated under M.A.S.
• Allows the pharmacist to provide any over the counter medication
from an agreed formulary for any condition that product is licenced
for.
• This prevents patients being excluded due to an oversight in the
inclusion/exclusion criteria. Though not an exhaustive list the
scheme covers treatment for the following conditions:
Constipation
Indigestion / Heartburn
Diarrhoea
Haemorrhoids
Scabies
Sore Throat
Nasal Congestion (Infant)
Verruca / Wart
Temperature
Headache / Earache
Hay Fever
Soft Tissue Injury
Athletes’ foot
Cold sores
Contact dermatitis
Head lice
Insect bites & Stings
Dry Skin
Nappy rash
Vaginal thrush
Eczema
Conjunctivitis
Ear Wax
Threadworm
Allergy / Rash
Oral Thrush
Migraine
Acne
Achievements
AF -Developed resources for clinicians to support decision making re use of NOACS in AF and facilitate
discussion with patients. Worked with local GP who has an interest in AF management and IT
utilisation to develop a programme.
• identified how practices’ AF patients are being managed.
• promoted current guidance with respect to AF management.
• worked with CSU data quality team to help GP practices identify potential undiagnosed AF
patients in order to increase prevalence levels.
• developed resources for GPs to be used when counselling patients on anticoagulation options in
AF, supporting the decision-making process.
• case-study sessions with a local specialist to discuss best practice in managing this patient group,
plus follow review of patient lists to identify measurable outcome.
Asthma
• In specific practices, worked with pharma to provide nurse support for asthma register review
and deliver asthma clinics.
• Ran MMT audits of asthma in selected practices to highlight potentially uncontrolled asthma
patients and those in need of review and potential step down of steroid inhalers.
• Updating primary care asthma guidelines.
• Worked with practices to identify strategies to engage with asthma patients and improve
attendance for clinic reviews.
% of asthma register issued 10 or more "reliever" inhalers in 12 months
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
a
b
c
d
e
f
g
h
i
j
k
l
m
Practice
n
o
p
q
r
s
t
u
v
w
x
% of patients issued 10 or more reliever inhalers with a documented
asthma review in last 12 months
120%
100%
80%
60%
40%
20%
0%
a
b
c
d
e
f
g
h
i
j
k
l
m
Practice
n
o
p
q
r
s
t
u
v
w
x
4th Qtr
13/14
Aim
QIPP Com parators
w here the aim is to
decrease usage
QIPP Com parators
w here the aim is to
increase usage
Comparator
4th Qtr
12/13
Improved Y or
N
Score
Score
Cephalosporins & Quinolones
3
3
Hypnotics
0
0
Antidepressants ADQ
0
0
Lipid Modifying Drugs
1
1
Long Acting Insulin Analogues
1
1
3 Days Trim ethoprim
0
0
Antibacterial
0
0
Laxatives
0
0
Minocycline
3
1
NSAIDs
0
0
Om ega 3
2
0
NSAIDs Ibuprofen & Naproxen
3
0
ACE Inhibitor
1
2
Antidepressants: First choice
0
0
Hypoglycaem ic Agents
0
1
Low Cost Lipid Modifying Drugs
2
2
19
13
Total
South Manchester CCG Practices
AL-SHIFA MEDICAL CENTRE
DIDSBURY MEDICAL CENTRE- DR ASHWORTH
FALLOWFIELD MEDICAL CENTRE
THE BORCHARDT MEDICAL CENTRE
KINGSWAY MEDICAL PRACTICE
NORTHERN MOOR MEDICAL PRACTICE
MAULDETH MEDICAL CENTRE
BARLOW MEDICAL CENTRE
BROOKLANDS MEDICAL PRACTICE
BURNAGE HEALTHCARE PRACTICE
THE MAPLES MEDICAL CENTRE
TREGENNA GROUP PRACTICE
DAVID MEDICAL CENTRE - DR SHARMA
WOODLANDS MEDICAL PRACTICE
LADYBARN GROUP PRACTICE
BODEY MEDICAL CENTRE
CORNISHWAY GROUP PRACTICE
DIDSBURY MEDICAL CENTRE - DR WHITAKER
NORTHENDEN GROUP PRACTICE
BOWLAND MEDICAL PRACTICE
THE PARK MEDICAL CENTRE
RK MEDICAL PRACTICE
PEEL HALL MEDICAL CENTRE
BENCHILL MEDICAL PRACTICE
MERSEYBANK SURGERY
QIPP Score out of 48
Jan-Mar 14
38
36
34
33
33
31
30
30
27
27
26
24
24
23
21
21
20
20
19
19
19
17
15
14
14
Wasted Medicines Campaign.
The South Manchester CCG Plan
Community pharmacies – to contact patients to check which
items are required each time and stamp this has been done.
Practices – to NOT accept prescription requests from pharmacies
which do not indicate that the patient has been contacted.
If this hasn’t been done – to contact patients themselves.
Patients – to be made more aware of repeat prescribing systems
& the consequences of waste .
STOP BLAMING EACH OTHER!!
• All parties need to work together to ensure restricted
NHS resources are used to improve health outcomes
for the patients of South Manchester and NOT going
up in smoke or flushed down the toilet!!
• Reducing waste will increase monies to invest in
future collaborative working with local Community
Pharmacies, which will benefit our local population.
• Other CCGs have taken this approach and seen
significant reductions in their prescribing cost
growth.
Greater Manchester Medicines Management Group
www.gmmmg.nhs.uk (new address)
•
The GMMMG is the coordinating group for decision making around medicines and in
particular high cost medicines for Greater Manchester. It also has a role in
performance monitoring of health economies prescribing.
•
The Group consists of GPs, pharmacists and other key healthcare professionals. They
seek to identify and champion the appropriate use of medicines across Greater
Manchester taking into account cost effectiveness, quality, equity and patient safety.
•
The group is formally accountable to the GM collaboration of CCG’s and the work
plan is facilitated and supported by the Regional Drug & Therapeutics Centre in
Newcastle and the GM CSU.