Benchmarking data identified Eastbourne Hailsham and Seaford (EHS) and Hastings and Rother (HR) CCGs as having high outlying strong opioid prescribing. We began to address this over the course of 18-19 through education and Medicines Management pharmacist support to GP practices with the highest outlying prescribing locally.
HR CCG has reduced from 3rd to 12th highest strong opioid prescriber (cost / 1000 patients) nationally since the start of 18-19, with EHS reducing from 59th to 70th highest in the same time period; this resulted in savings of £230k. More importantly, we have seen a significant reduction in strong opioid volume, measured as ADQ / ASTRO PU. In the period Q1 17-18 to Q4 18-19, HR reduced strong opioid ADQ / ASTRO PU by 22% and EHS by 17%, while the national reduction was 10.9%. Some practices with initially high outlying strong opioid prescribing reduced the number of patients prescribed strong opioids for chronic non-malignant pain by between 30 – 40%.
We are now building on the successes of Medicines Management (MM) support to highest opioid prescribing practices locally in 18-19 with high dose strong opioid review, i.e. prescribing >120mg oral morphine equivalent daily (OME), incentivised through our 19-20 Prescribing Support Scheme (PSS). High dose strong opioid reviews have been undertaken in other areas, but we are additionally utilising the opportunity to identify risky co-prescribing (gabapentinoids / benzodiazepines / Z-drugs) / whether there is concurrent laxative prescribing. We are continuing to take an education heavy approach to effect change.
