The project is aiming to reduce waste repeat medicines. The project is working holistically with patients, GP practices and community pharmacies to deliver sustained system improvements to improve safety and reduce waste medicines across the Chesterfield federation area. The project is supporting and educating GP practice staff, patients and working with community pharmacies to implement the Derbyshire Repeat Prescribing Code of Practice (to reduce waste medicines, and ensure patients are asked which medicines they require within 5 days of the pharmacy submitting a managed repeat prescription request on behalf of a patient), or stopping managed repeat prescriptions from pharmacies that have not signed up to work in line with the Code of practice.
The aims of the project:
The project was initiated by the Chesterfield Federation practices in conjunction with the North Derbyshire CCG and Medicines Management Team. There had been many instances where huge amounts of prescription items were found in patients homes, with repeated instances where patients were unsure how the medicines kept on arriving at their house. The project team decided that they wanted to tackle waste medicines and work to improve patient adherence to prescribed medicines and employed Practice Medicines Co-ordinators (PMCs) to work in the Chesterfield GP practices. Repeat prescriptions requests received at the GP practice are prioritised for action from the PMCs. The PMCs telephone the patient at the time of receiving their repeat prescription request and discuss with the patient what medications are needed, intervening to ensure only medicines that are needed by the patient are ordered. They also discuss the use of online ordering and the electronic transfer of prescriptions to streamline practice systems. They process the prescription requests following discussion with the patient generating a prescription for the patient in line with normal practice processes.
The PMCs make suggestions to the GP practice about improvements that can be made to the repeat prescribing system and practice systems for issuing prescriptions. They also work through lists of patients in order to ensure that course lengths are correct for the quantity of medication to be issued in order to ensure that early orders are appropriately highlighted by the clinical system. This has been a particular problem with some inhalers, and items that should be required infrequently e.g. spacers. They ensure that practices are aware how to set up future new prescriptions to prevent similar issues in the future, delivering sustained improvements for the future.
PMCs work closely with practice prescription staff, providing brief education and ongoing support so that best practice when looking at repeat prescriptions has spread throughout prescriptions teams, building on the work that had been done previously providing education to practice prescription clerks. The project team plan to deliver training on the issue of repeat prescriptions to new staff starting within practices to ensure that best practice is embedded.
The PMCs work closely with local pharmacies to ensure that a good communication route is established and work with them to improve systems for patients and practices.
The project has supported the process to stop managed repeat prescriptions being ordered by pharmacies that are not signed up to the Derbyshire Repeat Prescribing Code of Practice across Chesterfield. The affected pharmacies were given two months' notice of the change with an effective change date of the 1st March 18. The PMCs supported practices, pharmacies and patients during this transition time and afterwards to ensure that the correct information was reaching patients, correct documentation on the patients record and that pharmacies concerns were noted. The PMCs continue to monitor the implementation of the code of conduct and the Project team are actively visiting pharmacies where there are still issues.
Patients:
Patients benefit from reduction of stock in their homes which could cause confusion about which items to take and is a safety issue.
They have reduced stock in their home which means that storage difficulties should not arise (one patient had to buy a new cupboard for excess stock).
They have a point of contact in the practice with whom to discuss their medication.
The PMCs pick up any issues with the patients medication adherence during telephone calls and these are passed onto the relevant clinicians in the practice to enable that patient to be reviewed. This helps to improve health outcomes.
There has been increased use of online ordering of medicines by patients, more patients are now responsible for ordering their own medicines increasing their own responsibility for their health supporting the CCG self care aims.
Practices:
Practices have improved repeat prescribing systems, including improvements in practice medication review systems, increase in EPS and online ordering of prescriptions.
There is better communication with the pharmacies in order to streamline systems.
PMCs discuss with pharmacies items that are not collected by the patient and highlight on the clinical system.
Practices have increased knowledge of patients who are non-adherent to the medication and have a chance to review these patients.
The project team are able to help train the practice prescription teams on the issue of repeat prescriptions and what to look for improving systems and delivering sustained benefits.
There has been a decrease in requests for prescription items that had previously been stopped by the prescriber, reducing queries in GP practices, improving patient safety and delivery prescribing savings.
Pharmacies:
Some community pharmacies have improved their systems for managed repeat prescription to align in to the Derbyshire Repeat Prescribing Code of Practice.
Some pharmacies have stopped managed repeat prescription systems, retaining this service only for those patients that are vulnerable and require support to order their medicines.
Pharmacies have a point of contact within the practice in order to discuss any repeat prescribing issues that may arise.
North Derbyshire CCG:
Although the project is still in its infancy, it has already evidenced a reduced spend on the prescribing budget.
There will be potential for reduced admissions for patients with medication related issues.
There will be better health outcomes for patients.
The project is saving money, supporting the CCG to deliver QIPP:
In addition, March prescribing data demonstrates a reduction in prescribing costs of £29,000 for the month of March 18 vs March 17. This trend has continued into April, and therefore it is forecast that this will save in excess of £300,000 in 18-19. This is due to change of behaviour by practices, pharmacies and patients following the start of PMCs working in practice and the implementation of the code of conduct, and the practices having served notice on the pharmacies that were not signed up to the code of practice with effect from 1st March 18.
Since Jan 18 – in one practice the PMC has withheld prescriptions for 623 months worth of stock. Of these, 190 were items that were withheld for more than 1 month.
There has been an increase in the number of patients registered for online services:
Practice 1: 22/5/17 - 1501 (18%) registered for online services. 18/6/18 -1852 (22%) registered for online services.
Practice 2: 19/6/17- 4,387 22.6% registered for online services. 19/6/18 - 5,586 28.8%
The project has delivered reduced waste, improved safety, and improved GP systems:
A patient story: patient has methotrexate set to 64 tabs, take 8 a week. She has been having every month. Passed to practice pharmacist as patient has mental health problems. Pharmacist notes say patient will use up extra stock of medication and repeat template put back to a one month supply as it was changed for a holiday and never put back to the original quantity, therefore providing future savings, reducing waste, and reducing potential safety issues with a high risk medication.
The project has delivered improved health outcomes:
Improved health outcomes: Asthma safety searches (number of salbutamol inhalers per year in asthma, LABA without inhaled steroid).18/6/17 = 3 patients; 18/6/18 = 1 patient
System improvements:
Old prescriptions (system search on 22/5/17):
Number of patients with a repeat not ordered for more than 5 years: 17
Old prescriptions (system search on 10/8/2018):
Number of patients with a repeat not ordered for more than 5 years: 8
Graph to show the reduction in items and cost and reduction of Items per ASTRO PU and Cost per ASTRO PU for the month of March (please see full project pack).
