The NHS faces unprecedented levels of pressure, driven by: an ageing population; increase in long-term conditions; rising costs; public expectations and a challenging financial environment. It is increasingly important that East Riding of Yorkshire Clinical Commissioning Group (CCG) collaborate with their partners to achieve efficiencies, whilst improving quality and patient experience.
In 2015-16, the CCG was under significant pressure to work within its financial allocation and needed to address this financial situation urgently if it was to maintain control over commissioning decisions and avoid reductions in essential services later. The prescribing budget alone was forecasting c£1.7m – £2m deficit. Compared to the 10 Office for National Statistics, the CCG spent £2m more than the upper quartile and could save in excess of £9m if it moved to best in class.
The challenges facing the CCG were:
The North of England Commissioning Support (NECS) Medicines Optimisation team produced a prescribing recovery plan in late 2015/2016 to then start late 2015/2016 and run into 2016/2017. This was based on reviewing prescribing data including the information on the PrescQIPP website. The prescribing recovery plan identified specific areas that could release an estimated £6 million of potential prescribing savings. Following a 12-week consultation period with stakeholders, patients and members of the public, a range of options to reduce prescribing costs, over and above the previous medicines management work plan agreed at the beginning of the 2015/2016 financial year, was then agreed via the CCG Service Redesign and Commissioning Committee and the CCG Council of Members. This supported ten actions across a broad spectrum of medicines management areas:
1. Prescribing the best value for money option to maximise value for money
GPs throughout East Riding of Yorkshire were encouraged and supported to prescribe 'best buy' medication for their patients.
2. Asking people to buy their items over the counter
The CCG carried out a large-scale marketing communications campaign aimed at the local public, encouraging them to self-care, be prepared and have a well-stocked medicine cabinet with essentials such as:
3. Reducing waste and improving safety
The CCG estimated that unused medicines cost them around £1.5 million each year. As a result, in 2016/17, the CCG implemented a number of initiatives including:
The NECS Medicines Optimisation team reprioritised the prescribing recovery plan areas and worked with individual practices to implement the plan. This work was completed under appropriate protocols, and the trusted relationship between the practices and the NECS Medicines Optimisation team was integral to the success of the plan. In addition, the CCG GP prescribing lead provided strong and essential clinical leadership in implementing the plan. The CCG also produced a 'Managing Potentially Excessive or Inappropriate Prescribing' policy and worked with the Local Medical Committee on agreeing approaches to effect changes when it they considered it relevant to the policy.
The CCG has organisationally owned the prescribing recovery plan and completed ongoing scrutiny on its performance via the CCG Delivery Group. This has also provided an organisational audit trail and the platform for continuously targeting opportunities.
The CCG goals were to reduce costs and improve patient safety, and in addition:
PrescQIPP 'cost avoidance' information was used in monthly reports back to the CCG and GP practices. Outcomes from implementation of the prescribing recovery plans included 'cost avoidance' reductions from baseline in the following areas:
Outcomes:
The value created:
The initiatives have seen a significant reduction in prescribing costs. In 2016-17, the CCG saw a reduction of 0.9% in prescribing costs, this despite two successive years of increasing costs of circa 4%. This equates to a total identified QIPP saving of £1.6 million included within wider cost mitigation of £2.6m. In the following year (2017-18) the CCG achieved an additional £3.7 million costs saving. This ultimately will lead to greater stability in the commissioning of local services to patients in East Riding of Yorkshire area. This should also lead to improved patient experiences and create value for taxpayers and patients alike.
The CCG has also maintained prescribing quality and outcomes within the prescribing recovery plans. An example is the reduction in prescribing antibiotics associated with health care related infections that has contributed to a continued reduction in Clostridium difficile levels 66 against a target of 85 in 2016-17 and 56 against a target of 85 in 2017-18. In addition, latest prescribing information for 2017-18 shows we have met the NHS England CCG Improvement & Assessment Framework antibiotic indicator targets for reducing the prescribing of broad-spectrum antibiotics and the number of antibiotics prescribed.
