Reduce variation in referral rates and prescribing spend across the three Worcestershire CCGs which should result in a cost saving.
The three CCGs had a previous medicines optimisation service that required practices to undertake and report on a number of areas including medication review, audit and delivery of QIPP savings. In addition to this in 2016-17 one CCG introduced an enhanced service which required GPs to work in groups to peer review referrals prospective and retrospective referrals which resulted in a reduction in referrals.
For 17-18 a Local Improvement Scheme (LIS) was developed which combined referrals and prescribing and required practices to work together to promote best practice, consistency and reduce variation between practices. Practices were paid £4.50 per head of population and groups of practices had to submit an initial plan as to how they would achieve this, which included how they would work together, which areas for prescribing and referrals they would be reviewing both in house and as group peer review. The groups were provided with data to show the clinical areas providing the most opportunity. For prescribing one of the opportunities was review of adherence to the Worcestershire formulary and specific medicines were highlighted. Practices with lower opportunity were expected to assist those with greater opportunity thus reducing the variation and recognising they had less scope to reduce prescribing and referrals themselves.
The plans were reviewed by the CCG with clinical scrutiny and challenge where there was inconsistency. The groups then met on a regular basis with support from members of the CCG and reported their actions which as well as peer review included some practice actions such as medication reviews in high risk patients. The referral numbers, prescribing costs and EMIS patient numbers were monitored by the CCG.
The objective of the Local Improvement Scheme was to reduce variation in both referrals and prescribing which would result in a cost reduction for the CCGs.
The scheme resulted in a reduction in referrals of 11%, 15% and 12 % for each of the three CCGs, measured using EMIS and practices using specific EMIS referral codes.
Prescribing opportunity from formulary compliance was measured using prescribing spend and numbers of patients with a current course of the specific medicines. The list of Worcestershire 'do not dos' included a lot of the now NHSE items which should not routinely be prescribed. The opportunity was identified based on current spend for December 16-February 17, multiplied up to give an annual spend. The opportunity identified was £304,201. Using the data December 17-February 18 the opportunity identified had reduced to £98,698.
Using data from PrescQIPP and the elements of the NHSE list that were targeted in Worcestershire the three CCGs have reduced spend on these areas more than the England average. (See full project pack, chart one)
The drugs targeted were co-proxamol, doxazosin (MR), glucosamine and chondroitin, herbal therapy, homeopathic therapy, lutein and antioxidants, oxycodone and naloxone prolonged release, paracetamol and tramadol combination product, perindopril arginine, rubefacients (excl. topical NSAIDs), travel vaccines.
