Medicines Optimisation Team

Daniel Watts – Medicines Management Pharmacist

July 2014

Engagement Scheme 2014-15 - draftPrescribing 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 approachto 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 withincare 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 initiativesPractices 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

AchievementsScriptswitch – 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 / HeartburnDiarrhoeaHaemorrhoidsScabiesSore ThroatNasal Congestion (Infant)Verruca / WartTemperatureHeadache / EaracheHay FeverSoft Tissue InjuryAthletes’ footCold sores

Contact dermatitisHead liceInsect bites & StingsDry SkinNappy rashVaginal thrushEczemaConjunctivitisEar WaxThreadwormAllergy / RashOral ThrushMigraineAcne

AchievementsAF -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.

a b c d e f g h i j k l m n o p q r s t u v w x0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

% of asthma register issued 10 or more "reliever" inhalers in 12 months

Practice

a b c d e f g h i j k l m n o p q r s t u v w x0%

20%

40%

60%

80%

100%

120%

% of patients issued 10 or more reliever inhalers with a documented asthma review in last 12 months

Practice

Score Score

3 3

0 0

0 0

1 1

1 1

0 0

0 0

0 0

3 1

0 0

2 0

3 0

1 2

0 0

0 1

2 2

19 13

4th Qtr 12/13

4th Qtr 13/14

Improved Y or N

Low Cost Lipid Modifying Drugs

Total

Antidepressants: First choice

Hypoglycaem ic Agents

Om ega 3

QIPP Com parators w here the aim is to increase usage

NSAIDs Ibuprofen & Naproxen

ACE Inhibitor

NSAIDs

Laxatives

Minocycline

3 Days Trim ethoprim

Antibacterial

Lipid Modifying Drugs

Long Acting Insulin AnaloguesQIPP Com parators w here the aim is to decrease usage

Cephalosporins & Quinolones

Hypnotics

Antidepressants ADQ

Aim Comparator

South Manchester CCG Practices QIPP Score out of 48 Jan-Mar 14

AL-SHIFA MEDICAL CENTRE 38DIDSBURY MEDICAL CENTRE- DR ASHWORTH 36FALLOWFIELD MEDICAL CENTRE 34THE BORCHARDT MEDICAL CENTRE 33KINGSWAY MEDICAL PRACTICE 33NORTHERN MOOR MEDICAL PRACTICE 31MAULDETH MEDICAL CENTRE 30BARLOW MEDICAL CENTRE 30BROOKLANDS MEDICAL PRACTICE 27BURNAGE HEALTHCARE PRACTICE 27THE MAPLES MEDICAL CENTRE 26TREGENNA GROUP PRACTICE 24DAVID MEDICAL CENTRE - DR SHARMA 24WOODLANDS MEDICAL PRACTICE 23LADYBARN GROUP PRACTICE 21BODEY MEDICAL CENTRE 21CORNISHWAY GROUP PRACTICE 20DIDSBURY MEDICAL CENTRE - DR WHITAKER 20NORTHENDEN GROUP PRACTICE 19BOWLAND MEDICAL PRACTICE 19THE PARK MEDICAL CENTRE 19RK MEDICAL PRACTICE 17PEEL HALL MEDICAL CENTRE 15BENCHILL MEDICAL PRACTICE 14MERSEYBANK SURGERY 14

Wasted Medicines Campaign.

The South Manchester CCG PlanCommunity 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 Groupwww.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.