17th October 2017 – CPRG Meeting

Medicines management presentation Jay Voralia, Head of Medicines Management

Introduction

While more people than ever before are calling on its services, our NHS is facing the biggest financial challenge it has known. Last year, 1.1billion prescription items were dispensed in the community at a cost of £9.2 billion to the NHS.

  • NHS Crawley CCG spend £18.5 million on medicines for its population of just under 131,000. Approximately £600k of that spend is on medicines that have been supplied but never used.
  • NHS Horsham and Mid Sussex CCG spend £33 million on medicines for its population of just under 235,000. Approximately £1m of that spend is on medicines that have been supplied but never used.

Review of Over the Counter Medicines (OTC) and Gluten Free

Echoing a national consultation on future guidance for doctors and nurses who prescribe medicines we are asking local patients about their specific experiences and needs in relation to OTC and Gluten Free Products. We will combine this feedback with clinical expertise and local insight to review these items that are currently prescribed but:

  • Could be purchased over the counter, sometimes at a lower cost that would be incurred by the NHS
  • Treat a condition that is considered to be self-limiting (will get better on its own) and so does not need treatment
  • Treat a condition that lends itself to self-care, i.e. that the person suffering would not need to seek medical care or treatment.

This means we are looking at ways to reduce and/or stop use of a specific list of items for OTC medicines, many of which are already on the CCG’s black list (meaning they should not be prescribed for our patients).

In additions to this, we are also considering the withdrawal of Gluten Free product on prescription. This would mean that Gluten Free items will not be routinely prescribed.

Managed Repeats

Alongside this work, the CCG will no longer support Managed Repeat Prescriptions.

Managed repeats are when the pharmacy retains the patient’s prescription repeat request form and submits it to the surgery on their behalf. The next prescription can then be processed and dispensed ready for the patient to collect it at a convenient time, before they have run out of medication. This service is currently used for regular medication and/or patients who are receiving medicines in a compliance aid (e.g. a dosette tray).

These schemes are not covered by the NHS Pharmacy Contract (Essential Services) and as such there are no national standards around how they should be managed. They are different to the Repeat Dispensing Service which is a nationally agreed service and does have agreed protocols for handling and supplying medicines on batch prescriptions.

The CCG will no longer support this practice to:

  • Improve patient safety by ensuring that all patients get the right medication, in the right quantities, at the right time after a recent review with their healthcare professional
  • Reduce waste and save money. It is important that we get the most value out of every NHS pound we spend It is estimated that over-ordering, stockpiling and not using medication costs the NHS £300 million per year. This is money that could be better used to benefit the health of more people

Going forward patients will need to order their repeat prescription themselves either inperson at the GP practice, by telephone, or online. Patients are asked to only order what’s needed. They are asked to ensure that they have enough medicines left before ordering a new prescription and allow enough time for the GP to issue a prescription and time for the community pharmacist to order and dispense medication, so not leaving it until the last minute. They will also need to allow additional days for any bank holidays. Practices will be asked to identify those vulnerable patients who may need support

Implementing the changes and exemptions

Identify and understand the needs and preferences of vulnerable patients and the mitigating measures to ensure they are not negatively impacted, following the process of withdrawing access to over the counter medicines and gluten free products and withdrawal from managed repeats systems:

  1. Can you identify patient groups with possible scenarios and possible solutions which could apply?
  2. Can you add other patient groups to the list below?
  • Those with complex health needs
  • Those with Mental Health needs
  • Those with Disabilities
  • Those living in rural areas and living with a long term condition or vulnerability

Can CPRG/ PPG representatives please take this question to their PPG’s for discussion and return feedback by mid-December to:

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