BOB Prescribing Quality Scheme

Prescribing Quality Scheme (PQS) 2022-23

Details of the Prescribing Quality Scheme 2022-23 can be found here.

Details of how the money awarded can be used by practices for improving patient care can be found here

 

Prescribing Quality Scheme Resources for 2022-23

EMIS Searches will be built remotely by our team for all EMIS practices in Oxfordshire. They will be added to a folder in EMIS named ‘Oxfordshire (SCWCSU/OCCG)’ in a subfolder titled ‘ICB PQS 2022-23’ Instructions on how to edit and use these searches can be found here. This means you no longer need to download and import each individual search.

The Medicines Optimisation team can offer remote support to help with searches and switches. Our ‘Principles of Remote Working’ guidance can be found here.

 

1. Antimicrobial stewardship

Practices will undertake an audit of urinary tract infections in patients over 65-years- (non-catheterised patients).

SCAN guidelines are now available on the digital platform MicroGuide – this can be accessed as an app on a phone or tablet device or via a web viewer on a desktop computer or laptop. Instructions can be accessed here.

Antibiotic searches can be found on EMIS (in the Oxfordshire (SCWCSU/OCCG folder)

Information about appropriate prescribing and monitoring of antimicrobials in UTIs in over 65 year olds including how to carry out this audit, can be found here.

Data collection sheets can be found here.

 

2. Diabetes Medication Optimisation (oral agents)

Practices should identify their type 2 diabetic patients, who have had their diagnosis for more than 6 months, with the most recent HbA1c ≥ 64 mmol/mol, who are only prescribed a single oral antidiabetic agent. Practices should review the patients with a view to optimising treatment to achieve better control.

Searches to identify patients can be found on EMIS (in the Oxfordshire (SCWCSU/OCCG folder)

Data collection sheets can be found here

All current Oxfordshire Diabetes Guidelines can be found here: Local guidelines and pathways – ClinOx. This includes guidance on DDP4 inhibitors, GLP-1 Agonists, blood glucose monitoring.

 

3. Lipid Management

Practices should identify patients with type II diabetes and a QRISK of >20%, on a low-intensity statin for primary prevention, who may benefit from optimisation to a high intensity statin. The practice should review the patients with a view to optimising treatment to achieve better outcomes.

Searches to identify patients can be found on EMIS (in the Oxfordshire (SCWCSU/OCCG folder)

Data collection sheets can be found here

The current Oxfordshire guidelines can be found here.

 

4. Formulary compliance

Practices should review prescribing of ‘Red, block & specials’ products. The link pharmacist for each practice will be able to support practices with EMIS searches relevant to their prescribing in these areas 

 

5(a)    Safety interventions

Searches to identify patients within each of the categories, can be found on EMIS (in the Oxfordshire (SCWCSU/OCCG folder)

  • High risk drug monitoring – practices are asked to review all their patients prescribed a DMARD (methotrexate, sulfasalazine, and azathioprine only) and lithium, to ensure that monitoring is up to date. The feedback sheet to be submitted can be found here
  • Valproate – practices are asked to review all their patients who are prescribed valproate and are of child-bearing potential to ensure they have an up to date ARAF in place. The feedback sheet to be submitted can be found here
  • DOACs - practices are asked to review their patients prescribed low dose DOACs for AF, to ensure that treatment is optimised and appropriate. The feedback sheet to be submitted can be found here.

There are local guidelines for DOAC prescribing

Primary Care Prescriber Decision Support for DOACs in Atrial Fibrillation.

BOB Position Statement for further information on prescribing for nonvalvular atrial fibrillation

DOACs for Treatment and Secondary Prevention of VTE. 

 

5(b)    Savings

Searches to identify patients within each of the categories, can be found on EMIS (in the Oxfordshire (SCWCSU/OCCG folder)

  • Fostair® MDI – practices are asked to consider switching appropriate patients from Fostair® MDI and generic equivalents to Environmental DPI or Lufrobec®
  • Liothyronine - practices are asked to consider switching appropriate patients from unlicensed liothyronine tablets to licensed capsules. The liothyronone shared care protocol can be found here.
  • Ethosuxamide - practices are asked to consider switching appropriate patients from generic ethosuximide to Emeside capsules.
  • Cholecalciferol – practices are asked to consider switching appropriate patients from cholecalciferol 800iu to an OTC product or to Strivit-D3 800iu. Guidelines for prescribing vitamin D can be found here

 

6. Dietetics

On receipt of audit from prescribing support dietitian practices are requested to review patients who are prescribed infant formula milk to ensure prescribing is in line with the local formulary and continues to be appropriate for the patient.

Guidelines for infant feeding and the appropriate prescribing of infant formula

The Commissioning Policy Statement for specialist infant formulas