Prescribing Incentive Scheme
Prescribing Incentive Scheme 2019-20
The Oxfordshire Prescribing Incentive Scheme is offered to all of its member GP practices as encouragement and reward to improve the quality, safety and cost effectiveness of prescribing.
The objectives are to:
- Increase value for money by improving the quality and cost effectiveness of use of health care resources by practices in the CCG;
- Enable individual practices to realise benefits for patient care;
- Incentivise practices for changing practice in prescribing to improve the health of the Oxfordshire population.
Prescribing Data Report 2019-20
Prescribing Incentive Scheme Resources for 2019-20
EMIS Searches have been built remotely by our team for all EMIS practices in Oxfordshire. They can be found in a folder in EMIS named ‘Oxfordshire (SCWCSU/OCCG)’ in a subfolder titled ‘OCCG PIS 2019-20’. 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.
A number of other resources have also been produced.
Prescribing within Budget Allocation
The ScriptSwitch dashboard is available on request to show the top missed opportunities for the practice and therefore where the greatest potential for savings is available using the system. Please see the How To Guide.
Ensure maximum use of ONPOS and only prescribe dressings outside ONPOS/formulary where recommended by specialists if appropriate. Ensure all practice staff are aware of the local Wound Management Formulary and process for non-ONPOS/formulary prescribing.
Review liothyronine patients for appropriate discontinuation or switch to levothyroxine in line with local liothyronine prescribing guidance. Specialist advice is available via email@example.com.
Oral Nutritional Supplements (ONS)
The recently published Commissioning Policy Statement 277 clarifies our position on oral nutritional supplements. Resources are available below to support clinicians with reviewing their patients e.g. patient information leaflets, a template letter and a Prescribing Points newsletter with suggestions as to how to implement the policy etc. Our dietitian can also help review our sip feed patients and will provide an email advice service via firstname.lastname@example.org. Other resources can be found in the folder below.
Gluten Free Products
Gluten Free products such as bread, flour and bread mixes should only be prescribed as per the commissioning policy on Gluten Free Foods, quantities should be no more than 8 units per month regardless of age or gender. Biscuits, pasta, cake mix, crackers, etc. are low priority for funding and should no longer be prescribed.
Probiotics (e.g. VSL#3)
The Therapeutic use of probiotics in adults and children Commissioning Policy Statement 125b does not support the use of probiotics due to insufficient evidence in adults or children. Consider reviewing prescribing of probiotics in your practice.
GLP-1 Receptor Agonists
The GLP-1 Receptor Agonists in Type 2 Diabetes guideline has been updated, and lixisenatide is now first line. Lixisenatide is significantly more cost effective than the other options, so should be used where appropriate. GLP-1 Receptor agonists should only be given for a 6 month trial, and should only be continued beyond 6 months if certain criteria are met. The Patient agreement form can be used to gain patient agreement and monitor the treatment success.
Direct Oral Anticoagulants (DOACs)
The complexity of the DOACs various doses, indications and durations of therapy can result in patients inadvertently being left on treatment long term. An audit can be conducted to ensure DOACs are being prescribed at the correct dose and duration for short term licensed indications. The OCCG guideline on DOACs for Treatment and Secondary Prevention of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) in Primary Care contains more information.
Over the Counter (OTC) Products
The recently published Commissioning Policy Statement 88c clarifies the OCCG commissioning policy on prescribing OTC products. There are a number of resources that you can use to promote the Over the Counter Medicines Campaign. The ‘How to manage your conditions’ slides for practice waiting room screen display offer a very effective method of communication to your patients. A poster on 'How to manage your conditions' and a printable leaflet on 'Treating minor conditions' have been developed for practices to use. A number of importable EMIS searches can be found in the resource link below. The ‘No prescription required’ form is a new resource that allows the patient to highlight to the pharmacy that they do not require a prescription to treat their symptoms and that they can be treated with OTC medication.
Emollients should be prescribed in line with local guidelines. Choose a cost-effective emollient taking into consideration patient preference as well as the history, severity of condition and site of application before making a suitable choice. Ensure that the indication is a documented dermatological condition.
PrescQIPP DROP List
The ‘DROP’ list is an accumulation of medicines that are considered as low priority, poor value for money or for which there were safer alternatives. The folder contains a search to import.
Complex multimorbidity is often associated with polypharmacy and optimising medicines, through targeted prescribing review, is a vital part of managing long term conditions. This may involve starting new medicines or stopping inappropriate treatments. The deprescribing element can involve tapering, withdrawing, or discontinuing medications with the aim of reducing adverse drug effects, reducing the use of ineffective medicines and improvement of outcomes.
Evidence-based tools are available and can be used in the medication review process e.g. The STOPP/START toolkit can be downloaded as a PDF file from the North of England CSU website. Patients for review may be identified on an ad-hoc basis during routine medication reviews, by reviewing patients in care/nursing homes or the EMIS Web search in the polypharmacy resource link below will identify patients on 8 or more medications (the search can be easily adapted to identify patients prescribed different numbers of medications). This is not an audit included in the incentive scheme this year, but may still be of interest.
Prescribers should ensure that the new formulary choices are considered when starting a patient on new treatment or when reviewing existing treatment. The Maintenance Management of Asthma guideline and COPD guideline summarise the formulary inhaler choices in a clear pathway.
Cost Saving Audits
Prescribing of Blood Glucose Test Strips
Where appropriate, practices should move patients onto cost-effective strips as part of a review of their blood glucose monitoring. Current resources are listed below, but please refer to ClinOx or Prescribing Points, or seek advice from the Medicines Optimisation Team, regarding updated guidance available from May/June.There is an optional audit template available here which can be adapted to suite the practice.
- Choosing a Blood Glucose Meter *UPDATED*
- Self-Monitoring of Blood Glucose in Type 2 Diabetes – Patient Information Leaflet
- Blood Glucose Monitoring Guideline *NEW*
- Ketone Testing and Sick Day Rules
- Patient Letter - Meter Change
Target: reduction in spend (compared with 2018-19) on blood glucose test strips as shown by ePACT2 data. Review 0.5% of practice population across 1 or more topics.
The Medicines Optimisation Team has produced a protocol on switching DPP4i to Alogliptin (the first line and most cost effective DPP4i) and a patient letter to support to support this audit.There is an optional audit template available here which can be adapted to suite the practice.
Target: reduction in spend (compared with 2018-19) on DPP-4 inhibitors as shown by ePACT2 data. Review 0.5% of practice population across 1 or more topics.
Prescribing of infant formula should be reviewed regularly and discontinued when no longer appropriate. Prescribers can use the new Infant Formula Guidelines to ensure appropriate prescribing of specialist infant formulas and quantities. The updated commissioning policy on Specialist Infant Formulas will also help support prescribing decisions. For support with allergy related queries, clinicians can contact the consultant led email allergy advice service commissioned from OUH. The service can be accessed by emailing email@example.com. The Medicines Optimisation Team has also employed a dietitian, who is available to assist practices with reviewing their infant formula patients and will provide an email advice service via firstname.lastname@example.org. There is an optional audit template available here which can be adapted to suite the practice.
Target: reduction in spend (compared with 2018-19) on infant formula as shown by ePACT2 data. Review 0.5% of practice population across 1 or more topics.
Quality Audit: PINCER
Pharmacist-led Information technology intervention for medication errors (PINCER) is a proven IT-based intervention which has been shown to reduce clinically important medication errors in primary care. PINCER forms part of the 2019-20 Prescribing Incentive Scheme.