Prescribing Incentive Scheme

Prescribing Incentive Scheme 2021-22

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 Incentive Scheme Resources for 2021-22 

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 2020-21’ (update for 2021-22 available soon). 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.

Heart Failure

The Heart Failure Webinar held on 29th June 2021 can be viewed here: https://youtu.be/kl_2CtNakNs and slides are available here.

Guidance available on ClinOx includes:

The Prescribing Incentive Scheme requires all heart failure patients to be reviewed to ensure medication is optimised, an audit template is available here to support. 

 

Antimicrobial Prescribing

 

The Berkshire, Oxfordshire and Buckinghamshire (BOB) Primary Care Antimicrobial Webinar held on 17th Nov 2020 can be found by following the following link:

 

https://www.youtube.com/watch?v=T8-y0EDyfOg&feature=youtu.be

 

The slides are also available here.

 

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. 

 

On your desktop:

 

​The guidelines can be accessed directly through the url:  https://viewer.microguide.global/SCAN/SCAN

 

This url will remain the same (even when individual guidelines are updated) therefore consider adding this to your favourites.

 

On your phone/tablet:

 

The MicroGuide app is available to download free from the App store (Apple) or Google Play (Android). Search for MicroGuide in App Store/Google Play and download (as per icon below).

 

Once the user agreement has been reviewed you will be asked to create a profile.

 

Many other CCGs and hospital Trusts use this platform for antimicrobial guidance so the appropriate guidance ‘South Central Antimicrobial Network’ will need to be selected from the list of guidelines available. Do not select the acute Trust that you are usually associated with as those will be the acute Trust guidelines. Complete other boxes as appropriate. Then click Submit.

 

Click inside the circle next to the South Central Antimicrobial Network’ and finally on top left click ‘get selected guide’(for both Apple and Android users).

Antibiotic searches can be found on EMIS (in the Oxfordshire (SCWCSU/OCCG folder), and audit templates are available for both high risk and total.

 

Cost Effective Prescribing 2020-21 

HALO

Please use the HALO ordering system to source practice dressing supplies wherever possible. The majority of formulary dressings are available from HALO. However, on occasions, practices may be asked to prescribe outside of the formulary but it is anticipated that this should be limited and only on the recommendation of the Tissue Viability Team who will communicate this request to the practice concerned. The local woundcare formulary is available here.

Anticoagulant Prescribing 

The anticoagulation team will be providing several webinars throughout the year to support clinicians with prescribing, the recordings can be found below. The team can be contacted on doacsupport.ox@nhs.net and are happy to answer questions on individual patients or provide general support to practices.

20th July 2021 DOAC Webinar: https://youtu.be/Bkwv1yy39gY and slides.

Liothyronine

Review liothyronine patients for appropriate discontinuation or switch to levothyroxine in line with local liothyronine prescribing guidance. Specialist advice is available via oxon.endocrinologyadvice@nhs.net.

Oral Nutritional Supplements (ONS)

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 occg.dietitian@nhs.net. 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. There is now a patient information leaflet available detailing this information - Coeliac Disease and Gluten Free Prescribing.

Probiotics (e.g. VSL#3)

Probiotics are no longer on the OCCG formulary due to a lack of evidence to support their use. Patients wishing to use these products should be advised to purchase them OTC. 

Infant Formula

Prescribers can use the 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 email allergy advice service commsioned from OUH. The service can be accessed by emailing oxon.paedsallergyadvice@nhs.net.

Thickeners

The prescribing of thickeners for adults is suitable for continuation in primary care following recommendation from a specialist or Speech and Language Therapist only. The current first line thickener for adults is Resource Thicken Up Clear which is a gum based thickener. Older style starch based thickeners have largely been replaced by gum based thickeners which are more stable after mixing and more palatable.

The initiator will indicate which IDDSI level of thickness and which thickener to prescribe. The descriptors for levels of thickening of fluids have changed in line with International descriptors. Scoop sizes and product labelling have changed to support these changes.

The only suitable thickener for children under 3 years is Instant Carobel which can be prescribed for the treatment of vomiting and Gastro-Oesophageal Reflux (GOR) in infants. 

 

The Medicines Optimisation team dietitian is available to assist practices with reviewing their infant formula patients and also provides an email advice service via occg.dietitian@nhs.net .

GLP-1 Receptor Agonists

The GLP-1 Receptor Agonist in Type 2 Diabetes Guidelines were updated in September 2019.   The Agreement Form and Checklist has also been updated in line with the new guidance. This updated guidance aims to support GPs in deciding on the most appropriate GLP-1 agonist for their patients, taking in to account cost, effectiveness, side effects and practical considerations. The formulary options include semaglutide (oral and s/c), dulaglutide and liraglutide.

Prescribing of Blood Glucose Test Strips

In July 2019, APCO approved a new local Blood Glucose Monitoring Guideline and updated Self-Monitoring of Blood Glucose in Type 2 Diabetes Patient Information Leaflet. The aim of this guidance is to rationalise the number of different blood glucose testing devices across Oxfordshire whilst ensuring appropriate use of NHS resources. Advantages of compliance with the guidance include consistency of approach, reduced risk of errors due to unfamiliarity with equipment, a reduction in unnecessary prescribing, and improved cost-effectiveness.

Cost-effective blood glucose monitors are those with strips costing less than £6 for 50 strips (previously less than £10 for 50). The Finetest Lite Meter (Neon) is the favoured meter in Oxfordshire; however any meter falling in to this category may be used (e.g. GlucoRx Q). These meters should meet the need of majority of patients; however certain patient groups will require meters with additional functions (e.g. ketone testing, visual impairment). The guidance provides advice on these cohorts and suggestions of suitable options.

When initiating new patients on a blood glucose meter, ensure the guidelines are followed.  If appropriate, existing patients can be switched as part of a review of their blood glucose monitoring. A draft Patient Letter - Meter Change is available to adapt for practice use.

DPP4 Inhibitors

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. There is an optional audit template available here which can be adapted to suite the practice.

Emollients

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.

Respiratory

Prescribers should ensure that 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.

Over the Counter (OTC) Products

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 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.

The Medicines Optimisation Team have produced an article with information on the availability of OTC medication for hay fever to support practices which can be found here.