P& MOT Px UPDATE Description: The Pharmacy & Medicines Optimisation Team (PMOT) work to support the CCG GP membership to get the maximum return and positive patient outcomes from its financial investment from the prescribing and use of medicines in primary care. SERVICE SUMMARY KEY MILESTONES Date of Update: CURRENT RISKS AND ISSUES ACHIEVEMENTS/COMMENTARY UPDATE CCG Rx Forecast underspend (October data) = - 312,205, Practice growth +2.7% (budget 3.1%), overall CCG growth 2.86% Approval of use and validation of high-cost drug charges in 2 care recouped 278K ytd (5% of spend on HCDs) System Resilience PMOT support to NHS 111 locally to improve community pharmacy direction & usage All key antibiotic prescribing metrics show performance consistently better than national average since 2010 (when NHS Herts guideline first produced by PMOT) PhAd supporting IC beds has flagged quality concerns around communications and transfer of PID to IC commissioning manager. Improved usage of NHS PrescQIPP to provide data and workstream areas for PhAds Regular prescribing performance reporting schedule being adhered to, including antibacterials prescribing and Finance. Contributing to the Map of Medicine development group Objectives: -Achieve overall financial balance on Px at March 2015 whilst delivering high quality patient care -Provide expert pharmaceutical support to service re-design -Provide expert pharmaceutical advice to Herts Health Economy Infection Control Group (HHEICG) -Contribute to CCG QIPP plans -Work across Herts health economy to ensure managed entry of new drugs or therapeutic pathways for max benefit to patients from evidence based Tx. -Work with NHSE to ensure the CCG gets maximum financial and patient benefit from community pharmacy contract levers PreviousCurrentForecast A GA RAGRisk/IssueDescription / mitigation No Lead Board Clinician for medicines mgmt Awaiting appointment at January Board meeting - NICE CGs AF & lipid-lowering. estimated be 2.5m over 5 years (primary care) Work continues across 2/1 interface on supporting sustainable implementation. - Flu vaccine costsIncreased uptake of new tetravalent flu vaccines likely to produce a cost pressure this year Oct data shows overall 6.5% less vaccines Px but only 1.5% cost decrease CCG Medicines Strategy CCG yet to agree a MO Strategy as highlighted by internal audit. Draft Strategy to be revisited and updated by PMOT in line with auditors suggestions. KPIs for prescribing agreed with PCMMG lead GPs and shared with practices by July 2014 (achieved) All relevant practices to have prescribing MOT report and follow up visit by PMOT PhAd by August 2014 (95%) All relevant practices to have agreed prescribing action plan by Sept 2014 (achieved) Bi-monthly meeting of HMMC with ENHCCG representation to agree managed entry of new Tx with 2 care, dissemination of all decision documents to applicants and practices in 28 days Active membership of HHEICG and HCAI subgroup, all practices supported to produce antibiotic audits as part of Commissioning Framework and CCG support for European Antibiotic Awareness Day PCMMG=Primary Care Medicines Management Group, PhAd=Pharmaceutical Adviser HMMC= Herts Medicines Management Committee 2014/2015 EXCLUDED DRUGS MONTH 8 (Extrapolated) 2014/2015 Excluded Drugs Planned Budget to date 2014/15 Cumulative spend to date Plan difference Vs Actual Spend Amount Agreed Credited to date Amount still challneged and awaiting agreement on credit % saved Vs spend through validation work Barnet & Chase Farm Hospitals 484,000566,00082,000153,785Not available as at % Cambridge University Hospitals 313,000324,00011,00058,9933,48318% East & North Herts Trust 2,690,0002,478,000-212,0003,29454,9920% Princess Alexandra Hospital Trust 666,000879,000213,00017,52016,1572% Royal Free London Foundation Trust 203,000140,000-63,0002,156Not available as at % University College London Hospitals 114,000155,00041,00042,64331,10528% ENHCCG4,470,0004,542,00072,000278,391 6% Locality 2014/2015 Prescribing Budget Cumulative spend to date (incl PH, CRI & NHSE Commissioned Drugs) Forecast spend March 2015 (incl PH, CRI & NHSE Commissioned Drugs) Forecast spend March 2015 (excl PH, CRI & NHSE Commissioned Drugs) Forecast difference vs Budget (excl PH, CRI & NHSE Commissioned Drugs) % Forecast difference vs Budget (excl PH, CRI & NHSE Commissioned Drugs) % Forecast growth 2014/15 vs 2013/14 (excl PH, CRI & NHSE Commissioned Drugs) Cumulative spend to date per 1,000 ASO-PUs Lower Lea Valley9,079,9505,446,2739,362,6839,032,257-47, %2.73%20,776 North Herts15,307,0109,052,27215,561,75415,073,124-233, %1.70% 21,798 Stevenage11,519,0906,979,05311,997,68411,511,842-7, %3.20%22,946 Stort Valley & Villages including St Elizabeth's & Sawbridgeworth Medical Services 8,276,3384,980,0238,561,1548,277,300 %3.29%N/A Stort Valley & Villages excluding St Elizabeth's & Sawbridgeworth Medical Services 7,116,5484,307,7737,405,4907,125,2518, %3.41%20,790 Upper Lea Valley14,784,4208,747,69915,038,16214,523,617-260, %1.45%19,754 Welwyn Hatfield14,284,3788,680,58114,922,78014,419,722135, %4.24%22,575 Spring House Medical Centre Unregistered Patients 37,30425,65244,098 6, %22.04% ENHCCG73,288,49143,911,55375,488,31572,881,960-406, %2.70%21,933 Primary Care Prescribing Financial Performance April to October 2014 Locality 2014/2015 Prescribing Budget Cumulative spend to date (incl PH, CRI & NHSE Commissioned Drugs) Forecast spend March 2015 (incl PH, CRI & NHSE Commissioned Drugs) Forecast spend March 2015 (excl PH, CRI & NHSE Commissioned Drugs) Forecast difference vs Budget (excl PH, CRI & NHSE Commissioned Drugs) % Forecast difference vs Budget (excl PH, CRI & NHSE Commissioned Drugs) % Forecast growth 2014/15 vs 2013/14 (excl PH, CRI & NHSE Commissioned Drugs) Cumulative spend to date per 1,000 ASO-PUs Community Nurse Prescribing 283,495221,458380,708 97, %38.64%N/A Herts Urgent Care - E&N OOH 123,70472,522124,324123,593- %3.15%N/A Isabel Hospice5,0000 -5, %0.00%N/A Intermediate Care30,00018,71632,085 2, %84.32%N/A Other (eg. Deputising & Unidentified) 6,0286,168 %8.39%N/A Total Others448,227318,865543,286542,55494, %29.95%N/A ENHCCG Total73,736,71844,230,41876,031,60073,424,514-312, %2.86% N/A Hertfordshire & South Midlands Area TeamNot Available207,217,354356,227,185342,624,049N/A0.00%2.49%N/A National Not Available4,689,419,7298,061,577,6677,816,429,149N/A0.00%2.90% N/A Primary Care Prescribing Financial Performance April to October 2014 Pharmacy & Medicines Optimisation Reports ReportDescriptionFrequencyProduced For Monthly Financial MonitorMonitor Primary Prescribing SpendMonthlyPhAds, Finance Team & The Board Acute In Hours Visiting ServiceAnalysis of Service Prescribing SpendMonthlyTo feed into Monthly Financial Monitor Public Health Local Authority Smoking Cessation and LARCS (Long Acting reversible Contraceptives) Recharge costs to LAMonthly To feed into Monthly Financial Monitor and to send to LA to reclaim expenditure CRI (Crime Reduction Iniciative) Drug & Alcohol Recharge costs to CRIMonthly To feed into Monthly Financial Monitor and to send to CRI to reclaim expenditure NHS England Commissioned DrugsRecharge costs to NHSEMonthly To feed into Monthly Financial Monitor and to send to NHSE to reclaim expenditure Public Health NHS England VaccinesRecharge costs to PHE MonthlyTo feed into Monthly Financial Monitor and to send to PHE to reclaim expenditure Ad-hoc financial reports on miscellaneous prescribers For example: Nurse Prescribers, Intermediate Care Homes, Hospices etcMonthlyTo feed into Monthly Financial Monitor Price ConcessionsMonitor price rises in unavailable medicinesMonthlyTo feed into Monthly Financial Monitor Budget Setting ProcessAscertain GP Practice Prescribing Budget for yearYearlyFinancial Monitor Report & Final Figures passed to NHS PPA KPIsMeasure prescribing/performance of GP Practice against set criteriaMonthlyPhAds to report to GPs Home Oxygen ServiceMonitor Service Prescribing SpendMonthlyFinance Team 8 x HCD Challenges (from 8 Hospital Trusts) Check & Challenge costs incurred for drugs as agreed within a commissioning contract Monthly, Quarterly, Year End Commissioning Team & Finance Antibiotics ReportAnalysis of Antibiotic prescribingMonthlyPhAds to report to GPs and Infection Control Team SpecialsMonitoring of expensive unlicensed medicinesMonthlyPhAds to report to GPs High Cost Drugs for GPsMonitoring of regular GP HCD prescribingMonthlyPhAds to report to GPs Herts Urgent Care (FP10)Monitor Service Prescribing SpendMonthlyHUC Staff and Nominated PhAds ScriptSwitchMonitor Switches & Savings made/or possible for GP PracticesMonthlyPhAds and ScriptSwitch Lead and sent out to GPs MI Databank Monitor the queries received within the team from various sources (GP, CP etc)MonthlyPhAds Generic SavingsMonitor Prescribing Performance of GP PracticesQuarterly PhAds to report to GPs Top 50 DrugsMonitor Prescribing of Most Expensive DrugsQuarterly PhAds to report to GPs MOTGP Practice Performance and SpendYearlyPhAds to report to GPs Zero Items PrescribersMonitor Prescribers / Cross ChargingMonthly Whoever it may concern 9 Financial Risk Mgmt 369 million nationally spent on preventable adverse reactions to medicines Medicines -12% overall NHS expenditure 12% hospital admissions are medicines related Individual Funding requests Horizon scanning Public Health Support CCG public health functions Community Pharmacy Enable CCGs to maximise opportunities in the pharmacy contract to support CCG priorities Professional Leadership Networks - sharing ideas, best practice, collaborating, doing things once Advice on legal & governance requirements for medicines Commissioning of medicines and services Ensure, safe, legal and cost effective medicines processes in all commissioned services. Safe, cost effective and evidence based GP prescribing Scriptswitch support HCD validations.. Safety and Quality Reduce harm from medicines use Adverse drug reaction related admissions account for 0.7% of NHS expenditure - 59% potentially preventable, Errors resulting from the use or misuse of medication are the most common threat to patient safety Cross sector medicines management processes Partnership in local decision making on new medicines and implementation of local guidelines Pharmacy & Medicines Optimisation in East and North Herts CCG Strategic planning Service re-design and strategic planning to assure medicines optimisation PMOT Current Service