1. Gastrointestinal (GI)
Right Care Optimisation Workshop
Tuesday 10 November 2015

2. GI – Elective Opportunity

3. GI - Prescribing Opportunity

4. Deep dive The GI deep dive identified two projects:
Review of GI elective / day case activity
Reduction of GI primary care prescribing costs

5. Review of GI elective / day case activity
To reduce costs and variation and improve patient experience within GI planned care. Providing financial benefit of around £1,820,000. Scope includes:
Hepatobiliary spend
Lower GI
Other GI.

6. From deep dive data pack

7. Discussion questions How can we reduce hepatobiliary outpatient spend?
What can be done to reduce variation in referral rates for cholecystectomy and numbers of procedures?
What can be done to review coding for HRGs related to inflammatory bowel disease in the lower gastro-intestinal subcategory? And reduce variation in referral rates?
How should we improve the value of colonoscopies by reducing the ratio of diagnostic to therapeutic colonoscopies?

8. Discussion questions continued
Would increasing endoscopies, including a biopsy, from 45% to closer to the 65% for the comparator CCGs have any clinical or financial benefit?
Why are there a higher proportion of admissions that have complications and comorbidities recorded for cholecystectomies than elsewhere? What can be done?
How can we reduce admissions with a zero length of stay where there are no complications?

9. Reduction of GI primary care prescribing costs
To reduce primary care prescribing costs by a total of between £292,000 and £1,880,000.
Early implementation will lead to a proportion of savings within 2015/16.
Scope highlighted areas for review:
Stoma prescribing
Upper GI
Hepatobiliary
Lower GI

10. From Deep Dive Data pack

11. Mapping Stoma products cost per 1,000 patients

12. PrescQIPP Subscribers Stoma cost per 1,000 patients top 50%; Apr - Aug15

13. PrescQIPP Subscribers Stoma cost per 1,000 patients btm 50%; Apr - Aug15

14. Stoma: current work streams
North and East Stoma Formulary - chapter 19 on formulary website (accessory products)
Review of North and East Stoma Formulary
Creation of South and West Stoma Formulary
Scoping of CCGs - Portsmouth, Oxford, Herts Valley, North East Essex, Nene
Review of guidelines for issuing prescriptions for stoma appliances.

15. Upper GI prescribing Below national median
Variance driven by agents for dyspepsia
Below median for antisecretory agents
Drive to reduce PPI use as part of C. Diff strategy.

16. Hepatobiliary prescribing
Variance driven by immunosuppressants
Includes 20% of azathioprine and 25% of mycophenolate prescribing
These drugs have different supply mechanisms; may be prescribed in secondary care in some CCGs. Therefore primary care prescribing may not be an appropriate comparison.

17. Lower GI prescribing Variance driven by: Laxatives
High volume, low acquisition cost
Antispasmodics
Work already underway on switches
Treatment for acute diarrhoea
Includes 5% codeine
Main driver is generic loperamide.
Merbentyl – dicycloverine –phase 2
Mebeverine – colofac – pase 1

18. For consideration:
Is a re-procurement project around stoma prescribing, to negotiate a contract with a single supplier to minimise costs and reduce device variance a viable option? What is the best way forward?
How can we reduce prescribing volume and costs for primary care prescribing?

19. Thank you