1. City and Hackney Clinical Commissioning Forum
Thursday 7th July 2016
St Joseph’s Hospice

2. 5 Year View & Devolution Update
Agenda Items
Led by
Welcome
Clare Highton
2. 
5 Year View & Devolution Update 3.
Social Prescribing
Patrick Hutt 4.
Sustainability and Transformation Plan (STP)
Siobhan Harper | David Maher 5.
Rheumatology Service – HUHFT
Dr C Gorman 6.
Prescribing Programme Board (PPB) Update on
Quality & Financial Indicators
Haren Patel | Rozalia Enti

3. Devolution progress Dr Clare Highton Chair – City and Hackney CCG
Clinical Commissioning Group Forum
Thursday 7 July 2016

4. Money uncertainties: Post Brexit – who knows?
City and Hackney £30M reserves – unlikely to access
City and Hackney 1% required topslice – unlikely
Transformation money including devo money – only as part of NEL STP

7. Improving the NR investment opportunities
NHS overall finance improve – access to £30m drawdown allowed
Deliver more QIPP
Contain demand to secondary care
NR investment realises its potential – impact delivers financial benefit to at least cover costs
Running costs continue to be contained and underspend

8. Improving the NR investment opportunities – risks
NHS overall finance show no improvement – no access to £30m drawdown
QIPP stays at c£5m pa, CCG cant find more
Demand to secondary care rises
Continuing Healthcare costs continue significant rise
Impact of social care cuts hits NHS further
Cost shifts from NHSE for primary care/specialist
Quality and safety demands eg CQC financial impact
Cost of ‘transformation’ NEL, London-wide
STP costs borne by those with funds – C&H funds to other parts of NEL eg Barts, BHR

9. Rising costs: Doing well on referrals and prescribing
£4M extra last year on unplanned admissions – especially at BH
£1.5M extra on continuing health care

10. Devo is 3 things
Joint commissioning with London Borough of Hackney and City of London Corporation
Devo powers and estates
Integration of providers

11. Joint commissioning
Can’t separate out health from social services without inefficiencies
Public sector all work together
Focus resources locally – best use of the Hackney pound

12. Joint commissioning continued
Social services deficit about £32 a year by 2020/2021
Joint budget deficit £20m - £78m
Ring fencing?

13. How might joint commissioning work?
For example Glossop and Tameside intergrated CB
3 CCG GPs
1 CCG Lay Member
4 councillors
1 executive from LA and 1 from CCG
Then a professional reference group with providers

14. Devo powers Prevention – licensing and smoking
Immunisations and screening
Estates – who owns the buildings – a power struggle
Treasury, PropCo, GLA, NEL STP, LBH (devo)

15. Integration of providers
MCP
PACs
Alliance contract (extend One Hackney and City to all BCF services, FHV and Duty Doc, A&E, unplanned admissions??)

16. GP options – MCP contract by end of July?
Direct employment MCP or PACs
Remain GMS/PMS/APMS but negotiate an alliance contract via confed
Large organisation/company to hold the main MCP capitation budget as GP confederations too small?

17. Integration
Slide from Anna

18. Pathways and joint clinical leadership
Jointly run
Homerton (Martin Kuper)
Confed (Deborah Colvin)
CCG
New salaried CCG GPs

19. Principles Empower patients – promote independence
Empower frontline staff
Build relationships
Practice team
Quadrant extended team
To include social workers, MH, voluntary sector, community health services, team coordinators
Try to eliminate layers, contracts, handoffs as far as possible

20. END | NOTES

21. Social Prescribing CCF update Dr Patrick Hutt Clinical Lead for Social Prescribing
July 2016

22. Social Prescribing
Social Prescribing Pilot – now rolled out to whole of City and Hackney CCG
IAPT will be referring patients via GP practices
Minimum target of 700 total referrals for whole CCG for LTC contract (136 done so far)
Referral form available on CCG website
/book direct

23. Social Prescribing: National Context
‘We are seeing a big growth in social prescriptions where GPs are saying that actually the root cause of this person’s problems is isolation and loneliness, so effectively what I’m going to prescribe is that you join a lunch club or something like that to make sure you have company in your life ……
……..I do not think that is something we would want to stand in the way of’ Jeremy Hunt 2015
THE NEED FOR A SYSTEMIC SOLUTION

24. Evidence Base Good qualitative data – ‘life changing.’
Quantitative Data not conclusive – but there is no standard measure adopted throughout the UK.
Some emerging evidence of reduced GP consultation rates at 12 months

25. KEY THEME: Re-connecting with the world
“Best thing has been meeting new people and making friends. My mobile full up with names and numbers of friends before it was just family and doctor’s number. I was really depressed before but now really happy. Before I have nothing to do, now every day I wake I think ‘yes volunteer work!’ or ‘meeting friends!’” (patient)

26. Going Forward..
Trying to make social prescribing ‘part of the GP desktop’
Sharing positive stories about the service, gathering evidence
Innovative IT solutions – making local recommendations to GPs and patients based on EMIS ‘medical cookies’. Is this something you would be interested in?

27. Thank you for listening!
Qs as we go along
QUESTIONS, COMMENTS, MORE INFORMATION ?

28. Update on NEL STP July 2017

29. Steps to Date Develop local leadership and collaboration
Establish common purpose
Define early vision and priorities
Ongoing planning, implementation and learning
Engagement of staff and communities at every stage
30 June submission
Build the leadership
Develop the vision and take early action
Continued implementation
Set out early thinking
Collective leadership agreed
15th April checkpoint
Full Plan submitted to national bodies 1 2 3
18/09/2018

30. Key STP Delivery Themes by 2020
Better Care and Wellbeing (which includes PC)
Transforming Hospital Services
Productivity
Workforce
Infrastructure
Technology
Specialised Commissioning – Not yet confirmed
18/09/2018

31. Better Care and wellbeing
 New care models operational across NEL.
 Implementation of SCF standards with 100% coverage in line with London implementation timetable.
 Reduction acute referrals per 1000 population through improved demand management and primary / community services.
 Access across routine daytime and extended hours (8-8) appointments within GP practices and other healthcare settings.
 Alignment with NHS E 2020 goals for LD transforming care.
 95% of those referred will have a definitive cancer diagnosis within four weeks or cancer excluded, 50% within two weeks(“find out faster”).
 Provide the highest quality of mental health care in England by 2020.
 Deliver on the two new mental health waiting time standards and improve dementia diagnosis rates across NEL.
18/09/2018

32. Transforming Hospital Services
Implemented phase 2 and 3 7DS standards.
Establish surgical hubs at each hospital site that work together in a network.
Midwifery services will be reorganised to ensure that women can be offered continuity of care for each part of the maternity pathway.
Community care hubs will be established with full IT integration to allow seamless communication across the maternity pathway.
 Safely transition patients from King George Hospital’s emergency department, with closure in 2019/20.
18/09/2018

33. Productivity
 Proactive approach to finding areas for collaborative working in NEL. (emerging hospital chains)…
 Vision for shared back office approach and functions realised.
 Joint infrastructure and workforce planning across NEL’s organisations. This may be done only to inform rather than replace organisation plans.
 All trusts in NEL have implemented the findings of Carter and achieved agreed efficiency savings contributing to their financial sustainability.
18/09/2018

34. Workforce
 Retention improvement targets set in Year One# and bank/agency reductions, delivered.
 Full implementation of the right roles in the right settings.
 Integration of roles at the interface of health/social care.
 All staff to have structured career pathways.
18/09/2018

35. Infrastructure
Realise opportunities to co-locate healthcare services with other public sector bodies and services.
Dispose of inefficient or functionally unsuitable buildings in conjunction with estates rationalisation.
More effective use of ‘void’ space and more efficient use of buildings through improved space utilisation.
 Investment in capital development works to support of strategy delivery.
18/09/2018

36.  Full interoperability by 2020 and paper-free at the point of use.
Technology
 Full interoperability by 2020 and paper-free at the point of use.
 Every patient has access to digital health records that they can share with their families, carers and clinical teams.
 Offering all GP patients e-consultations and other digital services.
 Utilizing advanced/preventive analytics towards achieving population health and wellbeing.
18/09/2018

37. END | NOTES

38. Homerton Rheumatology Service
Dr Claire Gorman
Consultant Rheumatologist
Homerton NHS Foundation Trust

39. Rheumatology Team Members
3 Consultants Claire Gorman Piero Reynolds Clare Thornton 1 SpR, 1 Clinical Fellow, 1 CMT, 2 FY1s 3 Specialist Nurses 1 Research Nurse, 1 Research Assistant

40. Rheumatology Services
All inflammatory arthritides General rheumatology (but soft tissue problems to be referred to Musculoskeletal Centre at St. Leonard’s) Early Arthritis Clinics Lupus Clinic Combined Podiatric Clinic Combined Obstetric Clinic (Adolescent Transition Clinic)

41. Rheumatology Services
Rheumatology Advice Line
Consultant response to queries usually within 24 hours
Ultrasound Disease Activity Assessment in Clinic
Methotrexate Injection Clinics
Nurse-led telephone advice line

42. Expanding Service
Increased capacity New Consultant having 2 more clinics / week New Clinical Fellow 5 clinics / week Increased referrals from neighbouring CCGs New Attendances ‘14-’15 = 913 ‘15-’16 = 1051 New: FUP Ratio ‘14-’15 = 1:1.67 ‘15-’16 = 1:1.63

43. Specific Issues from Primary Care
Shared Care Guidelines Receiving blood test results Follow up of patients for dose adjustment of DMARDS Frequent follow up of patients Transfer of Subcutaneous Methotrexate prescribing to primary care

44. Shared Care Guidelines
SCGs for DMARDs are available on City and Hackney CCG Website or via eBNF
/shared-care.htm
Paper signed by both parties seems to add minimally to what clinic letters document
We send out shared care guidelines for Methotrexate if requested
This is likely to be reviewed in the near future -under review by the JPG

45. Receiving Blood Test Results
Homerton IT dept. says that all City and Hackney practices have direct link to our EPR with all blood test results Historically, our nurses spent a lot of time faxing out blood test results, taking away time from other duties

47. Follow up for DMARD dose adjustment
Disease activity assessment is clinically difficult -May need US assessment -May need review of sequential x-ray images Patient issues regarding DMARD use often need a lot of explanation and support Dose adjustment may need to account for blood test abnormalities outside guidance (i.e persistent mild elevation of ALT) Incorrect adjustment can lead to patient morbidity which needs intensive input to rectify

48. Frequent Follow Up
Stable patients seen by doctor every 6-8 months with one nurse visit between these Active problems need to be seen more frequently Some patients are more needy Nurses have been asked to limit frequency of follow ups

49. Subcutaneous Methotrexate
Alternative to oral which can decrease nausea and allow higher bioavailability -Lower rate of failing Methotrexate and subsequent need for anti-TNF (£9000/y) Patients administer themselves or attend hospital weekly Currently organised by HUHFT (via Homecare service) but discussion underway to transfer prescribing to primary care

50. Subcutaneous Methotrexate – current issues
HUHFT – 59 patients HAH – 109 patients – June 2014 Autoinjector pen HAH – 1.Poor service/patient satisfaction 2.Cost 3.Efficiency/capacity

51. Metoject

52. Subcutaneous Methotrexate
Could GPs prescribe?
Same monitoring requirements as oral
Training occurs in hospital
Continual competency assessment (+ helpline)
Prescription of purple sharps bins
?collection of bins
?cost
79% of UK prescribe in primary care via SCG

53. Thank you

54. END | NOTES

55. Prescribing Programme Board (PPB) Update on
Quality & Financial Indicators

56. Prescribing Indicators 2015-16 Summary (Jan-Mar2016)- Klear
Aim of indicator
Reduce
Increase
100%
Red
> 13%
>65
<57%
>10%
<65%
>55%
<60%
>128.67
<78.52%
>366
<100%
>2.5%
Amber -
78.52% %
Green
< 13%
<65
>57%
<10%
>65%
<55%
>60%
<57.03
>88.74%
<284
<2.5%
KLEAR
Practice Name
Cephalosporins, Co-amoxyclav & Quinolones (items) prescribing as a % of al antibacterials items
Antibiotic Items Per 1000 STARPU
Oral overactive bladder (OAB) drugs (formulary items) prescribing as a % of all OAB drugs
High Risk NSAIDs (items) prescribing as a % of all oral NSAIDs
Oral Nutritional Supplements (ONS formulary items) prescribing as a % of all ONS products
2nd Line insulins (items) prescribing as a % of all Long acting insulin
Metformin (items) prescribing as a % of all antidiabetes oral medication
Hypnotics and Anxiolytics (volume of prescribing) ADQ per 1000 STAR PU
Ibuprofen and Naproxen (Items) as a percentage of all Oral NSAIDs
NSAIDs (volume prescribing) ADQ per 1000 STAR PU
Lithium brand (items) prescribing as a % of all Lithium Items
Percentage (%) of asthma patients issued >12 Salbutamol inhalers per year
Blood glucose test strips for patients not on insulin or sulphonylureas
Abney House MC (9)
7.28%
61.34
52.17%
0.00%
42.86%
50.89%
40.73
96.20%
196.75
3.13%
Healy Medical Centre (5)
9.63%
70.16
43.64%
5.73%
47.83%
47.06%
59.58%
107.81
89.68%
363.88
68.18%
6.28%
1.45%
Kingsmead Healthcare (7)
4.59%
96.40
52.05%
4.05%
68.83%
47.11%
57.43%
48.09
90.89%
293.90
4.35%
0.70%
Latimer Health Centre (9)
3.78%
57.13
82.69%
4.24%
85.48%
38.26%
59.55%
78.55
92.73%
159.61
19.75%
3.60%
Richmond Road MC (11)
10.76%
62.75
64.29%
3.38%
69.23%
67.21%
62.92%
50.36
91.22%
265.72
1.60%
4.44%
The Dalston Practice (9)
12.92%
53.79
60.20%
3.64%
75.61%
57.78%
58.79%
74.64
93.18%
279.58
100.00%
6.95%
2.35%
The Lea Surgery (6)
10.49%
67.86
44.04%
7.98%
57.58%
62.78%
58.27%
52.30
87.18%
272.67
94.44%
1.36%
2.80%
The Riverside Practice (9)
4.91%
90.26
61.54%
3.21%
48.31%
57.59%
67.87
94.04%
254.11
3.70%
4.65%
Brooke Road (6)
10.88%
36.34
55.00%
7.77%
55.17%
60.76%
113.51
89.64%
488.56
2.94%
11.25%
Tollgate Lodge Practice (6)
9.50%
72.26
47.37%
7.44%
55.47%
42.05%
63.67%
144.74
90.63%
267.37
3.48%
11.90%
City and Hackney Practice average
8.86%
66.52
57.24%
8.29%
66.11%
54.11%
60.60%
112.96
87.22%
322.59
66.52%
5.04%
4.63%
Klear Key Points
All Achieved High Risk NSAIDs & all but 1 achieved Vol of NSAIDs
To improve: Lithium Rxing, Vol of Antibiotics, Metformin

57. Prescribing Indicators 2015-16 Summary (Jan-Mar2016)- N. Hackney
Aim of indicator
Reduce
Increase
100%
Red
> 13%
>65
<57%
>10%
<65%
>55%
<60%
>128.67
<78.52%
>366
<100%
>2.5%
Amber -
78.52% %
Green
< 13%
<65
>57%
<10%
>65%
<55%
>60%
<57.03
>88.74%
<284
<2.5%
N.Hackney
Practice Name
Cephalosporins, Co-amoxiclav & Quinolones (items) prescribing as a % of all antibacterials items
Antibiotic Items Per 1000 STARPU
Oral overactive bladder (OAB) drugs (formulary items) prescribing as a % of all OAB drugs
High Risk NSAIDs (items) prescribing as a % of all oral NSAIDs
Oral Nutritional Supplements (ONS formulary items) prescribing as a % of all ONS products
2nd Line insulins (items) prescribing as a % of all Long acting insulin
Metformin (items) prescribing as a % of all antidiabetes oral medication
Hypnotics and Anxiolytics (volume of prescribing) ADQ per 1000 STAR PU
Ibuprofen and Naproxen (Items) as a percentage of all Oral NSAIDs
NSAIDs (volume prescribing) ADQ per 1000 STAR PU
Lithium brand (items) prescribing as a % of all Lithium Items
Percentage (%) of asthma patients issued >12 Salbutamol inhalers per year
Blood glucose test strips for patients not on insulin or sulphonylureas
Barton House Group (8)
12.17%
61.58
69.48%
10.81%
40.23%
52.35%
60.70%
95.75
84.05%
208.76
61.54%
2.31%
4.90%
Somerford Grove (4)
6.57%
66.66
38.79%
16.77%
76.10%
55.69%
58.79%
91.75
77.90%
566.57
82.35%
0.85%
2.28%
Stamford Hill Grp (7)
13.85%
60.53
57.00%
6.20%
47.06%
50.69%
59.74%
60.25
90.91%
198.83
86.67%
3.92%
0.00%
Allerton Rd Surgery (7)
11.05%
73.44
58.90%
7.73%
81.40%
34.72%
58.87%
113.11
86.74%
362.92
100.00%
2.67%
Cedar Practice (10)
14.26%
60.83
63.53%
6.90%
96.77%
45.68%
59.77%
111.12
91.38%
249.39
1.46%
3.70%
Elm Practice (7)
5.78%
72.85
64.00%
8.55%
92.31%
68.75%
68.47%
158.54
88.03%
296.63
4.20%
2.94%
Heron Practice (5)
8.99%
68.45
42.72%
8.93%
66.67%
62.76%
59.70%
82.54
87.50%
358.89
2.73%
2.52%
Nightingale Practice (9)
10.41%
64.51
51.90%
6.07%
91.36%
50.00%
61.49%
64.05
84.81%
300.71
2.06%
2.97%
Springfield HC (5)
8.63%
74.22
52.00%
7.39%
48.28%
48.60%
58.81%
67.50
88.35%
342.79
85.71%
2.29%
1.38%
Statham Grove (7)
8.96%
68.06
33.08%
6.16%
37.70%
64.21%
67.25%
68.83
86.64%
275.13
0.61%
5.26%
Barretts Grove (10)
7.38%
49.50
2.50%
94.29%
41.56%
63.78%
100.48
94.17%
267.01
2.88%
7.04%
Cranwich Road (5)
18.95%
51.38
62.77%
15.93%
55.88%
83.61%
53.75%
246.46
75.93%
301.23
2.47%
6.67%
City and Hackney Practice average
8.86%
66.52
57.24%
8.29%
66.11%
54.11%
60.60%
112.96
87.22%
322.59
66.52%
2.37%
3.50%
North Hackney Key Points
Areas for improvement incl:- Antibiotics (Vol & Broad Spectrum), Vol of NSAIDs, Lithium, Metformin

58. Rainbow & Sunshne Practice Name
Prescribing Indicators Summary (Jan-Mar2016)- Rainbow & Sunshine
Aim of indicator
Reduce
Increase
100%
Red
> 13%
>65
<57%
>10%
<65%
>55%
<60%
>128.67
<78.52%
>366
<100%
>2.5%
Amber -
78.52% %
Green
< 13%
<65
>57%
<10%
>65%
<55%
>60%
<57.03
>88.74%
<284
<2.5%
Rainbow & Sunshne Practice Name
Cephalosporins, Co-amoxiclav & Quinolones (items) prescribing as a % of all antibacterials items
Antibiotic Items Per 1000 STARPU
Oral overactive bladder (OAB) drugs (formulary items) prescribing as a % of all OAB drugs
High Risk NSAIDs (items) prescribing as a % of all oral NSAIDs
Oral Nutritional Supplements (ONS formulary items) prescribing as a % of all ONS products
2nd Line insulins (items) prescribing as a % of all Long acting insulin
Metformin (items) prescribing as a % of all antidiabetes oral medication
Hypnotics and Anxiolytics (volume of prescribing) ADQ per 1000 STAR PU
Ibuprofen and Naproxen (Items) as a percentage of all Oral NSAIDs
NSAIDs (volume prescribing) ADQ per 1000 STAR PU
Lithium brand (items) prescribing as a % of all Lithium Items
Percentage (%) of asthma patients issued >12 Salbutamol inhalers per year
Blood glucose test strips for patients not on insulin or sulphonylureas
Athena MC (5)
8.06%
68.87
44.30%
20.66%
94.34%
35.63%
62.65%
81.07
75.12%
418.64
0.00%
3.10%
5.04%
Beechwood MC (9)
9.22%
65.87
75.00%
7.26%
47.25%
50.00%
59.74%
133.71
89.39%
248.88
100.00%
2.46%
2.53%
Fountayne Road HC (5)
5.57%
66.34
53.23%
11.55%
81.40%
70.37%
55.04%
257.93
86.93%
551.76
0.41%
5.00%
Rosewood Practice (5)
6.25%
81.78
45.00%
8.38%
49.15%
59.26%
54.09%
154.07
88.02%
236.36
1.10%
Sandringham Practice (3)
73.40
56.41%
22.48%
30.28%
52.17%
51.42%
156.19
72.87%
321.11
54.55%
3.01%
9.24%
Southgate Rd MC (5)
7.04%
69.86
37.32%
9.69%
95.74%
50.52%
55.78%
120.26
88.11%
516.69
11.90%
The Clapton Surgery (6)
5.51%
90.44
55.56%
2.45%
76.92%
63.81%
53.09%
78.00
95.99%
314.29
90.48%
1.75%
1.64%
City and Hackney Practice average
8.86%
66.52
57.24%
8.29%
66.11%
54.11%
60.60%
112.96
87.22%
322.59
66.52%
3.39%
3.35%
Rainbow & Sunshine - Key points
Broad Spec antibiotics - all practices achieved
Areas for Improvement: Vol of antibiotics, OAB drugs, Metformin, Hypnotics, NSAIDs, Lithium

59. Prescribing Indicators 2015-16 Summary (Jan-Mar2016)- South West
Aim of indicator
Reduce
Increase
100%
Red
> 13%
>65
<57%
>10%
<65%
>55%
<60%
>128.67
<78.52%
>366
<100%
>2.5%
Amber -
78.52% %
Green
< 13%
<65
>57%
<10%
>65%
<55%
>60%
<57.03
>88.74%
<284
<2.5%
South West
Practice Name
Cephalosporins, Co-amoxiclav & Quinolones (items) prescribing as a % of all antibacterials items
Antibiotic Items Per 1000 STARPU
Oral overactive bladder (OAB) drugs (formulary items) prescribing as a % of all OAB drugs
High Risk NSAIDs (items) prescribing as a % of all oral NSAIDs
Oral Nutritional Supplements (ONS formulary items) prescribing as a % of all ONS products
2nd Line insulins (items) prescribing as a % of all Long acting insulin
Metformin (items) prescribing as a % of all antidiabetes oral medication
Hypnotics and Anxiolytics (volume of prescribing) ADQ per 1000 STAR PU
Ibuprofen and Naproxen (Items) as a percentage of all Oral NSAIDs
NSAIDs (volume prescribing) ADQ per 1000 STAR PU
Lithium brand (items) prescribing as a % of all Lithium Items
Percentage (%) of asthma patients issued >12 Salbutamol inhalers per year
Blood glucose test strips for patients not on insulin or sulphonylureas
De Beauvoir Surgery (6)
6.07%
53.22
54.00%
13.28%
56.72%
53.13%
59.72%
84.66
82.49%
327.49
100.00%
1.20%
1.22%
Queensbridge Group (8)
8.55%
60.32
66.04%
6.77%
63.89%
49.72%
67.38%
88.08
82.71%
189.12
84.21%
4.04%
0.00%
Shoreditch Pk Surgery (8)
7.78%
45.74
47.46%
2.85%
77.78%
68.29%
57.75%
53.26
91.14%
412.38
62.50%
1.03%
1.43%
Hoxton Surgery (11)
12.92%
42.95
63.64%
3.29%
63.33%
65.19%
106.66
92.76%
164.98
1.82%
1.23%
Lawson Practice (5)
9.22%
68.98
51.97%
10.14%
47.66%
49.77%
62.31%
270.69
82.73%
388.40
2.67%
2.46%
Neaman Practice (6)
11.70%
53.20
48.18%
16.02%
55.26%
89.66%
61.56%
122.25
77.73%
241.41
86.89%
1.74%
5.00%
City and Hackney Practice average
8.86%
66.52
57.24%
8.29%
66.11%
54.11%
60.60%
112.96
87.22%
322.59
66.52%
2.79%
2.68%
SouthWest - Key points
All practices achieved Broad Spec antibiotics & all but 1 on Vol of AntibX
Areas for Improvement: ONS

60. Prescribing Indicators 2015-16 Summary(Jan-Mar2016)- Well
Aim of indicator
Reduce
Increase
100%
Red
> 13%
>65
<57%
>10%
<65%
>55%
<60%
>128.67
<78.52%
>366
<100%
>2.5%
Amber -
78.52% %
Green
< 13%
<65
>57%
<10%
>65%
<55%
>60%
<57.03
>88.74%
<284
<2.5%
Practice Name
Cephalosporins, Co-amoxiclav & Quinolones (items) prescribing as a % of all antibacterials items
Antibiotic Items Per 1000 STARPU
Oral overactive bladder (OAB) drugs (formulary items) prescribing as a % of all OAB drugs
High Risk NSAIDs (items) prescribing as a % of all oral NSAIDs
Oral Nutritional Supplements (ONS formulary items) prescribing as a % of all ONS products
2nd Line insulins (items) prescribing as a % of all Long acting insulin
Metformin (items) prescribing as a % of all antidiabetes oral medication
Hypnotics and Anxiolytics (volume of prescribing) ADQ per 1000 STAR PU
Ibuprofen and Naproxen (Items) as a percentage of all Oral NSAIDs
NSAIDs (volume prescribing) ADQ per 1000 STAR PU
Lithium brand (items) prescribing as a % of all Lithium Items
Percentage (%) of asthma patients issued >12 Salbutamol inhalers per year
Blood glucose test strips for patients not on insulin or sulphonylureas
Elsdale St Surgery (11)
6.32%
51.85
58.06%
7.65%
30.77%
38.46%
73.89%
25.98
84.18%
280.99
100.00%
1.38%
2.27%
London Fields MC (10)
7.53%
56.77
58.97%
11.78%
77.84%
46.39%
63.08%
217.40
84.20%
251.00
1.59%
4.52%
Lower Clapton Grp (9)
5.85%
70.15
70.29%
3.92%
95.28%
55.16%
67.68%
57.20
90.49%
273.96
3.35%
2.46%
Greenhouse Walk-in (8)
4.00%
110.64
85.71%
9.76%
93.65%
47.06%
70.73%
228.91
90.24%
479.10
0.00%
10.00%
5.88%
Sorsby HC (8)
9.24%
78.21
60.34%
2.64%
95.00%
52.82%
60.54%
118.35
95.38%
469.30
22.22%
5.22%
3.45%
Wick HC (3)
7.91%
85.81
80.00%
16.57%
47.78%
60.29%
59.63%
258.84
79.33%
698.51
7.66%
2.01%
Trowbridge Practice (9)
8.16%
62.43
72.88%
44.44%
53.03%
59.34%
52.11
92.12%
261.89
3.59%
1.49%
Well St Surgery (7)
10.92%
63.41
55.92%
15.61%
50.60%
64.67%
152.59
76.88%
254.01
1.19%
1.65%
City and Hackney Practice average
8.86%
66.52
57.24%
8.29%
66.11%
54.11%
60.60%
112.96
87.22%
322.59
66.52%
3.34%
2.84%
Well - Key points
All practices achieved Broad Spec antibiotics & all but 1 on OAB drugs, Diabetes
Areas for Improvement: Vol of AntibX, NSAIDs, Lithium

61. City & Hackney CCG QIPP Dashboard 2016/17 (showing baseline position)
2016/2017 QiPP Indicators
Indicator name
Indicator Aim
Mean
Worst Quartile
Median
Best Quartile
RED
AMBER
GREEN
Low and moderate dose inhaled corticosteroids (ICS items) prescribing as a % of all ICS/LABA inhalers
Increase
78.96%
74.87%
79.59%
81.34%
<79%
79%-82%
>82%
Least costly low/moderate dose ICS/LABA inhaler as a % of all low/moderate dose ICS/LABA inhalers
6.57%
1.80%
4.79%
6.36%
<6.6%
6.6-10%
>10%
Hypnotics and Anxiolytics (including z drugs) (volume of prescribing) ADQ per 1000 STAR PU
Reduce
0.59
0.61
0.42
0.28
>0.52
0.38 to 0.52
<0.38
Morphine (Items) precribing as a % of all strong opioids
34.81%
24.71%
32.08%
44.81%
<25%
25%-44%
>44%
Tramadol (volume of prescribing) Defined Daily Dose per 1000 Patients
86.30
110.31
79.51
62.98
>86
62-86
<62
2nd Line insulins (items) prescribing as a % of all Long acting insulin
69.44%
75.28%
68.45%
61.18%
>60%
≤60%
Cephalosporins, Co-amoxiclav & Quinolones (items) prescribing as a % of al antibacterials items
13.87%
14.26%
12.53%
10.70%
>11%
≤11%
Metformin (items) prescribing as a % of all antidiabetes oral medication
60.61%
57.21%
61.22%
63.43%
<61%
≥61%
Pregabalin (COST) per ASTRO PU
£94.57
£113.69
£90.94
£71.94
>£94
£71-£94
<£71
Emollients (COST) per 1000 patients
£250.46
£286.75
£250.27
£219.62
>£124
£89 to £124
<£89
Q3 2015/16 (Oct-Dec2015) data- Baseline for 2016/17
Areas selected to reflect areas where improvement in cost-efficiency / Quality of prescribing required
Thresholds/ Targets are Locally agreed (not Nationally set targets)

62. Quality Premium – reducing AMR
Quality Premium National indicators - prescribing
Ten per cent (10%) of the value of the Quality Premium to CCGs for 2016/17 will be awarded for
improving antibiotic prescribing in primary & secondary care. These will be measured as:-
A. reduction in the number of antibiotics prescribed in primary care by 4% reduction from the Financial Year baseline data value, or to below the England mean CCG value of for each CCG, whichever represents the smallest reduction. The target for C&H is In the 12months to Mar2016, C&H achievement on this was items/STAR-PU
B. No of co-amoxiclav, cephalosporins and quinolones as a percentage of the total number of selected antibiotics prescribed in primary care to be reduced by 20% from each CCG’s 2014/15 value, or to below ≤10%, whichever represents the smallest reduction for the CCG in question. The target for C&H is ≤12%. In the 12months to Dec2015, C&H achievement was 13.1%
Co-amoxiclav, cephalosporins and quinolones use has been historically higher in C&H so as per 2015/16, this indicator was included in 2016/17 CCE contract. Latest epact data (Jan-Mar2016) shows CCG at 8.86%, so the CCG is on track to overachieve on this QP indicator.

63. Prescribing Programme Board (PPB) 2016/17
Quality Premium Local indicators – prescribing
C. “Improve the quality of care of those with asthma and receiving salbutamol inhalers. To reduce the % of salbutamol inhalers issued (12 or more in one year) from a baseline of 3.32% in Q3 (15/16) to 2.5% by Q4 16/17”
D. “To increase the quality of care of those on insulin and to reduce the costs of long acting analogue insulin. We understand that there is variation in City and Hackney compared with RightCare comparator CCGs. To work collaboratively between secondary care and primary care to improve the quality and reduce variation. Reduce the costs of long acting analogue insulins by 10% by Q4 2016/17. We will expect to see a 10% reduction in costs - evidenced in Q4 2016/17 data - from a baseline Quarter cost of LAIA's of £155K [baseline Q4 2015/16 data calculated using Apr15-Feb16 data] to £140K for Q4 2016/17”

64. Cost per 1,000 Cost based AstroPUs
City & Hackney compared to other London CCGs for Items & Cost Growth Apr2015-Mar2016 data vs Apr2014-Mar2015 data
Items
Spend
Apr14-Mar15
Apr15-Mar16
CCG
% growth
Total Cost
Cost per 1,000 patients
Cost per 1,000 Cost based AstroPUs
Average cost per item
Actual growth
BARKING & DAGENHAM
4.04%
£24,271,050
£116,266
£43,168
£7.38
£25,780,869
£120,736
£44,904
£7.54
£1,509,819
6.22%
BARNET
1.51%
£48,002,706
£121,519
£38,560
£9.10
£48,728,939
£121,636
£38,401
£726,233
BROMLEY
-0.99%
£42,587,512
£126,559
£35,675
£9.91
£43,709,564
£128,901
£36,285
£10.27
£1,122,052
2.63%
CAMDEN
1.28%
£22,811,915
£87,317
£32,638
£9.36
£23,398,290
£89,322
£33,144
£9.47
£586,375
2.57%
CITY AND HACKNEY
1.86%
£27,269,577
£93,830
£36,834
£8.79
£27,635,520
£92,841
£36,264
£8.75
£365,942
1.34%
CROYDON
0.77%
£39,959,105
£101,582
£32,659
£7.28
£40,909,072
£102,498
£32,891
£7.40
£949,967
2.38%
EALING
-1.38%
£40,103,109
£96,572
£33,714
£7.00
£40,092,619
£94,370
£32,808
£7.09
-£10,490
-0.03%
ENFIELD
1.48%
£36,995,588
£116,171
£37,486
£7.18
£37,734,767
£116,871
£37,613
£7.21
£739,178
2.00%
HARINGEY
1.83%
£27,876,077
£94,468
£33,398
£7.19
£28,539,707
£94,597
£33,295
£7.23
£663,630
HARROW
3.23%
£29,239,767
£115,353
£35,883
£7.10
£31,272,222
£120,893
£37,637
£7.36
£2,032,454
6.95%
HAVERING
0.91%
£35,362,099
£136,036
£37,663
£7.79
£37,286,069
£140,376
£39,056
£8.13
£1,923,970
5.44%
ISLINGTON
1.63%
£23,669,723
£102,106
£37,461
£9.39
£24,212,778
£103,134
£37,573
£9.45
£543,055
2.29%
KINGSTON
1.37%
£18,742,840
£94,662
£30,648
£7.59
£19,146,420
£95,087
£30,761
£7.65
£403,580
2.15%
LAMBETH
1.67%
£33,908,326
£90,518
£34,075
£7.46
£34,696,495
£90,705
£34,023
£7.51
£788,168
2.32%
MERTON
1.10%
£22,491,447
£103,584
£34,396
£7.84
£23,044,890
£104,785
£34,701
£7.94
£553,443
2.46%
NEWHAM
1.45%
£37,427,418
£101,323
£41,890
£6.23
£39,445,825
£105,621
£43,195
£6.47
£2,018,407
5.39%
REDBRIDGE
2.22%
£35,434,810
£120,039
£40,311
£8.62
£36,795,027
£122,502
£41,101
£1,360,217
3.84%
RICHMOND
£19,755,501
£95,123
£29,515
£7.20
£20,306,233
£96,889
£29,903
£7.34
£550,732
2.79%
SOUTHWARK
2.59%
£30,670,962
£100,131
£37,560
£7.96
£31,762,132
£101,948
£38,028
£8.03
£1,091,170
3.56%
SUTTON
2.11%
£22,530,380
£119,755
£36,257
£23,079,173
£121,427
£36,759
£7.41
£548,794
2.44%
TOWER HAMLETS
6.18%
£28,354,732
£97,914
£42,233
£6.27
£30,467,182
£103,169
£44,327
£6.35
£2,112,450
7.45%
WALTHAM FOREST
-1.19%
£32,179,312
£108,028
£38,596
£8.67
£32,820,263
£109,861
£38,911
£8.95
£640,951
1.99%
WANDSWORTH
1.15%
£34,962,263
£93,718
£35,057
£7.50
£35,964,524
£94,064
£35,100
£7.63
£1,002,262
2.87%
Selected Average
1.50%
£31,069,836
£105,764
£36,334
£7.74
£32,036,025
£107,488
£36,812
£7.86
£966,189
3.11%
England/Wales Lowest
-2.97%
£9,159,391
£29,480
£6.20
£9,714,995
£6.18
England/Wales Highest
15.93%
£137,662,958
£203,313
£58,057
£142,542,933
£211,607
£60,492
£6,635,437
17.55%
England Total
£8,124,725,544
£143,072
£41,094
£8,436,277,035
£147,205
£42,119
£7.80
£311,551,491
3.83%
Overall
1.76%
£8,620,467,397
£7.58
£8,941,573,519
£153,025
£7.72
£321,106,122
3.72%

65. Prescribing Budgets 2016/17
Budgets for 2016/17 have been issued for each practice
Total Budget to practices of £27.8M for 2016/17 vs £27.7M 2015/16
For 20 practices, 2016/17 budgets is less than 2015/16 outturn
For 2016/17, the PPB has been committed to deliver the following savings
Savings Plan
Prescribing Savings
£600K
Warfarin monitoring
£525K
Total QiPP Savings
£1.125M

66. Opportunities for practices to remain within Spend
Wide variation – in practices Spend
>2 fold difference – in highest & lowest cost per deprivation adjusted ASTRO-PU £50 vs £22
Review of drugs agreed as hospital only
Review of drugs provided through alternative routes
Public Health commissioned drugs –: smoking, substance misuse
Dressings Scheme
Optimising recommendations made by:-
Practice support pharmacists – early in financial year
Scriptswitch
Joint Formulary
Review of repeat prescribing systems

67. Practice level Prescribing Budget Management – 2015/16
Over / Under Spend (Unadjusted )
Over / Under Spend Adjusted for List Size & Depot Antipsychotics
No of practices achieving budget balance or underspending 25
No of practices overspent 18
No of practices overspent by ≥ 5% 14 13
No of practices overspent by ≥ 10% 11 9
No of practices overspent by ≥ 15% 6 5
No of practices overspent by ≥ 20% 2

68. Prescribing Budget Management for 2015-16
Prescriber Name
Budget Allocated for
Outturn of the Prescribing Budget
Total Overspend or Under spend at 31 March 2016
% Overspend (-)/ Underspend (+)
ASTRO-PU Increase (+) Decrease (-)
Budget impact of change in ASTRO PU
Change in spend on High Cost Drugs at 31 March 2016
Spend on Depot antipsychotics at 31 March 2016
'Accountable' OverSpend - APU & Depot
Adjusted Overspend / £
Adjusted Overspend / %
Actual in-year Savings
Missed Opportunity for Savings
2016/17 Spend per adj-ASTRO-PU
Lawson Practice
£ ,299,151
£ ,546,756
-£ ,605
-19.06%
2.21%
£28,690
£6,949
£4,354
£33,044
-£214,561
-16.52%
£11,954
£52,390 £
Athena MC
£ ,720
£ ,302
-£ ,582
-31.02%
-0.90%
-£4,383
£14,429
£117
-£4,266
-£155,848
-31.89%
£10,105
£29,821 £
Sorsby Health Centre
£ ,668
£ ,397
-£ ,729
-19.41%
-0.03%
-£150
£17,405
£64
-£86
-£98,815
-19.43%
£7,930
£11,238 £
Wick Health Centre
£ ,173
£ ,899
-£ ,726
-14.72%
2.50%
£16,280
£31,363
£568
£16,848
-£78,878
-12.13%
£17,983
£15,166 £
Somerford Grove Practice
£ ,124,663
£ ,213,068
-£ ,405
-7.86%
2.17%
£24,394
£33,347
£1,011
£25,404
-£63,001
-5.60%
£14,350
£39,053 £
Fountayne Road HC
£ ,485
£ ,662
-£ ,177
-13.17%
1.43%
£7,378
£23,911
£119
£7,497
-£60,680
-11.73%
£16,158
£26,987 £
Cranwich Road
£ ,864
£ ,490
-£ ,626
-24.47%
10.19%
£44,830
£25,133
£344
£45,174
-£62,452
-14.20%
£8,703
£6,617 £
Beechwood MC
£ ,245
£ ,551
-£ ,306
-17.35%
1.87%
£7,160
£9,378
£403
£7,563
-£58,743
-15.37%
£14,336
£8,933 £
Springfield HC
£ ,497
£ ,991
-£ ,494
-12.58%
£11,808
£8,897
£40
£11,849
-£56,645
-10.40%
£9,895
£16,099 £
Neaman Practice
£ ,569
£ ,401
-£ ,832
-10.30%
3.55%
£26,855
£43,668
£73
£26,929
-£50,903
-6.74%
£6,593
£13,258 £
Rosewood Practice
£ ,574
£ ,631
-£ ,057
-19.59%
-0.59%
-£1,229
£7,911 £0
-£42,286
-20.18%
£2,491
£5,261 £
Additional Spends cross-charged for
Spend
From
Lawson
£19,489
E&N Herts over to

69. Prescribing Budget Management for 2015-16 (contd)
Prescriber Name
Budget Allocated for
Outturn of the Prescribing Budget
Total Overspend or Under spend at 31 March 2016
% Overspend (-)/ Underspend (+)
ASTRO-PU Increase (+) Decrease (-)
Budget impact of change in ASTRO PU
Change in spend on High Cost Drugs at 31 March 2016
Spend on Depot antipsychotics at 31 March 2016
'Accountable' OverSpend
Adjusted Overspend / £
Adjusted Overspend / %
Actual in-year Savings
Missed Opportunity for Savings
2016/17 Spend per adj-ASTRO-PU
Sandringham Practice
£ ,592
£ ,551
-£ ,959
-1.79%
-4.46%
-£19,791
£13,789
£729
-£19,062
-£27,021
-6.09%
£6,037
£33,904 £
Kingsmead
£ ,447
£ ,209
-£ ,762
-4.39%
0.71%
£4,000
£20,908
£4,729
-£20,033
-3.56%
£5,834
£25,372 £
Heron Practice
£ ,099
£ ,002,796
-£ ,697
-5.32%
3.36%
£31,950
£25,158 £0
-£18,747
-1.97%
£28,446
£18,233 £
Well St Surgery
£ ,258,621
£ ,341,652
-£ ,031
-6.60%
4.29%
£53,960
£26,724
£10,554
£64,514
-£18,517
-1.47%
£38,348
£73,077 £
Southgate Rd MC
£ ,723
£ ,963
-£ ,240
-10.16%
9.15%
£65,947
£22,121
£1,936
£67,883
-£5,357
-0.74%
£19,631
£14,990 £
Nightingale Practice
£ ,063,451
£ ,114,630
-£ ,179
-4.81%
4.51%
£47,952
£67,212
£5,364
£53,316
£2,137
0.20%
£11,695
£29,389 £
Statham Grove Surgery
£ ,581
£ ,610
-£ ,029
-2.42%
2.61%
£19,417
£31,024
£1,388
0.19%
£7,753
£16,349 £

70. Prescribing Budget Management for 2015-16 (contd)
Prescriber Name
Budget Allocated for
Outturn of the Prescribing Budget
Total Overspend or Under spend at 31 March 2016
% Overspend (-)/ Underspend (+)
ASTRO-PU Increase (+) Decrease (-)
Budget impact of change in ASTRO PU
Change in spend on High Cost Drugs at 31 March 2016
Spend on Depot antipsychotics at 31 March 2016
Accountable' OverSpend
Adjusted Overspend / £
Adjusted Overspend / %
Actual in-year Savings
Missed Opportunity for Savings
2016/17 Spend per adj-ASTRO-PU
Lea Surgery
£ ,391
£ ,565 £
0.08%
3.69%
£36,106
£44,410
£23
£36,130
£36,956
3.77%
£25,411
£28,440 £
Allerton Rd Surgery
£ ,825
£ ,027
£ ,798
1.29%
-2.95%
-£13,219
£33,488
£299
-£12,921
-£7,123
-1.59%
£13,342
£7,603 £
Lower Clapton Group Practice
£ ,177,754
£ ,171,499
£ ,255
0.53%
6.33%
£74,580
£28,080
£5,379
£79,960
£86,215
7.32%
£10,196
£30,200 £
Healy Medical Centre
£ ,555
£ ,121
£ ,434
1.37%
-0.03%
-£185
£25,538
£330
£146
£7,580
1.39%
£3,784
£5,293 £
The Greenhouse
£ ,200
£ ,699
£ ,501
11.42%
-18.50%
-£21,870
£2,496 £0
-£8,369
-7.08%
£200 £8 £
Elm Practice
£ ,004
£ ,439
£ ,565
7.73%
2.70%
£7,183
£4,324
£27,748
10.43%
£2,230
£8,621 £
Riverside Practice
£ ,039
£ ,910
£ ,129
6.50%
3.52%
£13,071
£21,253
£1,789
£14,860
£38,989
10.51%
£3,106
£7,001 £
Cedar Practice
£ ,014
£ ,707
£ ,307
4.77%
1.34%
£8,498
£19,723
£131
£8,629
£38,936
6.13%
£19,968
£14,966 £
Abney House MC
£ ,148
£ ,381
£ ,767
11.02%
2.71%
£7,571
£13,663
£2,287
£9,858
£40,625
14.55%
£2,914
£4,991 £
Queensbridge Group Practice
£ ,703
£ ,385
£ ,318
3.87%
3.97%
£35,205
£26,818
£212
£35,417
£69,735
7.87%
£8,765
£11,340 £
London Fields MC
£ ,661
£ ,996
£ ,665
4.34%
3.89%
£33,777
£19,426
£2,393
£36,171
£73,836
8.50%
£10,903
£23,657 £
Elsdale St Surgery
£ ,339
£ ,265
£ ,074
7.11%
2.38%
£13,073
£26,567
£935
£14,008
£53,082
9.66%
£5,370
£11,767 £

71. Prescribing Budget Management for 2015-16 (contd)
Prescriber Name
Budget Allocated for
Outturn of the Prescribing Budget
Total Overspend or Under spend at 31 March 2016
% Overspend (-)/ Underspend (+)
ASTRO-PU Increase (+) Decrease (-)
Budget impact of change in ASTRO PU
Change in spend on High Cost Drugs at 31 March 2016
Spend on Depot antipsychotics at 31 March 2016
Accountable' OverSpend
Adjusted Overspend / £
Adjusted Overspend / %
Actual in-year Savings
Missed Opportunity for Savings
2016/17 Spend per adj-ASTRO-PU
Richmond Road MC
£ ,529
£ ,343
£ ,186
12.50%
3.40%
£12,037
£4,880 £0
£56,223
15.90%
£2,659
£4,837 £
Barton House Group Practice
£ ,172,512
£ ,106,366
£ ,146
5.64%
3.29%
£38,523
£11,011
£3,097
£41,621
£107,767
9.19%
£8,581
£24,828 £
Brooke Road Surgery
£ ,091
£ ,222
£ ,869
29.77%
3.42%
£8,495
£6,186
£82,364
33.20%
£2,892 £
Trowbridge Practice
£ ,363
£ ,089
£ ,274
18.53%
8.22%
£34,715
£21,697
£1,161
£35,876
£114,150
27.03%
£1,334
£2,785 £
Stamford Hill Grp
£ ,101,071
£ ,018,010
£ ,061
7.54%
3.79%
£41,748
£79,098
£96
£41,843
£124,904
11.34%
£24,867
£25,158 £
The Clapton Surgery
£ ,761
£ ,579
£ ,182
16.21%
0.82%
£4,413
£29,741
£18
£4,431
£91,613
17.04%
£11,699
£11,999 £
De Beauvoir Surgery
£ ,844
£ ,784
£ ,060
14.25%
12.11%
£77,338
£18,816
£168,398
26.36%
£5,843
£11,198 £
The Dalston Practice
£ ,979
£ ,250
£ ,729
15.40%
-3.22%
-£20,205
£23,371
£298
-£19,907
£76,822
12.23%
£2,881
£3,807 £
Shoreditch Pk Surgery
£ ,905
£ ,553
£ ,352
15.36%
1.83%
£12,550
£10,898
£161
£12,711
£118,063
17.21%
£12,641
£22,126 £
Barretts Grove*
£ ,485
£ ,310
£ ,175
36.11%
1.96%
£6,370
£17,199
£2,019
£8,389
£30,155
9.29%
£5,075
£6,246 £
Tollgate Lodge*
£ ,683
£ ,408
£ ,275
22.84%
2.16%
£14,385
£25,658
£1,089
£15,474
£124,726
18.71%
£6,326
£25,963 £
The Hoxton Surgery
£ ,309.00
£ ,298.00
£ 155,011.00
29.68%
0.34%
£1,802
£321
£156,813
30.02%
£5,134
£12,894 £
Latimer HC
£ ,750.00
£ ,432.00
£ 231,318.00
39.63%
2.78%
£16,219
£941
£2,534
£18,753
£250,071
42.84%
£5,161
£1,602 £
Additional Spends cross-charged for
Spend
From
£95,409
Knowsley CCG
£43,023
West Essex CCG
Lawson
£19,489
E&N Herts over to

72. Prescribing Programme Board (PPB) 2016/17- Work Plan
Cost efficiency of Prescribing
The PPB continues to support practices in improving the cost and efficiency of prescribing across the CCG
In addition, the PPB will be reviewing opportunities for improving Quality & Cost efficiency – suggested through Right Care and will continue to utilise other available regional & nationwide benchmarking data sources
Activities led by PPB to mitigate risks of overspend on prescribing allocations include:-
(a) Pharmacists’ work within practices.
Data received from the PSPs for work undertaken during April Mar2016 show actual in year savings of £163K with an additional potential saving of £170K savings identified.
(b) Utilising ScriptSwitch to make recommendations on cost effective alternatives
Last year, (April 2015-March 2016), savings of £300K was agreed to by C&H practices against potential savings of £926K identified by ScriptSwitch (£626K missed savings where prescribers do not act on the recommendation made)
Formulary pharmacist (and electronic BNF) as key resources in supporting robust decision making on how to make best use of new/existing drugs
(d) Active support of the more cost effective use of the Dressings Optimisation Scheme through Formulary/ ScriptSwitch/ PSPs

73. Summary of Prescribing Programme Board’s Workplan for 2016/17
Reduce the inappropriate use of antipsychotic, antidepressant, anxiolytic, hypnotic and antiepileptic medicines in people with learning disabilities (LD) & support clearer information on medicines prescribed for LD patients
Improve our sustainability by:-
Improving antimicrobial use – through education for health care professionals as well as local residents
Increase the number of medication reviews carried out by a Practice Support Pharmacist (PSP), prioritising the following high risk patient groups:
Patients who have frequent hospital admissions including those referred for pharmacist follow up by ACERs team
Patients requiring domiciliary medication review
Patients on compliance aids / nursing homes / on polypharmacy
Patients in Patients on high risk drugs which require shared care
Patients on high dose inhaled corticosteroids
Enabling access to simplified patient information on medicines, including for patients with Learning Disabilities
Implementation of Guidelines on Prescribing for Asthma & COPD, agreed through Joint Prescribing Group
Deliver Respiratory Training for GPs and Practice Nurses by PSPs and ACERs Nurse
Supporting the uptake of dressings supply through the dressings optimisation scheme
Support prompt implementation of national warnings and local Formulary agreements
Continue to work to improve & maintain cost efficiency of prescribing -QiPP
Practice level training on repeat prescribing
Continue to engage with practices through annual prescribing visits, and through the CCG medicines newsletter
Continue to ensure that the CCGs expectations of HUHFT, ELFT and NHSE with regards to all commissioning intentions related to prescribing and medicines management are addressed and the outcomes monitored regularly.

74. MaPPs Medicines: a Patient Profile summary and more…

75. What information do patients need about medicines?
Essential:
What it does and what it’s for
Main side effects (common plus those to take action on)
Dos and don’ts
How to take it
Ideal:
Accurate, up-to-date, reliable and practically useful
Accessible (language, format, tone)
Customised or personalised
Available at time of consultation or counselling
Strikes balance between benefits and ADRs
(Dickinson and Raynor, BMJ 2003;327:861)

76. Solution
We need an information system that is:
Highly readable
-Consistent and accessible document
Personalised to that patient
Inclusive of all of a patient’s medicines
Quick, easy and flexible to produce
Available when needed
Reminder Charts from the same data

77. Introducing MaPPs 2 Medicines: a Patient Profile summary
Individualised leaflet (standard and larger print)
-Name(s)
-Main (licensed) and other (unlicensed) uses
-How to take it
-Main side effects
-Side effects that need some action
-Warnings and cautions
Reminder chart
Name, form, use, doses, times, how to take, free-text, extra
instructions

78. Comparison with patient.co.uk
Aspect
Patient.co.uk
MaPPs 2
Readability ‡
SMOG 8-9
Printing
4-5 pages per medicine
2-3 medicines per page
Font size *
Set (9pt, headers 14pt)
12pt or 16pt options
Information
Comprehensive
Essential only
Much duplication of PIL, including prescribing advice
Practical advice
Branding
Personalising
N/A
Patient name and date
City and Hackney logo
Can be saved as .pdf
“Sorry this is a long letter, I didn’t have time to write a short one”
Variously attributed to Mark Twain (wrong), Pascal, Lord Sandwich and many others
MaPPs is the short letter that essentially says the same as a long letter but without wasted paper, words or time, or losing the important bits in amongst the waffle.
‡ SMOG = Simple Measure of Gobbledegook, similar to Fry and Flesch. The aim is a score less than 10
* NHS Guidelines for writing for patients state “Font size should be of at least 12point. Any smaller than this and text becomes difficult to read”

79. All medicines covered by PILs -Branded and generic licensed drugs
Rationale
All medicines covered by PILs
-Branded and generic licensed drugs
Essential information not clearly readable
-Swamped by jargon, medico-legal defence
Non-uniform style, format, print size
Omit unlicensed uses
Patients often don’t read and throw away
Only available at point of discharge/supply
Impersonal
Empowers pts

80. You provide an individualised leaflet the patient won’t forget:
Key patient benefits
You provide an individualised leaflet the patient won’t forget:
Timely at any patient/carer consultation
All medicines available
-Licensed and unlicensed uses
One electronic document (pdf) per MaPP
Essential information
-Clear and readable (language SMOG <9, font)
-Uniform style, format, print size
-Personalised and patient-centred
-Reminder sheet
-Patient empowerment (e.g. monitoring)
Empowers pts

81. Governance
Full indemnity via Mistura Informatics
NHS Professionals:
-Dr. Chris Barclay, GP, medical writer
-Dr. Rick Adams, Pharmacist, medical writer
-Prof. Stephen Bazire, Pharmacist, author
-Lay readers
-Entries triangulated
MaPPs doesn’t legally replace PILs but complements them

82. http://mimapps.org/live/index .php?t=72680
Live demonstration
.php?t=72680