1. Nottingham West CCG Prescribing Team Beth Carney/ Dawn Gajree / David Sharpe September 2014

2. Who we are… Beth Carney and Nayna Zuzarte – Prescribing Advisor Dawn Gajree – Primary Care Pharmacist Kate Morris – Primary Care Pharmacist David Sharpe – Care Homes Pharmacist Total 2.5WTE

3. And the wider team Shared team across the five Nottinghamshire county CCG’s: – Area Prescribing Committee / Interface team Nicky Bird, Amanda Rawlings, James Sutton – Clinical Governance and Care Homes Lead Coral Osborn – Data Analyst Tim Oxley and Chris Day

4. What do we do? “Promote evidence based cost effective prescribing” £12 million prescribing budget £323,000 QIPP

5. A day in the life of a Primary Care Pharmacist Read/ respond to emails – Data analyst EPACT reports, meeting requests, request for comments. GP practice – read/respond to queries from emails and tasks, MI query, red drugs, alternatives for specials. – run report, identify patients, collect data for each individual, summarise, agree changes, make changes. – Medication reviews, formulary implementation, epact analysis Office/ meeting – CCG service reviews, team meetings, write work streams, next years work, MMF

6. Helping us with our prescribing plan Pain – Practices have been asked to review of patients taking high dose opioids for non-cancer pain – Locally what is the maximum recommended dose of morphine for non-cancer pain 60mg every 12 hours 100mg every 12 hours 200mg every 12 hours

7. Helping us with our prescribing plan Pain – Practices are reviewing the prescribing of pregabalin for neuropathic pain – In local guidelines what is 1 st line for neuropathic pain after conventional analgesics? Gabapentin Pregabalin Amitriptyline

8. Respiratory COPD – Ensure patients who have previously exacerbated are issued with rescue packs (NNT =5) – Patients with an FEV1>50% on an inhaled corticosteroid (ICS) should be reviewed to deem if treatment is appropriate. – Formoterol easyhaler should be used as the 1 st line treatment option for long acting therapy in patients with FEV1>50% – Patients receiving oral steroid courses have the number recorded in the last year and those receiving 3 or more courses are considered for bone protection

9. Asthma Responding to the National Review of Asthma Deaths 39% of patients who died during the monitoring period had >12 SABA reliever inhalers issued in the year prior to their deaths. 4% of patients had more than 50 inhalers issued in the year prior to their deaths.

10. Respiratory INHALER TECHNIQUE

11. Repeat prescribing processes Review of practices repeat prescribing processes Printing of “duplication” on re-printed prescriptions to aid identification of a duplicated prescription to prevent the risk of a patient receiving a double quantity of medicines

12. The Care Homes Pharmacist Review all care home patients registered with GP practices within CCG. All patients reviewed twice a year Indication, Dose, Quantity, Suitability Recommendations to GP Resolve issues with community pharmacies

13. Helping us with our prescribing plan Prescribing of Generics / Brands – Promotion of generic prescribing – But some exceptions to the rule….. – Gatalin, sinemet, fenbid, laxido, nystan Prescribing the cost effective formulation – Nitrofurantoin Caps – Azithromycin Caps

14. Generic Drug Tariff CostOriginal BrandCostAlternative BrandsCost Ethinylestradiol 20 micrograms/Desogestrel 150 microgramsn/aMercilon®£7.67Gedarel® 20/150£5.98 Ethinylestradiol 20 micrograms/Gestodene 75 microgramsn/aFemodette®£8.85Millinette® 20/75£6.37 Sunya 20/75®£6.62 Ethinylestradiol 30 micrograms/Desogestrel 150 microgramsn/aMarvelon®£6.45Gedarel® 30/150£4.93 Ethinylestradiol 30 micrograms/Gestodene 75 microgramsn/aFemodene®£6.73Millinette® 30/75£4.85 Katya 30/75®£5.03 Ethinylestradiol 30 micrograms/Levonorgestrel 150 micrograms£2.82Microgynon 30®£2.82Levest®£1.80 Rigevidon®£1.89 Ovranette®£2.20 Ethinylestradiol 30/40/30 micrograms Levonorgestrel 50/75/125microgramsn/aLogynon®£3.82TriRegol®£2.87 Ethinylestradiol 35 mcg / norgestimate 250 mcg Cilest®£7.16Lizzina®£5.37 Desogestrel 75 micrograms£3.51Cerazette®£8.68Cerelle®£3.50 Zelleta®£3.51

15. Where to find local guidelines and formulary http://www.nottsapc.nhs.uk/

16. ANY QUESTIONS?

17. Practices and Pharmacists Dawn Gajree: – Church Street Medical Centre – Hama Medical Centre – Hickings Lane Medical Centre – Linden Medical Centre – Saxon Cross Surgery – Abbey Medical Centre

18. Practices and Pharmacists Kate Morris – The Valley Surgery – Manor Surgery – The Oaks Medical Centre – Bramcote David Sharpe – West End Surgery – Church Walk Surgery