ponencia 08 pharmacist_uk_steele_j
TRANSCRIPT
Influencing Prescribing in Primary Care in the NHS
Janice SteelePrimary Care Pharmacist
Croydon Primary Care Trust
� 150 PCTs in England
� Population of Croydon 340,000� 65 GP surgeries
� 66 community pharmacies� Primary care drugs budget £45million
Local Health Issues
� Inequalities gap in life expectancy
� High black and minority ethnic group population
� 3 biggest killers – Circulatory disease– Cancer– Respiratory disease
History
� Prescribing advice pilot 1998� Team expanded 1999� Dual quality and cost effective prescribing
agenda� IT developments� Relationship building� Infrastructure� National Initiatives NICE , NPSA, QuOF
Key factors for success
� Strategic co-ordination
� Tailored implementation� Clinical engagement at all levels
� Communication� Well trained workforce
Strategic co-ordination
� Area prescribing committee– Clinical representatives from acute hospitals– Chaired by public health consultant– Members of the public– Links to networks and sectors
� Primary Care Prescribing Group– Agree practical implementation of annual
workplan
Tailored implementation
� 9 pharmacists provide tailored support� Annual visits - present data, discuss issues,
agree priorities to work on +/- support� Quarterly data provided to monitor progress� Comprehensive information packs developed
for each therapeutic area� Query answer service on individual patient
medicine management issues
Clinical Engagement
� Prescribing lead� Clinical opinion leaders� Peer pressure/ use of comparative graphs� Incentive scheme� Consistent use of the evidence base� Long term issues not just quick financial wins� Supportive� Look at prescribing processes as well as drugs
Communication
� Newsletters
� Reinforcement at practice meetings� Teaching sessions
� Website� Prescribing support tools
� Patient information material
Example- Statin switch programme
� Horizon scanning� Extensive review of the evidence� Explicit about risks as well as financial gains� Agreement by key committees� Presented to group of opinion leaders-consensus� Prepared support pack� Anticipated common questions/concerns � Patient information leaflet� Looked at clinical outcomes as well as financial
Statins continued
� Intervention form- standard approach� Communication with community pharmacists� Contact number for queries� Replicated pharmaceutical industry approach� Trained workforce� Piloted material� Incentive scheme� Targeted outliers � Messages reinforced regularly- newsletters , visits
Current Issues
� Structural reform of the NHS
� GP commissioning consortia� New initiatives + old ones to maintain
– Waste– Reducing patient admissions– Improving patient compliance– QIPP quality, innovation, PRODUCTIVITY,
prevention