The Specials Trajectory

Richard Jones, Head of Medicines Management Team & Accountable Officer for Controlled Drugs

8th February 2011

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NHS Spend - historicNHS Luton spend on ‘specials’ for 2009/2010 was £1,454,954.

This represents an increase of 62% in cost on 2008/2009 and a 1.3% decrease in number of items for the same time period and a variance of over £750,000 compared to SHA.

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Growth in Luton spend/National and SHA

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Total overcharge

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 No. of

prescriptions Percentage Cost PercentageSpecials with no licensed alternatives 757 22% £256,920 24%Specials with a suitable alternative 2666 78% £802,102 76%

•Using such reference sources and the prescribing data for 2009-10 the following figures were derived:

•Note: 76% of specials cost could have been avoided.

Total cost of pharmacy overcharge: £654,050.51 (62% of total spend on specials)

Ongoing interventions

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Practice Visits ongoing/ including nursing/care homes

NHS Pharmaceutical services Regulations 2005 – Fitness to Practice Guidance Efficiency: These grounds may be used when the inclusion of the chemist on the PCT’s pharmaceutical list could be “prejudicial to the efficiency on the service) . This relates to issues of competence 9bad practice and repeated wasteful resources or actions or burdens of others in the NHS.

Monthly spend on specified & unspecified items

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Variance in spend to SHA

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Background

Growth in Luton spend/National and SHA

Examples of 10 most commonly prescribed

Highest charge of specials

Top 10 breakdown of community pharmacies average spend per item)

Community pharmacy charges over 12 months.

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Specials timelineSpecials QiPP Project (March 2010- Jan 2011)

NEWT guidelines - information to GP practices (April 2010)

Practice pharmacists to identify specials patients (April 2010)

Practice visits (April –May 2010)

Practice pharmacist educating GPs (May 2010)

Practice pharmacist targets high spend Good practice dissemination & ongoing practice visits (June 2010)

Nursing & care home visits (Aug 2010)

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Specials prescribing?

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These are unlicensed medicines which do not have a fixed tariff price an do not provide the same guarantees of effectiveness and safety as associated with licensed products. They are occasionally necessary.

NHS Luton spend on specials was £1 million in excess of expected cost in 2009-10.

April 2010 spend was £114K (before)

Significant reductions in spend and number of items prescribed has been made in recent months.

November 2011 spend was £53K (after)

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Total Actual Cost Specials excluding unspecified cost– – highest March 2010 over £120Khighest March 2010 over £120K

10 most commonly prescribed - No alternative available.

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BNF Name Total Items Total Act Cost Tacrolimus_Liq Spec 5mg/5ml 34 £45,110.23Midazolam_Liq Spec Oromucosal 10mg/ml 100 £37,659.15Tetrabenazine_Liq Spec 25mg/5ml 18 £23,419.41Azathioprine_Liq Spec 50mg/5ml 74 £20,636.72Ergocalciferol_Soln 3,000u/ml 36 £16,759.39

Tacrolimus_Liq Spec 2.5mg/5ml 17 £15,175.59

Glycopyrronium Brom_Tab 1mg 22 £11,925.54Diltiazem HCl_Crm 2% 48 £11,341.41Sod Chlor_Eye Dps 5% 62 £10,072.51Mag Glycerophos_Tab 97.2mg 70 £9,606.87

10 most commonly prescribed – DID NOT need to be prescribed as specials/alternatives available

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BNF Name Total Items Total Act Cost Clobazam_Liq Spec 5mg/5ml 93 £58,790.57Simvastatin_Liq Spec 20mg/5ml 117 £42,849.92Omeprazole_Liq Spec 20mg/5ml 110 £42,308.16Amisulpride_Liq Spec 25mg/5ml 108 £34,515.40Melatonin_Cap 3mg 214 £30,461.31Quetiapine_Liq Spec 12.5mg/5ml 61 £28,554.41Gabapentin_Liq Spec 250mg/5ml 18 £26,037.49Amlodipine_Liq Spec 5mg/5ml 82 £24,772.39Dipyridamole_Liq Spec 100mg/5ml 37 £23,078.21Clobazam_Liq Spec 10mg/5ml 43 £21,753.94

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PHARMACY Average Spend per itemA £1,287.34B £1,016.69C £872.59D £641.56E £638.65F £622.56G £548.69H £497.67I £465.20J £459.61

Top 10 Community pharmacy average spend per item

Average Cost• Average cost of special and unspecified items are

£309.47 and £106.46 respectively:

Vs £8.85 - for all other items prescribed in 2009-10 (excluding specials and unspecified items)

Vs £172.68 -average cost of special in SHA

Vs £118.31 -average cost per special at most cost-effective prices

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Local interventions and timeline

Discussions with LPCDiscussions with GP practicesSourcing different pricesMeetings with community pharmacy

contractorsDiscussions with hospital specialist prescribing

specials

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QiPP Financial savings (Month 8) Actual>PlannedActual>PlannedReduction in Net Ingredient Costs per ASTRO PU

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Planned Savings for

2010/2011

Planned Savings to Date

Actual Savings to Date

£ 342,886 £132,213 £198,985

Luton’s success….thanks to team!!

Telephone 01582 53 2114

QiPP Medicines Management Team & PBC Finance Lead

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AgendaBackground to trajectory & proposed QiPP plan.

Steep increase in growth June 2009 & Pharmacist recruited in April 2010 to tackle spend.

Action plan and Community Pharmacy visits.

Monitoring growth

Savings to dateMedicines Management Team

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