Prescribing - Clinical Commissioning Groups - CCG - Prescribing teams - PowerPoint PPT Presentation

Prescribing - Clinical Commissioning Groups - CCG - Prescribing teams - ePACT data - APC & Joint Formulary - Traffic lights and shared care protocols - Medication review - Unlicensed meds / Specials

Primary Care Prescribing Team.  Part of the prescribing and medicine management team  Prescribing advisors - Alison Hale for Mansfield & Ashfield CCG  Primary Care Pharmacist & Prescribing Support Technician allocated to each practice

What do we do?  Monitor prescribing and budgets  Annual prescribing visit  Help practices work on their prescribing areas  Cost effective, evidence based prescribing  NICE and APC implementation  Clinics & Audits  Training  Medicine queries & MHRA alerts

How is prescribing monitored?  All NHS prescriptions sent for payment to the Prescription Pricing Division (PPD ).  Recorded against prescriber number  Analysis available after approx. 2- 3mths  Forms ePACT data and reports

NSAID prescribing across the CCG

Range of NSAIDs in one practice

Prescribing of diclofenac drilled down to prescriber within one practice Prescriber Total Name BNF Name Items Dr 1 Diclofenac Sod_Tab E/C 50mg 11 Dr 2 Diclofenac Sod_Tab E/C 50mg 1 Dr 3 Diclofenac Sod_Tab E/C 50mg 1 Dr 4 Diclofenac Sod_Tab E/C 50mg 1 Nurse 1 Diclofenac Sod_Tab E/C 50mg 1

Prescribing responsibility “It is the prescriber who signs the prescription who carries legal responsibility, not the person who may suggest it!”

Prescribing guides  Mrs LE has seen Dr Millard a dermatology consultant at QMC about her discoid lupus erythematosus. He would like you to prescribe Chloroquine to treat the condition dose = chloroquine (as base) 150mg daily. - You check the dose in the BNF and the indication and dose are correct – do you prescribe??

Checking a new medicine  Is the indication and the dose reasonable?  Is the dose licensed?  Has it been given a traffic light?  Does any monitoring need to be arranged  As a prescriber do I have enough knowledge to prescribe?

APC & Traffic lights - 1  Area Prescribing Committee APC website http://www.nottspct.nhs.uk/my-pct/napc.html  Drugs are considered for classification at APC  Shared care guidelines / clinical guidelines  Formularies / position statements

APC & Traffic lights - 2  Joint formulary website http://www.nottinghamshireformulary.nhs.uk/  Is it on M&A Preferred Prescribing List (PPL)?  The website is a guide and GPs can choose not to follow it if they believe they have reason, but the reason should be documented.

What do the traffic lights mean?  Red – specialist – secondary care only  Amber 1 – initiated by specialist, shared care once stable (with a protocol)  Amber 2 – primary care prescribing after specialist recommendation  Amber 3 – Primary care / non specialist may initiate under APC guideline  Green – routine use  Grey – not recommended at the present as limited clinical/cost effective data

Prescribing guides  Mrs LE has seen Dr Millard a dermatology consultant at QMC about her discoid lupus erythematosus. He would like you to prescribe Chloroquine to treat the condition dose = chloroquine (as base) 150mg daily. - You check the dose in the BNF and the indication and dose are correct – do you prescribe??

JF – traffic lights suggests

What about MRS LE?  The dose prescribed would be reasonable  The traffic light list states chloroquine is red for dermatology in this condition.  Refer back to consultant and ask that they retain prescribing responsibility

Scenario 2  MR HT has had a heart transplant at Newcastle Hospital in 2001 and is stable on his anti-rejection medication including tacrolimus and azathioprine. He has recently moved to the area from Durham and wants you to prescribe these as his last GP did. He only has one week supply left Do you prescribe?

Mr HT  Both medications are traffic lighted as RED in Nottinghamshire  No local heart transplant specialist  Contact the specialist at Tertiary centre  Request consultant takes back the prescribing  Confirm the dosages needed and supply enough until the prescribing can be passed back  Consultant will prescribe and CCG will be charged for the cost of this medicine.

Mrs T (Part one)  Has RA  Started oral methotrexate by hospital now on 20mg weekly  Consultant writes to ask you to prescribe  Do you agree to prescribe?

Shared care protocol  Shared clinical responsibility outlined in a standard agreement  Passed by APC  Only for stable patients  For the stated clinical diagnosis only

Prescribing methotrexate  Always 2.5mg tablets  Take …….. tablets ONCE A WEEK on a SATURDAY

Mrs T (Part 2)  Mrs T visits the consultant on a routine appointment  Consultant now asking you to prescribe methotrexate 10mg twice weekly as nausea with once weekly dosage  Do you prescribe?

Practice prescribing meeting.  Yearly meeting  3 action points & audit as part of Prescribing Incentive Scheme  Large report covering therapeutic areas  Evidence of completion needed to obtain the money.

Controlled drugs

CD requirements  Appropriate dosage?  to be taken as directed – not sufficient  One to be taken as directed  15mg to be taken when required  How long is it valid for?  28 days  Treatment length  Good practice for a maximum of 30 days. Need good reason documenting for any longer

If anyone collects a CD for a patient from the pharmacy they will need to:  Sign the back of the prescription  State their relationship with the patient  Provide proof of identification  Give their address for the pharmacy CD register

Can CD’s be destroyed?  A GP practice can take back a patients unused CD’s and destroy them NO  A GP can destroy any out of date CD’s in the doctors bag with the witness of another GP NO

Other CD info  All private prescriptions for schedule 2 and 3 CD’s need to be on a FP10PCD  All CD’s in a surgery or doctors bag need to be recorded in a CD register and monitored

Specials - Unlicensed / off label  Unlicensed medication is no UK licence on the product e.g. melatonin  Unlicensed indication/off label – used for a UK licensed medication being used for an unlicensed indication e.g. in children

Considerations before using a Special Is the medication still needed at all? 1. Can the patient have a licensed product in a 2. different form e.g. dispersible or liquid? Could you change to a different drug within the 3. same class? Consider using a licensed drug in an unlicensed 4. manner e.g. by dispersing in water or crushing. Not MR / SR as it destroys the release mechanism 1. Not cytotoxic or EC 2. Prescribe the special – documenting the reasons for 5. doing so. NB: Patient / carer must be aware that medicine is unlicensed   