Richard Crosby

Richard Crosby 722 Prince of Wales Road Darnall Sheffield S9 4EU Tel: 0114 3054567 [email protected] 30/Jun/2015

Dear Community Pharmacist

I have attached below for your information; the key areas the Medicines Management Team are currently looking at with regard to achieving cost savings and improving quality of prescribing in primary care.

These will affect different pharmacies to differing degrees so please talk to the Medicines Management Pharmacist/Technician at your local GP practice if you have any queries.

Table 1. Cost saving work

Workstream Not Dispensed Community Pharmacy Enhanced Scheme Community pharmacies ask patients if all prescribed medication is needed. Medication that is not required is not dispensed and the pharmacies then inform the practice. Optimisation of repeat prescribing systems can avoid unnecessary prescriptions and potentially save on future not dispensed fees (timescale - ongoing) Medicines Management Formulary Maintain and install the formulary on compatible practice systems promoting cost effective prescribing in line with local recommendations (timescale ongoing) Drug Switches To undertake a variety of cost effective drug switches e.g. vitamin b compound tablets to vitamin b compound strong, galantamine MR capsules to Luventa XL capsules, quetiapine XL tablets to Biquelle XL (timescale - ongoing) Potential Generic Savings Cost savings identified where branded medication could be switched to generic as more cost effective (timescale - ongoing) Pregabalin Pregabalin has a flat pricing structure i.e. each tablet regardless of strength costs the same. Ensure dose is optimised and its use rationalised in line with Sheffield Neuropathic Pain Guidelines (timescale - ongoing) Senna Review of patients on senna to consider whether continued use of stimulant laxative is required and if so switch to bisacodyl when clinically appropriate (timescale - ongoing) Respiratory Work stream to be defined, may concentrate on the use of the most cost effective licenced formulation of Seretide Accuhaler® for patients with COPD, rather than more expensive unlicensed preparation (Evohaler®) (timescale - ongoing) Specials Ensure all specials use is appropriate. (timescale - ongoing) Insulin Needle review Encourage formulary prescribing of Omnican fine® and GlucoRx finepoint® and where appropriate switch existing patients from BD microfine® (timescale - ongoing) Drop list Drugs reviewed where there is a lack of evidence of clinical effectiveness or evidence of risk outweighs the benefit of treatment. (timescale - ongoing). Oral nutritional supplements and infant feeds Review prescribing of sip feeds promoting appropriate and most cost effective use (timescale - ongoing) Care Home Medication Reviews (for the elderly) To review patients in line with national and local schemes improving quality of prescribing (proposed timescale - main focus on this from July onwards) Medication Reviews Targeted medication reviews in specific areas agreed to maximise adherence to local and national guidelines. (proposed timescale - main focus on this from July onwards) Waste Management Introduction of initiatives to reduce avoidable waste and promote medicines adherence (timescale ongoing)

Table 2. Quality work to begin in July 2015

Topical Diclofenac Ensuring that all 3% topical diclofenac is prescribed for the appropriate indication (proposed launch July) Ezetimibe Ensuring agents prescribed in line with national guidelines and best evidence base for effectiveness, e.g. reviewing use of ezetimibe Dual antiplatelets To review dual antiplatelets that have been prescribed for longer than 12 months and to stop treatment that is no longer needed Co-amoxiclav Audit against Sheffield Antibiotic Guidelines to determine whether use is appropriate Asthma 1 To identify patients who are receiving three or less issues of inhaled corticosteroids or 12 or more issues of short acting beta agonist in a year and arrange appropriate review. In line with National Review of Asthma Deaths (NRAD) Asthma 2 To look at patients prescribed a long acting beta agonist and no inhaled corticosteroid and where appropriate ensure a corticosteroid is prescribed, possibly as a combination product

If you want to discuss any of these workstreams further please either discuss with your Medicines Management Pharmacist/Technician or alternatively my contact details are below. Other pieces of work will come out through the year and I will keep you informed of these.

Yours sincerely

Richard Crosby Head of Practice Support Sheffield CCG Medicines Management Team