Medicines Management Adviser
NHS Institute for Innovation and Improvement
Programme Consultant in Medicines Management
NHS West Midlands
Richard is an experienced clinical pharmacist. Employed by NHS West Midlands, he also provides specialist advice to the NHS Institute for Innovation and Improvement on medicines management and prescribing issues
The current economic situation means that public sector expenditure will need to be reigned in and the NHS will be expected to play its part. Practice managers have an important contribution to make in helping to prepare for the challenging times that lie ahead for the NHS.
In reality, the economic situation will mean that the increases in NHS funding that we have become used to over the last few years will be significantly reduced. For general practice, this will mean tighter budgets, greater scrutiny of areas of significant expenditure and pressure to improve productivity.
So what actions can practice managers take to help general practice deliver good value-for-money at the same time as maintaining high quality care for patients? One area for consideration is the prescribing and management of medicines within the practice.
Prescribing medicines is not only one of the most common therapeutic interventions made by GPs, but it also accounts for a large percentage of expenditure in primary care. The drugs bill in general practice exceeds £8bn each year and there are certainly opportunities for saving money through more effective prescribing.
However, by reviewing the way in which prescriptions are managed in the surgery, practice managers can also provide a better service for patients and free up staff time.
The NHS Institute for Innovation and Improvement has been working on a number of initiatives that can help ensure that improvements in productivity are not made at the expense of the quality of patient care. One such example is the "Better Care, Better Value" (BCBV) indicators that have been published by the NHS Institute since 2006.
These are intended to identify potential areas for improvements in efficiency and are primarily aimed at commissioners of services such as PCTs and acute hospitals. However, there are three indicators that report on prescribing in general practice and these can be viewed by visiting the Institute's productivity website (see link to Better Care, Better Value Indicators below).
The purpose of the indicators is to enable NHS organisations to benchmark their performance against each other and to provide an estimate of savings that could be achieved by changing behaviour to match that of the higher-performing organisations.
The three prescribing indicators focus on drug groups that are commonly prescribed in general practice: drugs used for lowering cholesterol, drugs for indigestion and ulcer-healing and drugs used to lower blood pressure.
By prescribing cheaper drugs, where evidence suggests that these provide the same clinical outcomes for patients, practices can help PCTs achieve significant savings.
One way is to promote the use of generic medicines, which are often considerably cheaper than branded versions. For example, if all practices used generic simvastatin or pravastatin as firstline treatments for high cholesterol instead of more expensive and branded alternatives, the amount saved nationally could be up to £62m each year.
Although the BCBV indicators are only available at PCT level, it is important for practice managers to know what the indicators show, which drugs are included and to have an idea of the contribution that your own practice is making to local prescribing patterns.
Use prescribing data and practice budget reports to identify areas of high expenditure on medicines. You can help prescribers too by conducting drug searches for patients on the more costly medicines for each BCBV indicator using the practice clinical computer system.
These data can then be used to generate lists of patients who could potentially be swapped to less costly alternatives, if appropriate. You should also find out whether there are local incentive schemes to promote cost-effective prescribing linked to the BCBV indicators. PCT medicines management teams will be able to provide details of local schemes.
Practice-based pharmacists can conduct prescribing audits and may support practice switching programmes; some may even be prescribers in their own right and could run medicines management clinics in the practice.
Prescribing cost-effective medicines is one way of improving productivity in general practice, but there are other things that can be done to improve the management of medicines. For example, think about the way in which your practice responds to requests for repeat prescriptions. Table 1 shows some of the things that you could do to make this process more efficient:
Delivering both quality and value are essential skills for practice managers, and you can hopefully use some of these ideas for improving medicines management in your own practice.