Repeat Prescribing LES Contract Mechanism and Specification -Change Summary
Section / Previous - 2014/15 / Current - 2015/16Systems and Processes / Complete 3 Repeat Prescribing SEAs / Choose from one of:
- Complete 3 Repeat Prescribing SEAs
- Review of acute prescribing systems and processes, and provide evidence of one process change
- Patient awareness campaign – medicines adherence or wastage. Run patient questionnaire (pre and post campaign) and provide report reflecting on campaign
Formulary Compliance /
- Install electronic preferred list (and synonyms where appropriate) quarterly
- Target Preferred List Prescribing to be 78% or 1% baseline increase
Monitored Dosage System and Care Home Patients /
- Maintain register quarterly
- Patients to be on 7 or 28 day supply
- 90% of patients to have level 1 medication review previous year (at contract end)
- Process and protocol in place for communicating MDS and Care Home changes to Community Pharmacy
- Maintain register quarterly
- Patients to be on 7 or 28 day supply
- Process and protocol in place for communicating MDS and Care Home changes to Community Pharmacy
Level 1 Medication Review / 80% of active repeat patients to have review within previous 2 years (at contract end) / 85% of active repeat patients to have review within previous 2 years at contract end (10.03.2014 - 31.03.2016)
Improving Compliance and Reducing Wastage /
- Review and removal of selected obsolete drugs if not ordered within previous 6 months
- Identification of asthma non-attendees to Community Pharmacy
- Review patients ordering all repeat medication every order for the most recent three issues(as defined in appendix 3) using the Scottish Therapeutics Utility (STU) tool and EMIS/Vision Database Tool report, and take appropriate action
Submission of data / To be taken by automatic extraction / No change from 2014/15
Payments /
- £150 engagement fee
- £0.80 per registered patient achievement payment
Payment recovery / Not previously stated in contract / Schedule for recovery in event of non achievement noted for each individual section
Late Opt In (4f) / Not previously stated in contract /
- Engagement fee £150 to be paid on opt in (but no other advance payment)
- Remaining payment June 2016
Training / In Practice on request (unless significant demand) / No change from 2014/15
Resources /
- RPLES Database Tool to identify patients
- Additional supporting resources e.g. patient awareness campaign materials, database report and recommendations ‘what to look for’ for patients ordering all medication every order
Repeat Prescribing LES Contract and Specification 2015/16 (20150204)
REPEAT PRESCRIBING LOCAL ENHANCED SERVICE
Contract Mechanism and Specification 09/03/2015-31/03/2016
Introduction
1.All Practices are expected to make available to all their patients the essential and those additional services they are contracted to provide. This Local Enhanced Service (LES) provides for a review of repeat prescribing system processes. This activity is not covered by the GMS Contract Quality and Outcomes Framework (QOF) or existing Enhanced Services. The objective is quality improvement and reduced costs through improving repeat prescribing systems and processes. No part of the specification by commission, omission or implication defines or redefines essential or additional services.
Background
Evaluation of prior work has shown that non clinical staff members can positively impact on the safety and efficiency of repeat and acute prescribing processes. Participation in this LES will improve streamlining of repeat and acute prescribing systems, support practice work for the Quality QOF element of the GMS contract and assist in achievement of local prescribing indicators. Practices will be provided with staff training and support on request.
Service Aim
2.To improve repeat prescribing systems and processes within Practices with the objectives:
To improve patient medication compliance and minimise waste of medicines
To support review of repeat and acute prescribing processes
To optimise communication at primary and acute care interface, and between Community Pharmacy and GP Practices
To support implementation of NHSGGC agreed prescribing indicators
Service Outline
3.This enhanced service, to improve repeat prescribing systems and processes within Practices and reduce wasted medicines,will fund the following from 9th March 2015 to 31st March 2016:
Practices to:
a.Identify an appropriate member of Practice staff to progress the LES work.
b.Optional training is available for relevant personnel on request
c.Individual Practices to be paid as outlined in section 5.
i.Where the practice fails to complete the listed actions they will be subject to payment recovery mechanisms (5d, e).
Practices are expected to undertake the actions listed below (one from d, e, f and allofg, h, I and j) to achieve the whole of the LES payment:
Practice to select and complete action relating to one from sections d,e, f; and to inform prescribing team of choice by 27th March 2015 using form provided (appendix 1.1)
d.Systems and Processes - Repeat Prescribing Significant Events Review
Significant event review is a recognised methodology for reflecting on important events within a practice and is an accepted process as evidence for GMC revalidation. Further guidance is available in appendix 1.2.
i.In March 2015, Practice to consider a process for identification and recording of significant events in relation to repeat prescribing. If process already exists, Practice to review and amend it if necessary
ii.Practice to identify and record at least three significant events in relation to Repeat Prescribing
iii.Practice to hold a significant event meeting to discuss and action the three identified significant events
iv.Practice to provide evidence of completion via local CH(C)P Lead Clinical Pharmacist using template provided (appendix 1.2) by 17th March 2016
e.Systems and Processes - Review of Acute Prescribing Systems and Processes
A 2013/14 repeat prescribing audit within NHSGGC highlighted a variety of acute prescribing issues, potentially increasing the risk of patient harm and leading to excess prescribing waste. These included issues with ordering, processing, authorisation and collection. A review of acute prescribing systems and processes may be helpful to address Practice specific issues. Further guidance is available in appendix 1.3.
i.In March 2015, Practice to consider the best method for reviewing the acute prescribing process along with a plan for completion
ii.Practice to review the acute prescribing process and provide evidence of at least one acute prescribing process change which has occurred as part of the review using the pro-forma provided (appendix 1.3)
iii.Evidence to be submitted to local CH(C)P Lead Clinical Pharmacist by 17th March 2016
f.Systems and Processes - Patient Medicines Awareness Campaign
An estimated 3-4% of prescribing cost is incurred through prescribing waste, a half of which is thought to be cost effectively avoidable[i]. In NHSGGC this equates to approximately £4million per annum.
It is suggested that between a third and a half of all medicines prescribed for long-term conditions are not taken as recommended[ii]. A medicines awareness campaign for patients could assist the Practice in working towards reducing medicines waste andimproving patient safety. Further guidance is available in appendix 1.4.
i.In March 2015, Practice to hold initial discussions around a medicines waste / adherence campaign and consider a plan for implementation
ii.Practice to run an initial data collection in the form of a patient questionnaire (suggestaround 10 per day for an average working week)
iii.Practice to review the results of the questionnaire to help inform the campaign
iv.Practice to run a patient medicines awareness campaign (one simple message) around chosen area for a minimum period of two weeks (see appendix 1.4 for resource materials)
v.Practice to run an second data collection in the form of a patient questionnaire (suggestaround 10 per day for an average working week) and analyse to assess the impact of the campaign
vi.Practice to provide evidence of completion via local CH(C)P Lead Pharmacist using the pro-forma provided (appendix 1.4) by 17th March 2016
Practice to complete actions relating to:
g.Formulary compliance
Compliance with NHSGGC Formulary especially the preferred list which states the initial and second choice of drug in each BNF category supports cost effective prescribing.
The Prescribing Team will review any significant changes to the formulary preferred list and consider any detrimental effect that this may have on overall practice preferred formulary compliance. The formulary status of a medicine can be checked on or via the associated app.
i.Practices to check version and install if necessary in March 2015 the current NHSGGC Formulary (including synonyms where appropriate) containing the preferred list and then update as Formulary updates are published; usually every three months
ii.≥ 78% of all prescribing to be within the NHSGGC preferred list of Formulary drugs at 31.03. 2016 or an actual increase of 1% towards target
h.Patients on a Monitored Dosage System and patients resident in a Care Home
i.Review and update the Practice registers of patients on a Monitored Dosage System (MDS) and patients who are resident in a Care Home on an ongoing three monthly basis starting March 2015. Practices should aim for patients to receive seven or 28 days supply of their regular repeat medicines, excluding ‘when required’ medicines:
ii.Practice should have a process with supporting protocol in place for communicating medication changes to Community Pharmacy in relation to MDS and Care Home patients
i.Level 1 Medication Review (See appendix 2)
i.Perform a Level 1 medication review in 85% of all regular repeat prescribing records between 10.03.2014 and 31.03.2016 as defined within appendix 2. Practices are strongly encouraged to include Care Home / MDS patients and those patients who have never had a level 1 medication review
ii.Practices to readcode patient records when undertaking a Level 1 medication review (66RZ)
j.Improving Compliance and Reducing Prescribing Waste – Installation of the Scottish Therapeutics Utility (STU) and Review of Patients ordering all medication on one date every time they order(See appendix 3)
The Scottish Therapeutics Utility (STU) is an IT solution to help improve general practice repeat prescribing. Working within the clinical systems EMIS and InPS Vision, STU can identify and target potential problems with a patient’s list of repeat medicines.
Some patients may be ordering all repeat medication as one order(e.g. ticking all boxes on their repeat reorder slip) every time they order regardless of need or stock levels, particularly PRN medicines, dressings, appliances.
i.Using STU and the RPLES MS Access Database tool report for EMIS and Vision, Practices to review patients who order all repeat medication as a single order every order (excluding MDS and Care Home patients) for the most recent three issues and take appropriate action.
Appendix 3 provides guidance on what prescribing items to look for e.g. prn/mdu being ordered every month may warrant review, GTN sprays, large volumes of creams / ointments, catheters, stoma, etc.
ii.Practices to retain details of the prescription records reviewed and make available to view if required.
k.Submission of Data
i.Data to be automatically extracted from Practice five working days from the end of each quarter (June 30th, September 30th,December 31st, March 31st)
ii.Extracted data will be used to support local evaluation
Enhanced Service Time line
4.As recognition of the work required by 31/03/2016, this LES is starting in early March 2015, thus giving over 12 months to complete the requirements. Time line detailed below:
a.Practices asked to opt in by 03.03.2015; LES to start 09.03.2015
b.Practices to receive engagement payment (5a) and standard payment (5ci) in March 2015 if opted in to LES as 4a and undertake service outline sections relating to:
- Staff nomination and training (where appropriate) (3a,b)
- Formulary compliance (3gi)
- Selection of action around Systems and processes (3d, e or f)
- Initial actions around Systems and processes (3di, 3ei, or 3fi)
- Reviewing and updating lists of patients on MDS and Care Home registers (3hi)
c.Standard payment made March 2015 to enable Practices to cover resource costs and to enable commencement and completion of LES work (3d-j) as soon as practical
d.Further payment (5cii) to be made in June 2016 as appropriate
e.Submission data to be extracted automatically on a quarterly basis
f.Practices opting in after the opt in deadline of 03.03.2015 will receive the engagement fee (5a) but no advance standard payment (5ci). Payment (5ci-ii) to be made June 2016.
Payment
5.Engagement Fee
a.Payment of a one off engagement fee of £150 per Practice to be made in March 2015.
Achievement Payments
b.Practice extracted data to provide evidence of the work undertaken (see 3d-j)
i.£0.80 per registered patient as at 01.01.2015 for payment period March 2015 to March 2016
LES Standard Payment Schedule
c.Payment for financial year 2015-16:
i.£0.40 per registered patient to be paid in March 2015
ii.£0.40 per registered patient to be paid where appropriate on assessment in June 2016
Assessment of payment
iii.Once year end submission data is available achievement will be assessed. If submission data indicates non achievement or no evidence of work (see 3d-j) undertaken, the practice will be subject to payment recovery mechanisms as per 5d-e
iv.In the event of a dispute the Practice will be required to provide evidence of work undertaken. The Prescribing Management Group (Primary Care) will act as arbiter on the dispute using the evidence provided
Financial Recovery
d.Financial recovery to be limited to the maximum actual sum of money paid to the Practice for the Repeat Prescribing LES 2015-16
e.Schedule for Financial recovery:
i.Section 3d-f Systems and Processes - A maximum recovery of £0.20 per registered patient as at 01.01.2015
ii.Section 3g Formulary Compliance - A maximum recovery of £0.20 per registered patient as at 01.01.2015
iii.Section 3h Patients on a Monitored Dosage System and Patients Resident in a Care Home - A maximum recovery of £0.10 per registered patient as at 01.01.2015
iv.Section 3iLevel 1 Medication Review - A maximum recovery of £0.20 per registered patient as at 01.01.2015
v.Section 3jImproving Compliance and Reducing Prescribing Waste - A maximum recovery of £0.10 per registered patient as at 01.01.2015
Withdrawal
6.Both parties to provide a minimum of three months notice if they wish to withdraw from the contract.
Resources
All LES resources will be available on the NHSGGC website including training packs, audit tools, leaflets, Prescribing Indicator Scheme Implementation Guides and frequently asked questions.
Appendix 1Repeat Prescribing Systems and Processes guidance
Appendix 2 Level 1 Medication Review guidance
Appendix 3Improving Compliance and Reducing Waste Resources
Repeat Prescribing LES Contract and Specification 2015/16 (20150204)
[i]Trueman, P., Taylor, D.G., Lowson, K., Bligh, A., Meszaros, A., Wright, D., Glanville, J., Newbould, J., Bury, M., Barber, N. and Jani, Y.H. (2010) Evaluation of the scale, causes and costs of waste medicines. Report of DH funded national project. ISBN: 978 090 293 620 1. Technical Report. York Health Economics Consortium and The School of Pharmacy, University of London. , York and London.