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The Specials Trajectory Richard Jones, Head of Medicines Management Team

The Specials Trajectory Richard Jones, Head of Medicines Management Team & Accountable Officer for Controlled Drugs 8 th February 2011. NHS Spend - historic. NHS Luton spend on ‘ specials ’ for 2009/2010 was £1,454,954.

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The Specials Trajectory Richard Jones, Head of Medicines Management Team

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  1. The Specials Trajectory Richard Jones, Head of Medicines Management Team & Accountable Officer for Controlled Drugs 8th February 2011

  2. NHS Spend - historic • NHS 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. Medicines Management Team

  3. Growth in Luton spend/National and SHA Medicines Management Team

  4. Total overcharge Medicines Management Team

  5. Total cost of pharmacy overcharge: £654,050.51 (62% of total spend on specials) • 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. Medicines Management Team

  6. 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. Ongoing interventions Medicines Management Team

  7. Monthly spend on specified & unspecified items Medicines Management Team

  8. Variance in spend to SHA Medicines Management Team

  9. 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. Medicines Management Team

  10. Specials timeline • Specials 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) Medicines Management Team

  11. Specials prescribing? • 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) Medicines Management Team

  12. Total Actual Cost Specials excluding unspecified cost – highest March 2010 over £120K Medicines Management Team

  13. 10 most commonly prescribed - No alternative available. Medicines Management Team

  14. 10 most commonly prescribed – DID NOT need to be prescribed as specials/alternatives available Medicines Management Team

  15. Top 10 Community pharmacy average spend per item Medicines Management Team

  16. 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 Medicines Management Team

  17. Local interventions and timeline • Discussions with LPC • Discussions with GP practices • Sourcing different prices • Meetings with community pharmacy contractors • Discussions with hospital specialist prescribing specials Medicines Management Team

  18. QiPP Financial savings (Month 8) Actual>Planned Reduction in Net Ingredient Costs per ASTRO PU Medicines Management Team

  19. Luton’s success….thanks to team!! Telephone 01582 53 2114 QiPP Medicines Management Team & PBC Finance Lead Medicines Management Team

  20. Agenda • Background 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 date Medicines Management Team

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