NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update Primary Care

PostScript Primary Care Jan/Feb '13

Audit Scotland Report

Audit Scotland has published its third report on Prescribing in general practice in Scotland. ‘General Practice (GP) prescribing accounts for 70% of NHS spend on drugs in Scotland. This amounts to almost £1 billion a year with 24% of the population on four or more medicines. Spending fell by 11 per cent in real terms between 2004 and 2011, despite the volume of prescriptions rising by a third during that time.
The report highlighted GPs in NHS Greater Glasgow and Clyde are prescribing cost effectively with the lowest weighted cost per patient compared to all other NHS boards. The prescribed quantities per weighted head of population close to the Scottish average.
The report noted the NHSGGC investment in prescribing support teams through ‘invest-to-save’ initiatives and recommended other Health boards to consider doing the same. Over the last six years in particular, the team effort between prescribing support, prescribers and practice staff has led to improvements in prescribing quality and cost effectiveness supporting the board to meet a three per cent efficiency savings target.
Key recommendations from the report include;

  • Reduce medication waste
  • Reduce use of medicines considered less suitable for prescribing
  • Increase generic prescribing
  • Implement the National Guidelines on Polypharmacy
  • Undertake medication review of patients taking multiple medicines.


Controlled Drugs


PRESCRIBING CDs: ENSURE QUANTITY IS CLEAR: When writing scripts for CDs, the total quantity must be written in words and figures. This can be expressed either as the total dose to be supplied (commonly in milligrams) or the total number of dosage units (the number of tablets or ampoules or volume of liquid). To prevent confusion; it is best practice to write as the total number of dosage units to be supplied.We had a case recently where PRISMS showed a practice issuing 300 ampoules of diamorphine 10mg plus 600 ampoules of diamorphine 30mg. The intention and the supply was for 30 ampoules of diamorphine 10mg plus 20 ampoules of diamorphine 30mg. Computers default to showing the number of dosage units; please follow this convention for handwritten prescriptions. For any questions about CDs, contact the CD Team on 0141 201 5348

Dietetics


SOUVENAID ®
NHS GGC is aware of a new nutraceutical preparation, Souvenaid®, launched on January 14th with an approximate annual cost of over £1,200, which is promoted for use in the early stages of Alzheimer’s Disease. It is anticipated that there may be some demand to prescribe this preparation from patients and families. Souvenaid® contains omega-3 polyunsaturated fatty acids (docosahexaenoic acid, DHA;eicosapentaenoic acid, EPA), uridine and choline, together with phospholipids and other cofactors. These products are reputed to help with the development of synapses in the brain.
The director of research from the Alzheimer Society said that people are probably better putting their money towards good quality care or taking part in exercise.
The recommendation is not to prescribe Souvenaid® as it is not a licensed medicine and has not been assessed by the Advisory Committee on Borderline Substances (ACBS). As a pay and report item the prescriber would need to justify the reasons for prescribing. If and when this product is considered by ACBS local ADTC processes are in place to enable a local decision to be made on its place in therapy.

Scriptswitch


As you may be aware the Scriptswitch decision support software has been piloted over the last six months within GP practices in East Dunbartonshire and Inverclyde CH(C)Ps. The software has been very well received by practices and prescribers with the tool proving to be extremely beneficial in terms of  patient safety issues and improving cost effectiveness. The opportunity to sign up to Scriptswitch software has now been extended out to all practices across NHSGGC. Response to the roll out has been extremely positive and board wide installations commence W/C 18th February. Benefits of ScriptSwitch ;

  • improve patient safety especially when high risk medications are prescribed
  • improve performance in GMS contract, prescribing indicators and LES schemes
  • increase Formulary compliance and aid implementation of local and national guidelines
  • support sustainability of optimal prescribing habits including  locums and GP registrars
  • raise awareness of shared care agreements and clinical responsibility
  • Alert prescribers when drugs are not available due to supply issues

For further information or to opt into the software roll out please contact the central prescribing team on 0141201 5368

Non Medical Prescribing

Conotrane® silicone barrier cream is the only proprietary barrier preparation included in the NHSGGC Formulary, and is more cost-effective than Sudocrem® or Cavilon Durable Barrier Cream.  Conotrane® can help to maintain skin integrity when included in a structured skin care programme for those patients who are incontinent (SSKINS care bundle).Based on current prices, efficiency savings of £50,000 per annum across NHS GGC can be achieved by switching Sudocrem and Cavilon Durable Barrier Cream to Conotrane®
New patients should be prescribed Conotrane® when a barrier cream is required for the prevention of incontinence dermatitis.  A review of patients who are receiving other proprietary named products should be carried out and changed when appropriate.

Supply problems


Alliance Pharmaceuticals is currently unable to supply Slow-K® Tablets 600mg (potassium chloride) due to a manufacturing delay and there is unlikely to be any stock until the end of 2013. The list of other medicine shortages for February are below.

 

 List of Shortages  Pack size
 Isosorbide Mononitrate  tabs 20mg  56
 Temazepam tabs 10mg  28
 Temazepam tabs 20mg  28
 Trazodone caps 50mg  84
 Trazodone caps 100mg  56
 Trazodone tabs 150mg  28

 

What’s on soon


National open meeting for SIGN guideline on osteoporosis and prevention of fragility fractures - 8 March 2013, John McIntyre Conference Centre, 18 Holyrood Park Road, Edinburgh


Scottish Patient Safety Programme Primary Care Launch Event will be held on 14-15 March 2013, at Edinburgh Conference Centre, Heriot-Watt University, Riccarton, Edinburgh, EH14 4AS.

Stop Press: 

A £21m fund has been launched to help improve access to treatment for people with rare medical conditions. The new ‘orphan drug’ fund will cover the cost of medicines whose routine use has been rejected by the Scottish Medicines Consortium (SMC). Access to these medicines is managed through the Individual Patient Treatment Request (IPTR) process. An exception to this rule follows the recent SMC advice on ivacaftor (Kalydeco®) for the treatment of cystic fibrosis in patients age 6 years and older who have a G551D mutation in the CFTR gene (celtic gene). Ivacaftor was not recommended by SMC but special arrangements are in place, utilising the above fund, to facilitate patient access to the medicine across NHS Scotland. Full statement here

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