Nottingham West CCG Prescribing Team

1. Nottingham West CCGPrescribing Team Beth Carney/ Dawn Gajree / David Sharpe September 2014

2. Who we are… • Beth Carney and NaynaZuzarte – Prescribing Advisor • Dawn Gajree – Primary Care Pharmacist • Kate Morris – Primary Care Pharmacist • David Sharpe – Care Homes Pharmacist • Total 2.5WTE

3. And the wider team • Shared team across the five Nottinghamshire county CCG’s: • Area Prescribing Committee / Interface team • Nicky Bird, Amanda Rawlings, James Sutton • Clinical Governance and Care Homes Lead • Coral Osborn • Data Analyst • Tim Oxley and Chris Day

4. What do we do? “Promote evidence based cost effective prescribing” £12 million prescribing budget £323,000 QIPP

5. A day in the life of a Primary Care Pharmacist • Read/ respond to emails • Data analyst EPACT reports, meeting requests, request for comments. • GP practice • read/respond to queries from emails and tasks, MI query, red drugs, alternatives for specials. • run report, identify patients, collect data for each individual, summarise , agree changes, make changes. • Medication reviews, formulary implementation, epact analysis • Office/ meeting • CCG service reviews, team meetings, write work streams, next years work, MMF

6. Helping us with our prescribing plan • Pain • Practices have been asked to review of patients taking high dose opioids for non-cancer pain • Locally what is the maximum recommended dose of morphine for non-cancer pain • 60mg every 12 hours • 100mg every 12 hours • 200mg every 12 hours

7. Helping us with our prescribing plan • Pain • Practices are reviewing the prescribing of pregabalin for neuropathic pain • In local guidelines what is 1st line for neuropathic pain after conventional analgesics? • Gabapentin • Pregabalin • Amitriptyline

8. Respiratory • COPD • Ensure patients who have previously exacerbated are issued with rescue packs (NNT =5) • Patients with an FEV1>50% on an inhaled corticosteroid (ICS) should be reviewed to deem if treatment is appropriate. • Formoteroleasyhaler should be used as the 1st line treatment option for long acting therapy in patients with FEV1>50% • Patients receiving oral steroid courses have the number recorded in the last year and those receiving 3 or more courses are considered for bone protection

9. Asthma • Responding to the National Review of Asthma Deaths • 39% of patients who died during the monitoring period had >12 SABA reliever inhalers issued in the year prior to their deaths. • 4% of patients had more than 50 inhalers issued in the year prior to their deaths.

10. Respiratory INHALER TECHNIQUE

11. Repeat prescribing processes • Review of practices repeat prescribing processes • Printing of “duplication” on re-printed prescriptions to aid identification of a duplicated prescription to prevent the risk of a patient receiving a double quantity of medicines

12. The Care Homes Pharmacist • Review all care home patients registered with GP practices within CCG. • All patients reviewed twice a year • Indication, Dose, Quantity, Suitability • Recommendations to GP • Resolve issues with community pharmacies

13. Helping us with our prescribing plan • Prescribing of Generics / Brands • Promotion of generic prescribing • But some exceptions to the rule….. • Gatalin, sinemet, fenbid, laxido, nystan • Prescribing the cost effective formulation • Nitrofurantoin Caps • Azithromycin Caps

15. Where to find local guidelines and formulary http://www.nottsapc.nhs.uk/

16. Any Questions?

17. Practices and Pharmacists • Dawn Gajree: • Church Street Medical Centre • Hama Medical Centre • Hickings Lane Medical Centre • Linden Medical Centre • Saxon Cross Surgery • Abbey Medical Centre

18. Practices and Pharmacists • Kate Morris • The Valley Surgery • Manor Surgery • The Oaks Medical Centre • Bramcote • David Sharpe • West End Surgery • Church Walk Surgery