1. Portfolio/Number/Name:H/C4Improved prescribing of drugs |
2. Programme/Activity: Please
include a short description The plan is to deliver 20 million
savings through improvements in
prescribing, by adopting best practice and
reducing inappropriate prescribing. A
national co-ordinating plan was issued on
February 28, 2005 requiring Health Boards
to develop local plans which draw on
existing guidance, and which are capable of
monitoring to identify progress against the
national targets. |
3. Planned Savings | | 2005-06 | 2006-07 | 2007-08 |
Cash (m) | 5 | 10 | 20 |
Time Releasing (m) | 0 | 0 | 0 |
4. Accountable Officer for
delivery | K. Woods |
5. Project Manager | C. Naldrett |
6. EGDG account manager | G. Woolman |
7. Quality Impact | Describe any impact on the quality
of service delivery. Be specific and
explain if the expectation is positive,
negative or neutral. There is a risk that an insensitive
cost reduction exercise could work through
to reduced service provision and patients
not receiving therapies they would
otherwise have done, or alternatively to
lack of buy-in from key decision takers on
clinical grounds and non meeting of
targets. There is a further potential for more
effective prescribing and removal of
perverse incentives to work through to
lower remuneration of GPs in rural and
remote areas and adversely affect
recruitment and retention. The focus of the draft national
co-ordinating plan is therefore to improve
the effectiveness and thus the quality of
prescribing by the adoption of a series of
local plans which are accepted by local
stakeholders, and to develop nationally
more relevant remuneration arrangements for
dispensing doctors. |
8. Dependencies | Explain if your savings are dependant
on legislation or other structural changes
being achieved. The achievement of targets will involve
changes in the clinical practice of 4,250
General Practitioners and other independent
prescribers, for whom the prime driver is
improving the quality of prescribing for
the benefit of their patients. To some degree it will also depend on
the success of planned nationally
co-ordinated initiatives, as foreshadowed
in the national co-ordinating plan, to
support the efficient prescribing of non
drug prescription items, such as dressings
and nutritional products. More cost effective prescribing in
rural areas may need to go hand in hand
with revisions to dispensing doctor
contract arrangements to avoid
destabilisation of the aggregate funding
packages available to particular
practices. Critically, continuing development of
area wide formularies, jointly by Health
Boards and stakeholders including both
clinicians and the industry, which will
stimulate progress towards greater national
consistency in prescribing practice. We will review again whether mandating
generic dispensing through Regulations is
necessary and desirable to realise the last
remaining latent savings from comprehensive
generic prescribing. |
9. Description of efficiency and
actions to be taken | 9.1 How will the saving be made? Be
specific about number/size of contracts, staff,
posts dates etc. By adoption of local plans featuring,
but not exclusive to, areas identified in
the national co-ordinating plan issued to
all Health Boards in February 2005. This
identified for each Health Board the target
saving and approaches to achieve the
target, building on best clinical practice,
possible areas for savings identified by
SEHD including reference to existing
external guidance such as from the Audit
Scotland June 2003 report on GP
prescribing, which included detailed
recommendations. These local plans are to
be submitted to SEHD It will be for Health
Boards to consider whether further staff
are required to augment existing
prescribing advisory staff to help achieve
local plans. |
9.2 What action is critically needed to
secure delivery of this saving? Be specific,
and name the key action managers if they are
outwith your immediate management chain (e.g.
in an NDPB.) Early production of local plans, as
mandated by the national co-ordinating
plan, in which local stakeholders accept
target realistic prescribing quality
improvements. Sign-off of plans by HB Chairs/Chief
Executives and prescriber representatives
as locally appropriate, such as AMC/ CHP
chairs or officers. The action managers are the 4,250 +
clinicians with prescribing rights, and
ultimately the clinical discretion to
prescribe for their patient what is most
appropriate. It is, therefore, crucial that
clinicians be satisfied that local plans
aspire to improve quality in prescribing
and clinical benefits for patients and are
not crude cost savings targets. They are supported by an existing
network of prescribing advisers in Health
Boards, for which each HB has to determine
the appropriate complement and decide if
staff augmentation would improve the
ikelihood of a successful outcome. |
10. Impact on Staffing to achieve the efficiency
gain | If there are to be any changes in
staff numbers (at activity level) to
achieve the efficiency gain, please
indicate how many full time equivalents and
how far you expect savings to be achieved
by natural wastage (show additions as + and
reductions as -). |
| 2005- 06 | 2006- 07 | 2007- 08 |
+ | | | |
- | | | |
Net | | | |
Explanation | No change in complement planned.
Consultant support may be required to help
scope projects requiring national
co-ordination such as in non drug
prescribing. |
11. Benefits | In general, the benefits of the
Scottish Executive Efficiency Plan are the
enhanced outputs from the resources
Ministers have been able to allocate in
SR04. But if there is a direct connection
between this efficiency saving and the
enhancement of a particular service please
describe it here. N/A |
12. Gross/Net Cash Savings | 12.1 Please set out the gross recurring
saving and any offsetting recurring
expenditure. Gross Target: 20m. Costs of any
consultant contribution not yet
scoped. |
12.2 Against what budget does this
expenditure and saving fall? Health Boards' Unified Budgets |
12.3 Has this saving been built into your
budget? Yes, in that there is an assumption
that Boards and prescribers will
continually pursue the potential for
prescribing efficiencies to offset rolling
cost increases associated with greater use
of effective therapies and costs of new
drugs. |
12.4 If so, what is the maximum allowable
expenditure against the published budget data,
in each year, for that saving to be
delivered? Health Boards establish local
prescribing budgets on the basis of
standard data which is available to other
HBs and SEHD, and to achieve the optimum
use of the totality of funds available to
them. Savings against targets accrue
directly to local budgets and can be used
to cover the costs of other services. SEHD do not publish forecasts for year
on year prescribing costs. |
12.5 If not, how do you propose to invest
the additional cash back into public
services? N/A |
12.6 What plans do you have to exceed the
required saving? Explain by how much in each
year. Action has been taken to achieve supply
side savings that will impact during 2005-6
and these are accounted for within other
targets. |
13. Time - release savings | 13.1 Please explain any time-releasing
savings indicated at question 3 N/A. |
13.2 Please describe the method you
plan to use to calculate the cash
equivalent of those time release
savings. N/A |
14. Measurement and
Monitoring | 14.1 How are you proposing to measure the
expected efficiency benefits (e.g. in terms of
costs, level of output or quality of
service)? National aggregation of local plans,
which will establish local benchmarks in
the light of the headings provided in the
national co-ordinating plan.. |
14.2 What monitoring & reporting
procedures will be put in place to measure the
efficiency savings (How often will progress
towards the target be monitored? Who will have
lead responsibility for reporting progress and
what procedures will be in place?) Monitoring will be done in the SEHD,
based on NSS ISD aggregation. There is
extensive data available from NHS NSS
Information Services Division to GP
practices and Health Board prescribing
advisers to allow their prescribing
behaviour to be monitored. Availability
however lags prescribing by 3-4 months.
Monitoring will be quarterly -after
availability of data- by each Health Board
and will be aggregated centrally by NHS
NSS. This will be used by NHS NSS ISD to
provide tailored reports for each Health
Board, but in a format that is capable of
aggregation to allow SEHD to monitor
national progress. |
14.3 Monitoring Data: Sources, validation
and risks - What data will be used to
measure progress? Is all the required
information quantifiable and readily
available? If not what action will be
taken to rectify this?
- What measures will be in place
to validate the accuracy of the data?
Who will take responsibility for
this?
- Are there any issues or risks
relating to how you plan to use the
data? (e.g. accuracy, difficulties in
collection)
See answer to previous question.
Health Boards will be instructed to
agree individual monitoring
arrangements with NHS NSS ISD, and SEHD
will agree with NHS NSS ISD the form of
a national monitoring report to track
overall progress..
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