1. Portfolio/Number/Name:H/C 4 Improved prescribing of drugs |
2. Programme/Activity: 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. Efficiency | 3.1 Current target; £m | | 2005-06 | 2006-07 | 2007-08 |
Cash | 5.0 | 10.0 | 20.0 |
Time | 0 | 0 | 0 |
3.2 Efficiencies delivered; £m | | 2005-06 | 2006-07 | 2007-08 |
Cash | 21.6 | - | - |
Time | 0 | - | - |
4. Accountable Officer for delivery | Dr Kevin Woods |
5. Project Manager | Mr Chris Naldrett |
6. EGDD Portfolio Manager | Rowena Simpson |
7. Description of efficiency and actions to be taken | 7.1 What is the efficiency improvement? How will the efficiencies be made? By adoption of local plans featuring, but not exclusive to, areas identified in the national co-ordinating plan issued in February 2005, NHS Boards will release cash due to improved prescribing. The plan identified for each Board the target saving and approaches to achieve the target is built upon best clinical practice, possible areas for savings identified by SEHD, and included reference to existing external guidance such as the Audit Scotland June 2003 report on GP prescribing. Local plans have been submitted to SEHD. It will be for Boards to consider whether further staff are required to augment existing prescribing advisory staff to help achieve local plans. Savings are achieved by a reduction in the quantities of certain prescribed drugs/items being replaced, offset in some cases by increases in prescriptions of other, usually cheaper, drugs/items. |
7.2 What are the main actions that are needed to secure the delivery of this efficiency improvement? Local plans, as mandated by the national co-ordinating plan, in which local stakeholders accepted realistic targets for prescribing quality improvements. Plans signed off by Board Chairs/Chief Executives and prescriber representatives as locally appropriate, and were completed in Summer 2005. 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 likelihood of a successful outcome. |
8. Associated costs | 8.1 Are there any development or redundancy costs associated with the delivery of this efficiency? There are no development or redundancy costs. No change in staff complement is planned. |
9. Measurement | 9.1 What are the inputs that will be measured? The spend on drugs will be monitored. The gross target is a reduction in expenditure of £20m by 2007/08. |
9.2 What are the outputs that will be measured? National aggregation of local plans will establish local benchmarks in the light of the headings provided in the national co-ordinating plan. |
9.3 What is the baseline for inputs and outputs? 2004/05 provides the baseline for drugs volume and expenditure. |
10. Quality cross-check | 10.1 What quality indicators are being used to ensure that quality of service is maintained or improved? The programme is quality based and drawn on quality indicators detailed in the Audit Scotland Report of June 2003. |
11. Monitoring | 11.1 What are the arrangements for monitoring the delivery of efficiencies? Monitoring will be done in the SEHD, based on NSSISD aggregation. There is extensive data available from NHSNSS 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 NHSNSS. This will be used by NHSNSSISD to provide tailored reports for each Health Board, but in a format that is capable of aggregation to allow SEHD to monitor national progress. |
12. Reporting | 12.1 What are the arrangements for reporting the delivery of efficiencies? SEHD will agree with NHSNSSISD the form of a national monitoring report to track overall progress. |
13. Dependencies | 13.1 Explain if your efficiencies are dependent on legislation or other structural changes being achieved. No legislative changes are required. 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. |
14. Use of efficiencies | 14.1 How are the efficiencies released from improvement activity being used to improve front-line services? This efficiency saving was assumed as part of the allocation made by the Scottish Executive to NHS Boards. This freed up resources for Ministers to allocate to their priorities through NHS Boards. |