Practice Based Commissioning Prescribing Meeting
-Parkwood Drive Surgery 9.2.07-

Present
Richard Gallow, Zunia Hurst, Rasila Shah, Sapana Sheth

Summary of Actions Agreed

1. The PBC Prescribing Role
The role of this PBC meeting was reiterated as not to take over the PCT Prescribing role. They should continue to work directly with practices on prescribing policy issues. The PBC, however, will agree to take action on some agreed cost effective prescribing issues. These will be described in the business plan.
These issues will be locality driven.
A  PBC Prescribing/FRP Newsletter will be produced and circulated to all GPs every 3-4 months.
A PBC Prescribing meeting will preceed this for editorial advice and to update the Business Plan.

2. Financial Recovery Plan Update

Dacorum Practices were on line to achieve the suggested prescribing budget. 
However, the Eastern Regional HA has revised this budget due to higher than expected generic costs and an excessive Acute Trust overspend. 
West Herts PCT needs to save £1 million by the end of March 2007 of which Dacorum must save £200k. This raised certain PBC issues
•	Dacorum is unlikely to support 28 days prescribing as it will only give a one off saving. This is not quality but management driven and will not help future prescribing costs. It would be difficult and expensive for Practices to undertake the date switches and reviews. Three months of confusion will occur and the patients are likely to run out of tablets during this time, creating potential dangers.
•	Two practices in Dacorum are so overspent that they could single handedly clear this deficit and probably next year’s as well. (Rothschild House and Everest House)
o	Help has been offered but refused by one practice. The other is responding only slowly to suggestions.
o	No cooperation for PPI or candesartan switch with huge overspends in both.
o	They will be left to peer pressure and for the PCTs to sort out. Nevertheless, there will be a feeling of unfairness for these Practices to excessively consume the budget but freely use the services that will be made available from the savings by the hard work of other Practices. (Would the PBC have a role in this?)

3. Current Prescribing projects supported by PBC

1.	Sartan switch is going well with some practices achieving the 90% target. The PACT data does not include those starting this in December. Savings to date should be assessed and advertised with the up to date graph in the next Newsletter (SS)
2.	Statin switch is being achieved by most practices although there are some non – co-operators. Graph in Newsletter with a big thanks to those who have cooperated and a statement of how much more could be saved if there was done full y. SS
3.	PPI switches are easy. Either Lansoprazole or omeprazole can be used but in Capsule form.  These are one third of the cost of the tablets. Newsletter SS 

4. PCT Prescribing Projects led by Eastern Region SHA

Some of these should be endorsed by the Dacorum PBC Exec and put into its Business Plan in addition to continuing support for the current projects.
They should be based on evidence and cost effectiveness to Dacorum PBC.

•	Amlodipine should only be used and not amlodipine besylate. There is no advantage and full swap would save £22k. RH &GH will not swap.
•	Switch perindopril to ramipril or lisinopril. There is no advantage, which is endorsed by the cardiologists although Elderly Care continue to use it and patients remain on it.
I believe that this could be a cost effective project, subject to ascertainment.
The work has been done to establish dose equivalents
How many patients are on perindopril in Dacorum and how much saving will the switch make? (SS)
<PWD have 52 on perindopril - @£12pm ; ramipril 5mg c £2.50pm; lisino 5mg £1.50pm. This would be saving of approx 52x£10x 13 = £6,760 per annum. PWD look after 1 in 9 of Dacorum- potential saving of £60k>
•	      Percentage of sartans to ACEIs should be <20% All new patients should be started on a ACEI. A sartan should only be used if they develop an allergic cough. Ensure not infection or ccf. Incidence of cough is 7-17% thus one would not expect to exceed 20% ratio.  Guidelines for this and explanation should be written in a newsletter… NB Perindopril has the highest recorded incidence of cough! A cost analysis of savings if adopted could be worked and the PCB could back this up if substantial.  (SS)
•	Grey List is based mainly on good prescribing so should be undertaken by the PCT but supported by PBC.

4.	Future Projects

•	Switch fosamax 70 to allendronic acid 70mg. Undertake cost analysis. If substantial, this should be on the Business plan   SS to work determine.
•	Blood glucose monitoring should not be undertaken in type 2, stable, non-insulin dependent diabetics. These should be stopped. The West Herts Diabetic Guidelines should be revisited and circulated at the time

Richard Gallow