QIPP Delivery Local Incentive Scheme (LIS) for Prescribing

Size: px

Start display at page:

Download "QIPP Delivery Local Incentive Scheme (LIS) for Prescribing"

Marilynn Benson
5 years ago
Views:

1 QIPP Delivery Local Incentive Scheme (LIS) for Prescribing Introduction For a number of years the CCG has been aiming to reduce spend on prescribing towards the Surrey average ASTRO-PU1 or better. During excellent progress has been made, but there remains a gap of approximately 217,000 (1.5%) per annum (based on figures for October to December 2015, see Graph 1) compared to the Surrey average; the gap to the lowest cost CCG in Surrey is approximately 532,000 (3.8%), a reduction of around 400,000 from the same period in Graph 1 All Prescribing Net Ingredient Cost (NIC)/ ASTRO-PU: Surrey Heath CCG compared with local CCGs For the CCG has set a prescribing budget that requires practices to make QIPP savings of 500,000, which will be deducted from practices prescribing budgets. Although this is challenging, the pace of change to prescribe more cost-effectively and reduce potential waste needs to be continued to ensure that the CCG meets its financial commitments going forwards. 1 ASTRO-PU: Age Sex Temporary Resident Originated Prescribing Unit

2 To support delivery of the QIPP target, a Local Incentive Scheme (LIS) for Prescribing has been developed as a framework to support QIPP delivery at practice level. It has been agreed to continue to commit up to 1 per registered patient to the scheme and will be measured against delivery of the individual practice s differential shares of the 500,000 QIPP target. Details of the scheme are provided below. The scheme for is similar to , but will make allowances for a number of potential in-year uncertainties (see section 2.2). LocaI Incentive Scheme (LIS) for Prescribing Principles The scheme is aimed at working with the Medicines Management Team on innovative solutions to improve the cost-effective use of drugs and appliances within Surrey Heath CCG as well as supporting quality, safety and improving the patient experience. Supports fairness in prescribing across the Commissioning Group Payments will be based on achievement of the practice QIPP targets against the practice prescribing budget after adjustments for unexpected changes in costs (see section 2.2) If the CCG need to find additional savings due to in-year financial pressures these will be managed through a Financial Recovery Plan and not through adjustment to the LIS. All payments under the scheme should go into practice funds and not to individuals. The scheme rules specify that payments must be used for the benefit of patients, and, for audit purposes, practices should keep written records of expenditure For , there are a two specific factors that could significantly impact on overall prescribing costs; a description of how these will be managed is described below: 1.2 Category M generics In recent years price reductions in the cost of these commonly used drugs which represent 64% of all drugs prescribed in the CCG have generated substantial savings. For , there is little on the horizon to indicate significant windfalls from drugs losing their patent exclusivity. However, if Category M prices published for Q continue into then there could be a benefit in the region of 207,000 in the first half of Historically, these assumptions have not always been realised so this figure should be treated with some caution. It should also be noted that proposed changes to the community pharmacy contractual framework (CPCF) are indicating a 6% reduction ( 170M) in funding for , with the changes planned to occur in October It is not clear at this time where this reduction will occur as the CPCF funding is split between NHS England and CCGs (via the retained margin that is linked to category M prices). As such, there is a potential that there could be a significant changes to Category M prices mid-year. The availability of pregabalin as a generic has the potential to release around 240,000 per annum across the CCG if generics become available with the full set of licensed indications and this leads to a 70% decrease in the Drug Tariff cost. However, ongoing issues in relation to patent protection on certain licensed indications remain unresolved and means that these savings are unlikely to be released during As such it is likely that no savings can be attributed to this drug for at this time, although this could change once court proceedings are finalised.

3 Although there are uncertainties around the costs of these drugs no adjustment will be made to practice budget performance. If savings do occur through price reductions, practices will be able to utilise these savings against their QIPP target. Likewise, in the event that price changes are unfavourable, practices would be required to manage this risk. 1.3 Use of non-vitamin K antagonist oral anticoagulants (NOACs) Since 2014, NICE have issued a number of guidance documents that support the use of NOACs for the management of atrial fibrillation (AF), deep vein thrombosis (DVT), and acute coronary syndrome (ACS). In the past two years growth of these drugs has increased significantly as prescribers gain more confidence in the use of these drugs and as more patients suitable for treatment are identified. During 2016, reversibility agents for these drugs will become available, potentially alleviating concerns that has restricted there use in some patients up until now. As such, there is the potential for growth in prescribing to increase at a greater rate than before. In order to support practices to anticoagulate patients appropriately, the CCG will make an adjustment for NOAC prescribing, subject to certain thresholds (see section 2.2). 1.4 Details of the scheme An agreed practice QIPP delivery plan will act as a gateway to the scheme and must be received by the CCG by end May As in , the Medicines Management team have been working with practices to identify innovative projects in addition to the identification of prescribing efficiencies which will support the development of practice plans. A template for completing and agreeing a plan is provided. A further requirement for signing up to the LIS for Prescribing will be that a GP Practice Prescribing Lead agrees to meet with their practice support pharmacist a minimum of 4 times per year (the first meeting will be to agree the action plan). In addition the GP Practice Prescribing Lead meets with the SHCCG Prescribing Lead at least twice per year. 2. Payments The LIS for prescribing provides 1 per head of registered population to support practices to achieve the practice QIPP savings. 100% of the potential payment will be dependent on practice performance against the practice QIPP target. Payments for partial achievement will be staged as follows: Incremental conditions % achievement of 25% 40% 60% 80% 100% target % of LIS payable 18% 32% 56% 77% 100%

4 2.1 Practice target for payment The SHCCG Practice QIPP target of 500,000 will be apportioned by adjusted (weighted) cost per ASTRO-PU to practices and used for purposes of costing the savings opportunities for the action plan. The practice QIPP target will also be used to calculate achievement. Payments will be based on achievement of the following actions: Action Practice Element Development of a detailed plan explaining the actions that the practice intends to take to achieve a managed budget and agreed by the CCG in conjunction with the Medicines Management Team GP Practice Prescribing Lead agrees to meet with their practice support pharmacist a minimum of 4 times per year (the first meeting will be to agree the action plan). GP Practice Prescribing Lead meets with the SHCCG Prescribing Lead at least twice per year Achieving the practice QIPP target as measured against the practice prescribing budget after adjustments for unexpected changes in costs (see Section 2.2) e.g. expensive drugs, expensive feeds, and changes in list size [based on ASTRO- PUs]) To be received by the CCG by end May 2016 to confirm the practice s entry into the LIS for Requirement for signing up to the LIS Requirement for signing up to the LIS 1 per head of registered population. Progress towards the practice QIPP target will be paid on a pro-rata basis 2.2 Practice prescribing budget adjustments Practice prescribing budget performance will be adjusted at year end to account for both windfalls and cost pressures that are unforeseen, and outside the control of both the CCG and the practice. An adjustment will be made for the following significant unforeseen changes: Prescription Pricing Division pricing and coding errors Variation in high cost drug spend (in line with agreed high cost drugs / feeds list) Significant changes in list size measured by ASTRO-PUs, compared to CCG as a whole NOACs in order to support practices to treat appropriate patients with anticoagulants an adjustment will be made for any practice spend on NOACs equivalent to between 2.3% and 3.1% of the practice capitation based budget. The 2.3% is derived from the percentage of the total CCG budget expected to be spent on NOACs in if prescribing growth continues at the current trend (i.e. underlying growth that has been budgeted for); the 3.1% represents the likely spend if NICE guidance is fully implemented. 3. Medicines Management team support The Medicines Management team will provide clinical support and facilitation to practices, but there is an expectation that practices take responsibility for selected activities. Additional Medicines Management team support has been included to provide a pharmacist medication review service in care homes and also for practices to identify high risk/polypharmacy patients that may benefit from a medication review. The team will work with the CCG to identify data requirements with the aim to provide regular and timely updates where possible.

5 The team will support practices /CCG to resolve issues arising from external requests to prescribe medicines outside of agreed care pathways The team will support education and training for clinical and non-clinical practice staff in relation to medicines management Prescribing Support Software the MMT will continue to work closely with software providers to deliver a more focussed approach to the use of this software to generate a greater return on investment and to maximise clinical governance benefits.

CCG Policy on Primary Care Rebate Schemes (PCRS)

CCG Policy on Primary Care Rebate Schemes (PCRS) 1. Introduction A number of manufacturers have established rebate schemes for drugs used in primary care. Their motive for this could be speculated on for