Challenge
Wirral CCG wastes an estimated £2.2 million every year on unused or partially used medication. Wirral CCG asked MLCSU Medicines Management and Optimisation (MMO) team to implement changes to the way repeat medicines are ordered locally and reduce the amount of wasted medicines locally. We were asked to replicate and learn from successful schemes at Luton CCG and South Sefton CCG to change repeat prescribing systems in Wirral.
We facilitated the successful implementation of the pilot at eight GP practices, supporting stakeholders to implement the changes required in a safe and effective manner. The aims of the pilot were to reduce the high cost of wasted medicines to the local NHS and to improve patient safety issues due to stockpiling medication.
Solution
We implemented the ‘Patient Led Repeat Ordering Pilot’ with Wirral CCG in November 2016 to empower patients to directly order their own medicines from their GP practice. Eight practices opted into the five month pilot including a total of 29,514 patients who were prescribed repeat medication. The third party ordering option via pharmacies was removed for the majority of patients. A small percentage of patients were identified, by the practice or pharmacy, as unable to order their own repeat medication and were excluded from the pilot and so continued to order their medicines through the pharmacy.
We provided bespoke support to the eight pilot practices, including face-to-face briefings, in-depth practice staff training, expertise and support within the practice, particularly on ‘go live’ dates, dealing with individual patient and pharmacy concerns. Wirral CCG funded the cost of writing to patients and producing posters for surgeries and community pharmacies. A variety of resources were produced by the MMO team to support practices in their interactions with patients, carers and their patient participation groups.
We liaised with the Local Pharmaceutical Committee (LPC) prior to the pilot commencement to discuss plans for implementation and the dissemination of communications to community pharmacies. During the initial phase of the pilot we visited a number of community pharmacies situated near to the pilot practices. Throughout the pilot, we regularly liaised with the Wirral LPC representative to ensure the committee was kept involved and up-to-date, including any issues or concerns raised from pharmacies.
We provided expertise and leadership to implement this project in conjunction with Wirral CCG team.
Impact
Findings from the pilot showed a reduction in spend on medicines resulting from a significant reduction in the number of items issued, which correlates with associated improvements in patient safety and quality.
The average numbers of items prescribed on a monthly basis, in each practice, after the implementation of the pilot were significantly reduced compared to the period prior to implementation. On average 2,500 fewer scripts were issued each month as a total for all eight practices.
Item growth within the eight participating practices was reduced, with an average for the participating practices of -1.2% in 2016/17 (when compared to 2015/16) against the overall CCG items growth for 2016/17 of 1.6% – a variance of -2.8%.
Practices involved the pilot were also compared to a group of local practices with a similar patient demographic. These controls showed no growth reduction in the same period.
Each practice’s average cost per item (ePACT) was used to estimate a cost saving. The total estimated cost reduction across all eight practices was £20,824 per month. This equates to approximately £104,000 for the five months of the pilot. The eight practices cover 20% of the total Wirral population.
Please see the full pilot evaluation report at: https:\/\/emsplus.midlandsandlancashirecsu.nhs.uk//emsplus.midlandsandlancashirecsu.nhs.uk//www.wirralccg.nhs.uk/media/3793/final-patient-led-repeat-ordering-pilot-evaluation-oct-2017v3final.pdf
Testimonial from Dr David Thomas, GP Partner, Upton Group Practice:
“It is anecdotally reducing our workload and costs. I am keen to see the actual cost savings but believe that the project has been worthwhile, I am glad that we volunteered as a pilot site and would strongly recommend that the project is rolled out Wirral-wide.”
Testimonial from Dr Sian Stokes, GP, The Village Medical Centre and CCG GP Lead for Long Term Conditions:
“Our practice was keen to be involved in the pilot as we were aware that many of our patients were receiving medication that they didn’t always require. This is not only wasteful but a safety concern as patients may end up with a stockpile of medication which can lead to confusion… Many more patients have signed up for online ordering, which they generally find more convenient.”
Testimonial from Phil McGunigall, Practice Manager, Civic Medical Centre and CCG Practice Manager Lead:
“We have saved around £6k per month our prescribing budget which is fab for us and the wider health economy. From a practice perspective we have had some gains that where not obvious at the beginning – our online registration patient numbers have increased by 20%. NHS England contacted us to ask what we had done to get such an increase in sign-up for online access!”
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