This document summarizes strategies used by a primary care trust in England to influence prescribing in primary care. Key factors for success included strategic coordination through prescribing committees, tailored implementation with pharmacist support tailored to each practice, and clinical engagement at all levels. An example statin switch program demonstrated how evidence-based review, consensus-building, comprehensive support materials, and regular reinforcement of messages can successfully implement a prescribing change. Current issues include structural NHS reforms and maintaining initiatives amid new priorities around waste reduction and improving quality and productivity.

1. Influencing Prescribing in Primary
Care in the NHS
Janice Steele
Primary Care Pharmacist

2. Croydon Primary Care Trust
150 PCTs in England
Population of Croydon 340,000
65 GP surgeries
66 community pharmacies
Primary care drugs budget £45million

3. Local Health Issues
Inequalities gap in life expectancy
High black and minority ethnic group
population
3 biggest killers
– Circulatory disease
– Cancer
– Respiratory disease

4. History
Prescribing advice pilot 1998
Team expanded 1999
Dual quality and cost effective prescribing
agenda
IT developments
Relationship building
Infrastructure
National Initiatives NICE , NPSA, QuOF

5. Key factors for success
Strategic co-ordination
Tailored implementation
Clinical engagement at all levels
Communication
Well trained workforce

6. Strategic co-ordination
Area prescribing committee
– Clinical representatives from acute hospitals
– Chaired by public health consultant
– Members of the public
– Links to networks and sectors
Primary Care Prescribing Group
– Agree practical implementation of annual
workplan

7. Tailored implementation
9 pharmacists provide tailored support
Annual visits - present data, discuss issues,
agree priorities to work on +/- support
Quarterly data provided to monitor progress
Comprehensive information packs developed
for each therapeutic area
Query answer service on individual patient
medicine management issues

8. Clinical Engagement
Prescribing lead
Clinical opinion leaders
Peer pressure/ use of comparative graphs
Incentive scheme
Consistent use of the evidence base
Long term issues not just quick financial wins
Supportive
Look at prescribing processes as well as drugs

9. Communication
Newsletters
Reinforcement at practice meetings
Teaching sessions
Website
Prescribing support tools
Patient information material

10. Example- Statin switch programme
Horizon scanning
Extensive review of the evidence
Explicit about risks as well as financial gains
Agreement by key committees
Presented to group of opinion leaders-consensus
Prepared support pack
Anticipated common questions/concerns
Patient information leaflet
Looked at clinical outcomes as well as financial

11. Statins continued
Intervention form- standard approach
Communication with community pharmacists
Contact number for queries
Replicated pharmaceutical industry approach
Trained workforce
Piloted material
Incentive scheme
Targeted outliers
Messages reinforced regularly- newsletters , visits

22. Current Issues
Structural reform of the NHS
GP commissioning consortia
New initiatives + old ones to maintain
– Waste
– Reducing patient admissions
– Improving patient compliance
– QIPP quality, innovation, PRODUCTIVITY,
prevention