My practice's project to reduce any stockpiles of repeat medication that patients have at home has proved highly successful. Set up under practice-based commissioning (PBC) it ran from January to March 2008 and produced drugs budget savings of £207,000. It is a scheme that other PCTs and practices could easily copy.
My practice is in Margate, Kent and this particular scheme was a version of one we tried some years ago after a relative of an elderly patient who had died at home brought in several carrier bags full of unopened medication.
The core part of the project we then set up was getting our patients to provide us with details of how much of the repeat medication requested they already had. We then adjusted the amounts of each item on their next repeat prescription to take into account the amounts they had at home.
In a year we saved over £20,000 on our drug budget and were allowed to spend 75 per cent of the savings in the practice as part of that year's prescribing incentive scheme.
The following year we helped a neighbouring practice make similar savings. But then the incentive scheme rules changed and the reward element was no longer available.
Practice-based commissioning (PBC) then came along and has allowed us to develop the project further. We approached our PCT (Eastern and Coastal Kent) with a plan to help other local practices take part. The PCT was enthusiastic and agreed our business case proposal in October 2007.
We needed to agree with the PCT a way of funding the work involved. We were confident that savings would be made and the PCT approved a reward incentive payment scheme as a way of financing the project.
Of the savings generated, 60 per cent would be available to each participating practice as freed-up resources and 20 per cent would go to each practice as an incentive.
The remaining 20 per cent would go to my practice as project provider. This meant there was no financial risk for the PCT, while the practices had an incentive to run the project well and achieve savings. The method for calculating the savings achieved by participating practices needed to be endorsed by the PCT.
We agreed that the savings made would be calculated by comparing a practice's prescribing spend during the three-month period with the average of the practice's prescribing spends for the previous four quarters. The difference between the two figures would be the savings achieved.
We canvassed practices within the PCT to see which were interested in taking part. Twenty one decided to participate and we worked out a detailed project plan with each practice.
We went through the project with the GPs and staff and provided them with detailed forms and written guidance. We helped with producing information for patients and pharmacies, and explained the best ways to ensure that the project ran smoothly.
The result was confirmed savings totalling just over £207,000 made by the practices involved. There were also medicine management benefits.
For example, one patient had 600 co-codamol tablets at home; another was not taking important medication and some patients were requesting repeat prescriptions of items they no longer took.
Practices were able to flag up patients who needed a more detailed medication review. Practice staff dealing with repeat prescriptions found the project useful as a way of lining-up the amounts of each item on patients' repeat prescriptions in order to reduce the frequency of repeat requests.
As project providers, we found that PBC provided the ideal structure for promoting the project to other practices.
It had worked well at our own practice and we knew it would do so at other practices. We were able to share the positive medicine management benefits as well as freeing up resources for improved patient services under PBC.
The incentive reward payment scheme allowed the project to be self-financing.
- Dr Henry is a GP in Kent