Antimicrobial Prescribing Report. Medicines Optimisation 2012/13

Transcription

1 Antimicrobial Prescribing Report Medicines Optimisation 2012/13

2 Executive Summary Antimicrobial resistance and antibiotic prescribing, especially in relation to healthcare associated infections are key issues for CCGs. The DH report 3 published in March 2013 placed the issue of antibiotic resistance and antimicrobial stewardship centre stage and warns of a major increase in the number of bugs resistant to antibiotics. Of particular concern are MRSA and Clostridium difficile infections which remain serious threats, especially to hospital inpatients. The UK Five Year Antimicrobial Resistance Strategy sets out key challenges and areas for action in slowing the development and spread of antimicrobial resistance. The Medicines Optimisation team have already done considerable work in this area, including development of antimicrobial prescribing guidance based on HPA recommendations and audits of the appropriateness of antibiotic prescribing, however despite a positive impact, especially upon broad spectrum antibiotic prescribing, antimicrobial resistance is still on the rise. The Medicines optimisation team continues to work with GPs, local hospital trusts and infection control teams to build on this work to address antimicrobial resistance and to ensure antimicrobial stewardship remain high on the local prescribing agenda. This winter patients will be supported by an antibiotic awareness campaign as part of the Choose Well Cumbria winter programme. Other work includes the development of educational materials, the provision of comprehensive prescribing reports and working with local infection control teams. In antibacterial items increased by 3.57% (2nd lowest increase of the 13 North East CCGs) Cumbria CCG prescribing frequency compares favourably with other NE CCGs (5 th lowest) but Cumbria CCG prescribing average of 130.7items per 100 QIPP antibacterial STAR-PU is slightly higher than the England value of of the 81 practices in Cumbria (16%) participated in the antibiotic audit for QOF MM, 8 of these improved QIPP score workplan includes an improved audit, promotion of the RCGP Target Toolkit, 26 Practices (32%) have chosen to work on Antibiotic prescribing in The CCG Communications Team have developed resources to support the Cumbria winter antibiotic campaign. The aim of the material is to raise awareness among patients that antibiotics are not always the answer and to encourage patients to self care when they have a common winter illness. Recommendations - All practices should audit any Red or Amber QIPP antibacterial indicators and aim to achieve green. - All Practices should participate in a group reflective learning session &/or e-learning on antibiotic prescribing - All Practices should promote the Winter Antibiotic campaign - All Prescribers should ensure patients understand their responsibilities around compliance once an antibiotic is prescribed - Prescribers should use No prescription or delayed prescription strategies and patient information as appropriate. 2

3 Introduction Primary care is responsible for the majority of antibiotic use (80%). 40% of people consult their Doctor with an infection each year 1 and about one-quarter will present with an acute respiratory tract infection (RTI) which in turn accounts for 60% of antibiotics prescribed 2. This prescribing pattern encourages people to consult again when they have similar symptoms. The DH report 3 published in March 2013 from The Chief Medical Officer placed the issue of antibiotic resistance and antimicrobial stewardship centre stage and warns of a major increase in the number of bugs resistant to antibiotics. The UK Five Year Antimicrobial Resistance Strategy sets out key challenges and areas for action in slowing the development and spread of antimicrobial resistance, based around 3 strategic aims: 1. Improve the knowledge and understanding of antimicrobial resistance 2. Conserve and steward the effectiveness of existing treatments 3. Stimulate the development of new antibiotics, diagnostics and novel therapies Key actions for primary care highlighted by this strategy continue to involve: Only prescribing antibiotics in situations where they are clearly indicated Appropriate choice of antibiotic if an agent is actually required Ensuring patients understand their responsibilities around compliance once an antibiotic is prescribed Of particular concern are MRSA and Clostridium difficile infections which remain serious threats, especially to hospital inpatients.nhs organisations have been mandated to implement national guidance that includes restriction of broad spectrum antibiotics, and in particular second and thirdgeneration cephalosporins, quinolones, co-amoxiclav and clindamycin, often referred to as the 4Cs. The prescribing of quinolones (e.g. ciprofloxacin) is a particular cause for concern. Resistance to quinolones is increasing at a considerable rate. Extended Spectrum Beta-Lactamases (ESBL s) producing Escherichia coli (E.coli) and Klebsiella are also becoming problematic especially in UTI s. Most ESBLproducing E. coli are resistant to cephalosporins, penicillins, quinolones, trimethoprim, tetracycline and some other antibiotics, leaving very limited options for oral treatment in the community. The Medicines Optimisation team continue to raise awareness among prescribers of the high volume antibiotic prescribing in Cumbria and support good prescribing practice with audit tools, quarterly antibacterial prescribing reports, QIPP comparators and the annual winter antibiotic campaigns. In 2008/9 Cumbria was the 3 rd highest prescriber of antibiotics (by volume) in the North West with few practices comparing favourably against the national and North of England averages, by 2011/ 12 Cumbria had improved to the 8 th highest and was below the North West and England averages. In 2011/12 Antibacterial items reduced by 2.43% compared to previous year In antibacterial items increased by 3.57% ( 2 nd lowest of the 13 North East CCGs) 3

4 The Regional RDTC Antibacterial report now compares Cumbria with North East CCG s (13) North East & Cumbria CCG antibacterial prescribing frequency Cumbria CCG prescribing frequency compares favourably with other NE CCGs (5 th lowest), but slightly above the England prescribing frequency. North East & Cumbria CCG antibacterial prescribing frequency North East & Cumbria CCGs: Weighted prescribing frequency of antibacterial drugs - April 2010 to March Items per 100 QIPP antibacterial STAR-PU Cumbria Darlington Durham Dales, Easington & Sedgefield Gateshead Hartlepool & Stockton Newcastle North and East Newcastle West North Durham North Tyneside Northumberland South Tees South Tyneside Sunderland Teaching North of England England Cumbria Q1 1011Q2 1011Q Q1 1112Q2 1112Q Q1 1213Q2 1213Q This shows seasonal variations as well as prescribing trends. Cumbria mirrors other Northern CCGs. copyright RDTC

5 Cumbria Antibiotic Prescribing trend 45,000 42,500 Antibiotic Prescribing , Number of Prescriptions 37,500 35,000 32,500 32, ,000 30,639 27,500 25,000 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec This graph shows the increasing number of antibacterial prescriptions prescribed. In April ,928 items were prescribed compared to 30,639 in April 2012, an increase of 2,289 items (7.47%) Broad Spectrum Antibiotic Prescribing /6 Q1 2006/7 Q2 2006/7 Q3 2006/7 2006/7 Q1 2007/8 Q2 2007/8 Q3 2007/8 2007/8 Q1 2008/9 Q2 2008/9 Q3 2008/9 2008/9 Q1 2009/10 Q2 2009/10 Q3 2009/ /10 Q1 2010/1 Q2 2010/1 Q3 2010/1 2010/1 Q1 2011/2 Q2 2011/2 Q3 2011/2 2011/2 Q1 2012/3 Q2 2012/3 Q3 2012/3 2012/3 Q1 2013/4 Month % of all antibiotics prescribed Cephalospori Co-amoxiclav Quinolones This graph Illustrates the fall in prescribing of the 3 Cs-broad spectrum antibiotics Cephalosporins has decreased significantly. - During there was a further drop of 0.42% 3.98% 3.56% Co-amoxiclav has shown no recent decrease but a small increase - During an increase of 0.30% 3.72% 4.02% Quinolones have shown a smaller decrease. - During a further drop of 0.09% 1.70% 1.61% However,Q is showing an increase in prescribing of all 3 high risk broad spectrum antibiotics. 5

6 The RDTC report April 2013-March compares Cumbria CCG with the other 12 North East CCGs Cumbria ranking ( 13 CCGs) Macrolides 2 nd highest Quinolones 3 rd highest Cephalosporins 5 th highest Co-amoxiclav 8 th highest Minocycline 5 th highest Topical antibiotics 6 th highest Clindamycin 3 rd lowest Tetracyclines 2 nd lowest Y:\Docs\antibiotics\ 2013\Annual Report\C The report shows there is further improvement to be made in the prescribing of all broad spectrum antibiotics including macrolides as well as volume of all antibiotics prescribed. Please refer to RDTC report for further detail on prescribing of broad spectrum antibiotics. A recent Guardian newspaper article 4, includes an interactive digital map and shows the areas where GPs are most, or least, likely to give a patient a prescription for antibiotics. The area which prescribed antibiotics the most was Newcastle West clinical commissioning group (CCG). The incidence rate of prescribing by GP surgeries there was 8.4%. Cumbria CCG rate was 7.2% By contrast, GP practices in Camden, north London, prescribed antibiotics the least. incidence rate was just 4% for There is a pronounced North/South divide, with Northern GPs much more likely to prescribe antibiotics than their Southern counterparts. Ambler's research 4 shows that 69% of northern CCG areas prescribe more than the national average, compared with 39% of southern ones. QOF Audits The Practices used the QIPP indicators as a measure for the QOF MM audits. 1. Antibacterial items STAR-PU (lower the better) 2. Cephalosporin & Quinolones % items (lower the better) 3. 3 days Trimethoprim ADQ/item (lower the better) 13 of the 82 Cumbria GP practices (16%) chose to audit antibiotic prescribing.highest participating locality was Allerdale, the lowest was Furness. Copeland locality Catherine St & Lowther Allerdale locality Oxford St, Bank St, Maryport & Dalston Carlisle Locality Longtown, Stanwix & Fusehill Eden locality Glenidding & Court Thorn South Lakes Lunesdale & Sedbergh Furness no practices 6

7 Antibiotic QIPP comparators Locality Performance % Cephalosporins & Quinolones 3 days trimethoprim ADQ/item 2011/ /13 change 2011/ /13 change Baseline Q1 2012/ /13 change LOCALITY ALLERDALE CARLISLE COPELAND EDEN FURNESS SOUTH LAKES CUMBRIA average % Cephalosporins & Quinolones 3 days trimethoprim QDA/item baseline baseline baseline 2011/ / / / / / / / /14 England / PCT 75thcentile n/a England / PCT - 25th centile n/a England average n/a the QIPP comparators for show Carlisle, Copeland & Furness are the highest prescribers of antibiotics by volume. Eden is the lowest. Furness, South Lakes & Copeland are the highest prescribers of Cephalosporin and Quinolones %. Carlisle is the lowest. Furness % Cephalosporin and Quinolones have increased from Amber Red Furness is also the highest prescriber of longer courses of Trimethoprim but has decreased from Red Amber. Allerdale is the lowest. Locality Performance-charts England average England / PCT - 25th centile England / PCT 75thcentile CUMBRIA average SOUTH LAKES FURNESS EDEN COPELAND CARLISLE ALLERDALE Antibacterial items STAR PU change 2012/ /12 7

8 % Cephalosporins & Quinolones England average England / PCT - 25th centile England / PCT 75thcentile CUMBRIA average SOUTH LAKES FURNESS EDEN COPELAND CARLISLE ALLERDALE change 2012/ /12 3 days trimethoprim ADQ/item England average England / PCT - 25th centile England / PCT 75thcentile CUMBRIA average SOUTH LAKES FURNESS EDEN COPELAND CARLISLE ALLERDALE change 2012/ /12 Practice Results (See table on next page for more detail) Antibacterial items/star PU Longtown achieved a significant reduction from STAR PU, a 47% decrease and has moved from being the highest antibiotic prescribing practice in Cumbria Red Amber Stanwix Medical Practice has improved Red Amber Oxford St improved still Red Catherine St & Lowther Medical Practice figures increased from and still Red Fusehill Medical improved from still Red Dalston Surgery small reduction from still Red % Cephalosporin and quinolones Glenridding, Bank St and Maryport achieved Green indicators Fusehill Medical improved from Red Amber Bank st improved from Red Amber Dalston Surgery improved from 8.62% 6.00% Red Amber 3 days trimethoprim ADQ/items Court Thorn moved from Red Green Sedbergh moved from Amber Red Lunesdale surgery is still Red 8

9 Indicator Lower the Better Oxford ST Stanwix Longtown Lowther Catherine St Dalston Fusehill Practice Results QIPP Practice Dashboard January to March 2013 Baseline Current Quarter Previous Quarter Upper Quartile Target Lower Quartile Target Locality PCT England Change Previous Quarter Cephalosporins & Quinolones % items Bank St Cephalosporins & Quinolones % items Glenridding Cephalosporins & Quinolones % items Maryport Cephalosporins & Quinolones % items Fusehill Cephalosporins & Quinolones % items Dalston 3 days Trimethoprim ADQ/item Court Thorn Surgery 3 days Trimethoprim ADQ/item Sedbergh 3 days Trimethoprim ADQ/item Lunesdale

10 Locality & GP Practice Results Cephalosporins & Quinolones % items ALLERDALE QIPP INDICATORS 2012/ /12 % change 2012/ /12 A82014-CALDBECK SURGERY A82014-CALDBECK SURGERY A82028-CASTLEHEAD MEDICAL CENTRE A82028-CASTLEHEAD MEDICAL CENTRE A82029-THE CROFT SURGERY A82029-THE CROFT SURGERY A82063-BANK STREET SURGERY A82063-BANK STREET SURGERY A82022-DALSTON MEDICAL GROUP A82022-DALSTON MEDICAL GROUP A82045-WIGTON GROUP MEDICAL PRACTICE A82045-WIGTON GROUP MEDICAL PRACTICE A82623-SOLWAY HEALTH SERVICES A82623-SOLWAY HEALTH SERVICES A82021-CASTLEGATE SURGERY A82021-CASTLEGATE SURGERY A82037-SILLOTH GROUP MEDICAL PRACTICE A82037-SILLOTH GROUP MEDICAL PRACTICE A82047-JAMES STREET GROUP PRACTICE A82047-JAMES STREET GROUP PRACTICE A82032-MARYPORT HEALTH SERVICES A82032-MARYPORT HEALTH SERVICES A82057-DERWENT HOUSE SURGERY A82057-DERWENT HOUSE SURGERY A82049-ORCHARD HOUSE SURGERY A82049-ORCHARD HOUSE SURGERY A82055-ASPATRIA MEDICAL PRACTICE A82055-ASPATRIA MEDICAL PRACTICE A82050-OXFORD STREET SURGERY A82050-OXFORD STREET SURGERY A82048-BEECHWOOD GROUP PRACTICE A82048-BEECHWOOD GROUP PRACTICE AVERAGE AVERAGE % change

11 Cephalosporins & Quinolones % items CARLISLE QIPP INDICATORS % % 2012/ /12 change 2012/ /12 change A82015-WARWICK ROAD SURGERY A82015-WARWICK ROAD SURGERY A82012-BRAMPTON MEDICAL A82012-BRAMPTON MEDICAL PRACTICE PRACTICE A82019-FUSEHILL MEDICAL PRACTICE A82019-FUSEHILL MEDICAL PRACTICE A82635-GROSVENOR HOUSE A82635-GROSVENOR HOUSE SURGERY SURGERY (W) (W) A82020-EDEN MEDICAL GROUP A82020-EDEN MEDICAL GROUP A82052-STANWIX MEDICAL GROUP A82052-STANWIX MEDICAL GROUP A82017-BRUNSWICK HOUSE A82017-BRUNSWICK HOUSE MEDICAL MEDICAL GROUP GROUP A82654-GROSVENOR HOUSE A82654-GROSVENOR HOUSE SURGERY SURGERY (A) (A) A82641-GROSVENOR HOUSE A82641-GROSVENOR HOUSE SURGERY SURGERY (F) (F) A82016-ST PAULS PRACTICE A82016-ST PAULS PRACTICE A82018-SPENCER ST SURGERY A82018-SPENCER ST SURGERY A82646-LONGTOWN MEDICAL CENTRE A82646-LONGTOWN MEDICAL CENTRE AVERAGE AVERAGE

12 Cephalosporins & Quinolones % items COPELAND QIPP INDICATORS % % 2012/ /12 change 2012/ /12 change A82023-DISTINGTON SURGERY A82023-DISTINGTON SURGERY A82075-MANSION HOUSE A82075-MANSION HOUSE SURGERY SURGERY A82024-SEASCALE HEALTH A82024-SEASCALE HEALTH CENTRE CENTRE A82064-WESTCROFT HOUSE A82064-WESTCROFT HOUSE SURGERY SURGERY A82060-TRINITY HOUSE A82060-TRINITY HOUSE SURGERY SURGERY A82040-CATHERINE STREET A82040-CATHERINE STREET SURGERY SURGERY A82044-FELLVIEW HEALTHCARE A82044-FELLVIEW HEALTHCARE LTD LTD A82058-QUEEN STREET MEDICAL A82058-QUEEN STREET MEDICAL PRACTICE A82041-LOWTHER MEDICAL CENTRE PRACTICE A82041-LOWTHER MEDICAL CENTRE AVERAGE AVERAGE

13 EDEN QIPP INDICATORS Cephalosporins & Quinolones % items 2012/ /12 % change 2012/ /12 A82620-GLENRIDDING HEALTH CENTRE A82620-GLENRIDDING HEALTH CENTRE A82031-SHAP MEDICAL PRACTICE A82031-SHAP MEDICAL PRACTICE A82617-KIRKOSWALD SURGERY A82617-KIRKOSWALD SURGERY A82036-THE LAKES MEDICAL PRACTICE A82036-THE LAKES MEDICAL PRACTICE A82038-TEMPLE SOWERBY MEDICAL PRACTICE % change A82038-TEMPLE SOWERBY MEDICAL PRACTICE A82004-ALSTON MEDICAL PRACTICE A82004-ALSTON MEDICAL PRACTICE A82035-BIRBECK MEDICAL GROUP A82035-BIRBECK MEDICAL GROUP A82006-APPLEBY MEDICAL PRACTICE A82006-APPLEBY MEDICAL PRACTICE A82013-UPPER EDEN MEDICAL PRACTICE A82013-UPPER EDEN MEDICAL PRACTICE A82631-COURT THORN SURGERY A82631-COURT THORN SURGERY AVERAGE AVERAGE

14 SOUTH LAKES QIPP INDICATORS Cephalosporins & Quinolones % items 2012/ /12 % change A82026-THE JAMES COCHRANE PRACT A82026-THE JAMES COCHRANE PRACT A82642-HAWKSHEAD MEDICAL PRACTICE A82642-HAWKSHEAD MEDICAL PRACTICE A82613-WRAYSDALE HOUSE SURGERY A82613-WRAYSDALE HOUSE SURGERY A82608-SEDBERGH HEALTH CENTRE (LUMB) A82608-SEDBERGH HEALTH CENTRE (LUMB) A82647-CARTMEL SURGERY A82647-CARTMEL SURGERY A82046-WINDERMERE HEALTH CENTRE A82046-WINDERMERE HEALTH CENTRE P81113-PARK VIEW SURGERY P81113-PARK VIEW SURGERY A82027-STATION HOUSE SURGERY A82027-STATION HOUSE SURGERY A82053-NUTWOOD SURGERY A82053-NUTWOOD SURGERY A82065-FAIRFIELD SURGERY/PENINSULA A82065-FAIRFIELD SURGERY/PENINSULA A82003-ULVERSTON HEALTH CENTRE (MURRAY) A82003-ULVERSTON HEALTH CENTRE (MURRAY) A82025-CAPTAIN FRENCH SURGERY A82025-CAPTAIN FRENCH SURGERY A82068-ULVERSTON HEALTH CENTRE (GRAHAM) A82068-ULVERSTON HEALTH CENTRE (GRAHAM) A82650-HAVERTHWAITE SURGERY A82650-HAVERTHWAITE SURGERY A82074-ARNSIDE SURGERY A82074-ARNSIDE SURGERY A82005-AMBLESIDE HEALTH CENTRE A82005-AMBLESIDE HEALTH CENTRE A82034-STONELEIGH SURGERY A82034-STONELEIGH SURGERY A82070-ST.MARY'S SURGERY A82070-ST.MARY'S SURGERY A82030-LUNESDALE SURGERY A82030-LUNESDALE SURGERY AVERAGE AVERAGE / /12 % change 14

15 FURNESS QIPP INDICATORS Cephalosporins & Quinolones % items 2012/ /12 % change % chang 2012/ /12 e A82071-BURNETT EDGAR MEDICAL CTR A82071-BURNETT EDGAR MEDICAL CTR A82009-BRIDGEGATE MEDICAL CENTRE A82009-BRIDGEGATE MEDICAL CENTRE A82619-NELSON STREET SURGERY A82619-NELSON STREET SURGERY A82062-ATKINSON HEALTH CENTRE (WIEJAK) A82062-ATKINSON HEALTH CENTRE (WIEJAK) A82039-DALTON SURGERY A82039-DALTON SURGERY A82651-DUDDON VALLEY MEDICAL PRACTICE A82651-DUDDON VALLEY MEDICAL PRACTICE A82007-DUKE STREET SURGERY A82007-DUKE STREET SURGERY A82629-THE FAMILY SURGERY A82629-THE FAMILY SURGERY A82008-NORWOOD MEDICAL CENTRE A82008-NORWOOD MEDICAL CENTRE A82621-ASKAM SURGERY A82621-ASKAM SURGERY A82072-RISEDALE SURGERY A82072-RISEDALE SURGERY A82011-HARTINGTON STREET MEDICAL PRACTICE A82011-HARTINGTON STREET MEDICAL PRACTICE A82010-ABBEY ROAD SURGERY A82010-ABBEY ROAD SURGERY A82033-WATERLOO HOUSE SURGERY A82033-WATERLOO HOUSE SURGERY A82077-LIVERPOOL HOUSE SURGERY A82077-LIVERPOOL HOUSE SURGERY AVERAGE AVERAGE

16 GP Practice Antibiotic Prescribing Chart Jan-March 2013 Cumbria Antibiotic Prescribing 2013 Jan-March WRAYSDALE HOUSE SURGERY DERWENT HOUSE SURGERY THE JAMES COCHRANE PRACT. THE LAKES MEDICAL PRACTICE KIRKOSWALD SURGERY CARTMEL SURGERY SHAP MEDICAL PRACTICE WARWICK ROAD SURGERY CALDBECK SURGERY CASTLEHEAD MEDICAL CENTRE NELSON STREET SURGERY ST.MARY'S SURGERY CAPTAIN FRENCH SURGERY ATKINSON HEALTH CENTRE (WIEJAK) DUDDON VALLEY MEDICAL PRACTICE GLENRIDDING HEALTH CENTRE SPENCER ST SURGERY BEECHWOOD GROUP PRACTICE PARK VIEW SURGERY TEMPLE SOWERBY MEDICAL PRACTICE WINDERMERE HEALTH CENTRE GROSVENOR HOUSE SURGERY (A) BIRBECK MEDICAL GROUP ARNSIDE SURGERY UPPER EDEN MEDICAL PRACTICE APPLEBY MEDICAL PRACTICE STATION HOUSE SURGERY ORCHARD HOUSE SURGERY HAWKSHEAD MEDICAL PRACTICE LUNESDALE SURGERY BURNETT EDGAR MEDICAL CTR ULVERSTON HEALTH CENTRE (HAMBLY) PENINSULA MEDICAL PRACTICE CASTLEGATE SURGERY HAVERTHWAITE SURGERY BENTHAM MEDICAL PRACTICE NORWOOD MEDICAL CENTRE WIGTON GROUP MEDICAL PRACTICE JAMES STREET GROUP PRACT WESTCROFT HOUSE SURGERY ULVERSTON HEALTH CENTRE DALTON SURGERY BANK STREET SURGERY TRINITY HOUSE SURGERY SEDBERGH HEALTH CENTRE (LUMB) ALSTON MEDICAL PRACTICE GROSVENOR HOUSE SURGERY (W) GROSVENOR HOUSE SURGERY (F) BRAMPTON MEDICAL PRACTICE DUKE STREET SURGERY THE FAMILY PRACTICE MANSION HOUSE SURGERY SILLOTH GROUP MEDICAL PRACTICE COURT THORN SURGERY AMBLESIDE HEALTH CENTRE DISTINGTON SURGERY LONGTOWN MEDICAL CENTRE STANWIX MEDICAL GROUP ST PAUL'S MEDICAL PRACTICE SEASCALE HEALTH CENTRE NUTWOOD SURGERY ABBEY ROAD SURGERY EDEN MEDICAL GROUP OXFORD STREET SURGERY MARYPORT HEALTH SERVICES FELLVIEW HEALTHCARE LTD ASKAM SURGERY FUSEHILL MEDICAL PRACTICE ASPATRIA MEDICAL GROUP THE CROFT SURGERY STONELEIGH SURGERY SOLWAY HEALTH SERVICES DALSTON MEDICAL GROUP BRIDGEGATE MEDICAL CENTRE WATERLOO HOUSE SURGERY IRONSIDE'S FAMILY PRACTITIONERS RISEDALE SURGERY BRUNSWICK HOUSE MEDICAL GROUP HARTINGTON STREET MEDICAL CATHERINE STREET SURGERY LOWTHER MEDICAL CENTRE LIVERPOOL HOUSE SURGERY GREEN RED Items per SUB THER STAR-PU Penicillins Cephalosporins Tetracyclines Aminoglycosides Macrolides Clindamycin Other AB's Sulphonamides/TMP Antituberculars Metronidazole etc Quinolones UTI's

17 Medicines Optimisation work plan for Prescribers across Cumbria have made significant reductions in the amount of broad spectrum antibiotics prescribed; however, the 2013/14 work plan aims to support Prescribers to continue to reduce the volume of antibiotics prescribed including the broad spectrum antibiotics. Taking feedback from the 2012/13 audit into account, a user friendly antibiotic audit toolkit has been produced to support prescribers audit their own antibiotic prescribing and group reflective sessions and e-learning are being facilitated by the Medicines Optimisation Pharmacists and the Practice Medicines Managers The Medicines Optimisation audit toolkit offers 3 options: 1 Antibiotic prescribing (all) 2 Cephalosporins & quinolones 3 Urinary tract infections This audit toolkit is intended to be used by all Prescribers including Non Medical Prescribers (NMP) and will measure individual prescribing, adherence to antibiotic guidelines and practice prescribing patterns. The RCGP Target Toolkit is being promoted Cumbria wide especially to GP practices choosing to audit antibiotic prescribing Consultant Microbiologists from NCUHT and MBUHT have also offered to continue educational visits to GP practices. Recommendations - All practices should audit their antibiotic prescribing specifically any Red or Amber QIPP antibacterial indicators aiming to achieve green indicators. - All Practices should participate in a group reflective learning session &/or e- learning on antibiotic prescribing - All Practices should promote the Winter Antibiotic campaign with materials provided - All Prescribers should ensure patients understand their responsibilities around compliance once an antibiotic is prescribed - Prescribers should use No prescription or delayed prescription strategies and patient information as appropriate 17

18 26 GP Practices have chosen to work on Antibiotic prescribing in topic x Interpretation-the lower the better Baseline QIPP indicators January-March 2013/14 GP Practice Locality Antibacterial Items/STAR PU Cephalosporins & Quinolones % items 3 days Trimethoprim ADQ/Item A82028-CASTLEHEAD MEDICAL CENTRE ALLERDALE A82037-SILLOTH GROUP MEDICAL PRACTICE ALLERDALE A82014-CALDBECK SURGERY ALLERDALE A82032-MARYPORT HEALTH SERVICES ALLERDALE A82029-THE CROFT SURGERY ALLERDALE A82623-SOLWAY HEALTH SERVICES ALLERDALE A82045-WIGTON GROUP MEDICAL PRACTICE ALLERDALE A82021-CASTLEGATE SURGERY ALLERDALE A82055-ASPATRIA MEDICAL PRACTICE ALLERDALE A82047-JAMES STREET GROUP PRACTICE ALLERDALE A82063-BANK STREET SURGERY ALLERDALE A82057-DERWENT HOUSE SURGERY ALLERDALE A82049-ORCHARD HOUSE SURGERY ALLERDALE A82022-DALSTON MEDICAL GROUP ALLERDALE A82050-OXFORD STREET SURGERY ALLERDALE A82048-BEECHWOOD GROUP PRACTICE ALLERDALE A82012-BRAMPTON MEDICAL PRACTICE CARLISLE A82015-WARWICK ROAD SURGERY CARLISLE A82635-GROSVENOR HOUSE SURGERY (DR WARD) CARLISLE A82019-FUSEHILL MEDICAL PRACTICE CARLISLE A82654-GROSVENOR HOUSE SURGERY (DR WIGMORE) CARLISLE A82020-EDEN MEDICAL GROUP CARLISLE A82018-SPENCER ST SURGERY CARLISLE A82052-STANWIX MEDICAL GROUP CARLISLE A82641-GROSVENOR HOUSE SURGERY (DR FROST) CARLISLE A82646-LONGTOWN SURGERY CARLISLE A82016-ST PAULS PRACTICE CARLISLE A82017-BRUNSWICK HOUSE MEDICAL GROUP CARLISLE A82023-DISTINGTON SURGERY COPELAND A82024-SEASCALE HEALTH CENTRE COPELAND A82075-MANSION HOUSE SURGERY COPELAND A82064-WESTCROFT HOUSE SURGERY COPELAND A82060-TRINITY HOUSE SURGERY COPELAND A82040-CATHERINE STREET SURGERY COPELAND A82041-LOWTHER MEDICAL CENTRE COPELAND A82044-FELLVIEW HEALTHCARE LTD COPELAND A82058-QUEEN STREET MEDICAL PRACTICE COPELAND A82620-GLENRIDDING HEALTH CENTRE EDEN A82036-THE LAKES MEDICAL PRACTICE EDEN A82031-SHAP MEDICAL PRACTICE EDEN A82038-TEMPLE SOWERBY MEDICAL PRACTICE EDEN

19 Baseline QIPP indicators January-March 2013/14 GP Practice Locality Antibacterial Items/STAR PU Cephalosporins & Quinolones % items 3 days Trimethoprim ADQ/Item A82004-ALSTON MEDICAL PRACTICE EDEN A82617-KIRKOSWALD SURGERY EDEN A82035-BIRBECK MEDICAL GROUP EDEN A82631-COURT THORN SURGERY EDEN A82013-UPPER EDEN MEDICAL PRACTICE EDEN A82006-APPLEBY MEDICAL PRACTICE EDEN A82071-BURNETT EDGAR MEDICAL CTR FURNESS A82062-ATKINSON HEALTH CENTRE (WIEJAK) FURNESS A82619-NELSON STREET SURGERY FURNESS A82651-DUDDON VALLEY MEDICAL PRACTICE FURNESS A82007-DUKE STREET SURGERY FURNESS A82039-DALTON SURGERY FURNESS A82072-RISEDALE SURGERY FURNESS A82629-THE FAMILY SURGERY FURNESS A82009-BRIDGEGATE MEDICAL CENTRE FURNESS A82621-ASKAM SURGERY FURNESS A82011-HARTINGTON STREET MEDICAL PRACTICE FURNESS A82008-NORWOOD MEDICAL CENTRE FURNESS A82033-WATERLOO HOUSE SURGERY FURNESS A82010-ABBEY ROAD SURGERY FURNESS A82077-LIVERPOOL HOUSE SURGERY FURNESS A82026-THE JAMES COCHRANE PRACT. SOUTH LAKES P81113-PARK VIEW SURGERY SOUTH LAKES A82647-CARTMEL SURGERY SOUTH LAKES A82642-HAWKSHEAD MEDICAL PRACTICE SOUTH LAKES A82046-WINDERMERE HEALTH CENTRE SOUTH LAKES A82065-PENINSULA MEDICAL PRACTICE SOUTH LAKES A82053-NUTWOOD SURGERY SOUTH LAKES A82613-WRAYSDALE HOUSE SURGERY SOUTH LAKES A82027-STATION HOUSE SURGERY SOUTH LAKES A82650-HAVERTHWAITE SURGERY SOUTH LAKES A82025-CAPTAIN FRENCH SURGERY SOUTH LAKES A82074-ARNSIDE SURGERY SOUTH LAKES A82608-SEDBERGH MEDICAL PRACTICE SOUTH LAKES A82003-ULVERSTON HEALTH CENTRE (MURRAY) SOUTH LAKES A82068-ULVERSTON HEALTH CENTRE (GRAHAM) SOUTH LAKES A82005-AMBLESIDE HEALTH CENTRE SOUTH LAKES A82030-LUNESDALE SURGERY SOUTH LAKES A82034-STONELEIGH SURGERY SOUTH LAKES B82061-BENTHAM MEDICAL PRACTICE SOUTH LAKES A82070-ST.MARY'S SURGERY SOUTH LAKES CCG average England / CCG - 75th centile * England / CCG- 25th centile * England average

20 CCG Communications Team Winter Antibiotic Awareness Campaign Following discussions with GPs, Practice Nurses and Pharmacists, the Communications team have produced patient materials to support the winter antibiotic campaign. Initially Stanwix Surgery in Carlisle and practices in the Furness area will pilot the draft materials and if successful the materials will be available to all practices in The aim of the campaign is to raise awareness among patients that antibiotics are not always the answer and to encourage patients to self care when they have a common winter illness. Posters and Non-prescription pads are being produced with a Keep Calm theme and distributed to all GP practices in Cumbria. Community pharmacies will receive posters and door stickers. In addition, a wider campaign to support patients this winter Choose well Cumbria is underway which encourages patients to choose the most appropriate care setting this winter. References 1. Chief Medical Officer. Getting Ahead Of the Curve. DH NICE guidance

21 Contact details: Melanie Graham Medicines Optimisation Pharmacist for NHS Cumbria CCG, Eden locality, North of England Commissioning Support (NECS), 4 Wavell Drive Rosehill Industrial Estate, Carlisle Cumbria.CA2 2SE Mobile: melanie.graham@cumbriapct.nhs.uk. 21