Prescribing Quality Scheme 2017/18 In line with national policy and the Quality Premium, we are continuing to promote good antimicrobial stewardship and, therefore, include this element in an incentive scheme again. The aim of this scheme will be to improve the quality of antimicrobial prescribing through the promotion of self-care and management of minor infections, the use of back up prescriptions or no prescribing strategies, and education for both patients and clinicians to reduce the incidence of Health Care Associated Infections (HCAIs) eg C.difficile by decreasing the prescribing of high risk, broad spectrum antibiotics eg cephalosporins, quinolones and co-amoxiclav to reduce the incidence of E.Coli bacteraemia by reducing the prescribing of trimethoprim for urinary tract infections. Mandatory surveillance of Escherichia coli (E.Coli) has indicated an alarming rise in rates of E. coli bacteraemia (60.4 to 66.2 per 100,000 population from 2012-2015). A report from Public Health England found that approximately half of E.Coli bacteraemias arise from urinary tract infections. 72% of these occurred in patients >65years, and 64% of patients had reported at least one UTI in the previous 12 months. The report states that: it is it clear that a significant proportion of the rise (in E.Coli bacteraemias) may be due to patients being prescribed inappropriate antibiotics, resulting in relapsing infections. It is important that antimicrobial prescribing is appropriate and effective Resistance rates for trimethoprim, the antibiotic most commonly prescribed for the treatment of UTIs, vary from 16-67% (Oxfordshire currently has a resistance rate of 29%). In the latest Public Health England guidance, nitrofurantoin is the preferred option for the empirical treatment of UTIs in the majority of patients in a Primary Care setting. Local guidance is due to be updated shortly to reflect this change. CCG level data for these antimicrobial resistance indicators can be found on the Public Health England (PHE) Fingertips website and practice data in appendix 1 at the end of this document. Please note that the second graph just gives an indication of the level of prescribing of trimethoprim for over 70s in each practice using the baseline data (provided by NHS England). All practices will be required to reduce their use of trimethoprim in this age group by 10% (see metrics below and third graph) Sara Wilds, Head of Medicines Optimisation and Urgent Care and Louisa Griffiths, Medicines Optimisation Pharmacist. June 2017
Updated prescribing dashboard metrics proposed for 2017/18: a) Antimicrobials items per STAR PU to be below 0.52 (the OCCG average for Q3 and Q4 2013/14) PLUS high risk antimicrobial items (cephalosporins, quinolones and co-amoxiclav) as a % of all antimicrobial items to be < 11.3% (national average 2013/14) This target will be measured using total figures for Q3 and Q4 i.e. Oct 2017 - Mar 2018. b) NEW for 2017/18 Antimicrobial prescribing in UTI (In line with Quality premium 2017/18) Trimethoprim to nitrofurantoin ratio : target 1.04 (based on a 10% or greater reduction compared with CCG baseline June 15 May 16) Trimethoprim items prescribed to patients aged 70 or over (When data available via EPACT 2): Target a 10% (or greater) reduction compared with practice baseline Jan-Dec 16 This target will be measured using figures for June 17 May 18 Practices will be able to track their progress on the Prescribing Dashboard There will be an exception reporting mechanism in place for these antimicrobial elements which will require details and evidence to be supplied by the practice and considered by the Medicines Optimisation team and programme board. Payment and funding As in previous years, the scheme will be funded through a top slice from the prescribing budget and the maximum payment available will be 0.40 per patient (using practice population data at January 2018. The split will be as follows: Element a: antibacterial items per STAR PU PLUS % high risk antimicrobials Element b: prescribing in UTI Total 0.20 per registered patient 0.20 per registered patient 0.40 per registered patient Practice use of Incentive scheme payment Previous DH interim guidance on Strategies to Achieve Cost-Effective Prescribing (June 2007 Gateway reference 8313) stated that: All payments under a [prescribing incentive] scheme should go into practice funds and not to individuals. It is good practice to specify the use of the money, e.g. for the benefit of patients of the practice. These principles have been used and adopted. Any queries will be arbitrated by the Medicines Optimisation Programme Board or equivalent. Sara Wilds, Head of Medicines Optimisation and Urgent Care and Louisa Griffiths, Medicines Optimisation Pharmacist. June 2017
Appendix 1 Sara Wilds, Head of Medicines Optimisation and Urgent Care and Louisa Griffiths, Medicines Optimisation Pharmacist. June 2017
Sara Wilds, Head of Medicines Optimisation and Urgent Care and Louisa Griffiths, Medicines Optimisation Pharmacist. June 2017
Sara Wilds, Head of Medicines Optimisation and Urgent Care and Louisa Griffiths, Medicines Optimisation Pharmacist. June 2017