A clinical commissioning group (CCG) reports that sharing good practice enabled it to cut its prescribing costs by nearly 10% in 2011-12, yet its prescribing rates for some drugs actually increased.
Providing GP practices with information on how their prescribing compared with both their peers and practices nationally has proved a great motivator for change, said Stephen Kell, chair of Bassetlaw CCG, reporting the initiative's success in a new study, Clinical Commissioning in Action, which features 12 case studies of how CCGs are already making a difference to their patients.
Bassetlaw CCG's best practice initiative, which sought to ensure that prescribing is appropriate and efficient, created a £1.5 million saving which has allowed for investment in other services such as paediatrics locally, the report notes.Prescribing leads were appointed from among Bassetlaw’s GP practices to lead work on where prescribing could be more efficient and of better quality. The initiative reduced the prescribing of some drugs - including a 60% drop for cephalosporin and quinolone antibiotics, which in turn led to a decrease in community-acquired clostridium difficult cases - but also increased levels of prescribing for some drugs such as statins, as GPs became more convinced of the evidence base of their efficacy for more patients.
Another study in the report shows how Rushcliffe CCG reduced emergency hospital admissions for patients with chronic obstructive pulmonary disease (COPD) from around 900 in 2009-10 to less than 700 in 2011-12. This was achieved through development of an integrated COPD service which covers patients from screening and diagnosis, through management in the community to hospital care.
The project has included working with a pharmaceutical company which provided a COPD nurse to work with practices which have a high rate of COPD-related emergency admissions. The nurse provided support and improved management of patents identified as high-risk, and also worked with practice nurses.
The report has been produced by NHS Clinical Commissioners (NHSCC), which is a coalition of the National Association of Primary Care (NAPC) and the NHS Alliance, working in partnership with the NHS Confederation. Its case studies cover a range of issues including end-of-life care, patient access, referrals, working with secondary care and service redesign, and show how CCGs have engaged with clinicians, partners, secondary care colleagues, patients and other stakeholders to find solutions to local needs and challenges, says the NHSCC.
NHS Confederation chief executive and NHSCC steering group member Mike Farrar described Clinical Commissioning in Action as "a valuable snapshot of work being carried out by emerging CCGs across the country, even before they are fully up and running."
Dr Mike Dixon, chair of the NHS Alliance and interim president of the NHSCC, added that many CCGs already have good stories to tell about the positive impact clinical engagement is having on the ground, particularly improvements to patient care and experience. "Clinical commissioning has a huge potential to bring real transformation to the NHS and better outcomes for patients," he said.