Prescribing & Medicines Management
page PM4
June 2005

Features

Making improvements across an SHA

The Audit Commission’s fitness for purpose audits carried out in December 2003 identified prescribing as a key area for improvement within strategic health authorities (SHAs). The report revealed that despite prescribing being a key risk area, there was minimal pharmacy input in many SHAs. Performance management was often limited to prescribing spend. In addition support from primary care trust prescribing teams was limited and it was difficult to tackle prescribing issues (such as the use of expensive, new drugs that affect the whole health community) in a cost-effective, equitable manner.

The challenge

South Yorkshire Strategic Health Authority was formed in 2002 to serve the 1.32 million inhabitants of Barnsley, Doncaster, Rotherham and Sheffield. It covers nine PCTs, four hospital trusts and two care trusts and encompasses an area that, as a whole, is one of the most deprived parts of the UK. The challenge was to promote a region-wide approach to medicines management at a time when the focus of PCTs was very much confined to local needs. The only way to do this was to adopt a facilitative approach to encourage organisations to work together on a common agenda.

Establishing a forum One of us (SA), formerly head of medicines management at a PCT within the region, was appointed the SHA’s prescribing adviser. The post is part-time (two and a half days per week) and started with pretty much a blank canvas. Without a team to help implement recommendations the only way to progress was to rely on the full co-operation of all the trusts and their medicines management teams.

A prescribing leads group, which had previously existed but had failed to provide any substantial outcomes or agreements, was re-established. The aim of the group was to facilitate a uniform approach to the development and implementation of prescribing policies across South Yorkshire. Each PCT, hospital trust and community area prescribing committee was represented on the group. Critical to the effectiveness of the group was to maintain a clear focus, high status and the commitment of all the members to drive the agenda. To ensure this, group practice was to report to the PCT chief executives forum. The group is also co-chaired by a PCT chief executive and the director of public health and clinical engagement at the SHA. The role of the SHA prescribing adviser is to co-ordinate group activity using a facilitative approach (see Panel 1), to share best practice and to encourage collaboration.

The prescribing leads group sets the agenda so that its actions are “owned” by the members and the organisations they represent. Each organisation still has flexibility to prioritise and pursue its own agenda, while working alongside the wider group.

Medicines management framework The group’s first step was to develop a framework for medicines management that each organisation would sign up to. This consisted of the following four elements:

· An annual self assessment of prescribing and medicines management
· Action on key therapeutic areas
· Improved procurement of medicines
· Joint working of area prescribing committees

Self assessment The group developed a self-assessment questionnaire to allow PCTs to review the processes and systems they have in place to optimise medicines management and to identify any areas requiring further action. This tool complements others, such as those produced by the National Primary and Care Trust Development Programme.

Action on key therapeutic areas The group identified a number of key therapeutic areas for action (see Panel 2), including optimising generic prescribing. The next step was to agree the most effective approach to take to tackle these. The group agreed to produce recommendations for each area in the form of prescribing statements and each organisation is responsible for the prioritisation and implementation of these statements as appropriate.

The SHA provides support by funding printing costs and local meetings, and supplying literature. Although these drug areas and messages are not necessarily new, for the first time all PCTs and hospitals across the region are working together towards the same goals.

Improved procurement A number of areas where improved procurement through a common approach across South Yorkshire could result in significant savings were identified (eg, oral nutrition, stoma care, Helicobacter pylori test kits and nicotine replacement therapy). We are working alongside the South Yorkshire Supply Management Confeder-ation to take this work forward.

Prescribing committees A major piece of work being tackled by the prescribing leads group is to review the “traffic light” prescribing lists across the region with the aim of producing a single agreed list. This involves co-operation between area prescribing committees. The prescribing leads group has provided an excellent forum for this.

The future

Advantages to working together in this way include:

· The opportunity to share best practice and learn from each other
· Consistency in clinical practice which, it is hoped, will lead to improved patient care
· Greater negotiating power as a group

The project is still in its early stages and there is a long way to go before it meets its aims but, so far, the results are encouraging and the prescribing leads group seems to be working well. Many challenges lie ahead, and it will be interesting to see how the relationship between the SHA, foundation trusts and PCTs develops.

It is hoped that despite any forthcoming organisational changes, a community approach can continue. There is potential for real value to be added to medicines management across the region and thus make a difference for patients.