Agenda item

Stuart Lakin, Head of Medicines Management, Rotherham Clinical Commissioning Group, presented a report on the work taking place in Rotherham to reduce pharmaceutical and medical waste as identified in the Select Commission’s 2013-14 work programme.

The report highlighted that in Rotherham:-

Summary of Savings

-          Nationally 10.7% (£831,292,864.99 per annum) of prescribing expenditure was on appliances (continence/stoma), nutritional supplements and wound care products – Rotherham had managed to significantly decrease the cost whilst improving the patient experience

-          Estimating that if Rotherham’s nutritional expenditure had increased in line with national cost growth trends since the service redesign – then spending would have been 89% higher, a potential saving of £468,125 per annum

-          Continence prescribing costs had decreased in Rotherham by -8.99%

-          Management of gluten free products through prescribing by the dietician had resulted in a -19.61% decrease

-          Stoma prescribing costs had decreased from £964,687 in 2011/12 to £748,159 in 2012/13 (-22.45%)

-          The above savings had been achieved by the improved management of prescriptions and regaining prescribing of appliances from the Direct Appliance Contractors – estimated savings of £1,094,753 against Rotherham’s 2012/13 prescribing costs

Reducing Waste

-          Patients understood that excess medicines was a waste of NHS resources

-          Approximately 300 patient questionnaire had been sent directly to patients in 2012 but had not revealed waste as an extensive problem nor identify any causes of waste

-          Continence and stoma patients reported receipt of unrequired products or surplus quantities – requests to practices to change the prescription/appliance companies went unheeded.  Similar issues with medication from pharmacists

-          Patients were genuinely resistant to tell their doctor that they were not taking a particular medication

-          Only intervention demonstrated to reduce medicine waste was the adoption of a 28 day prescription policy – 34 of Rotherham’s 36 GP practices had this in place

-          Pharmacies were paid for everything they dispensed under the current contract

Discussion ensued on the report with the following issues raised/clarified:-

·           Care homes tended to throw medication away at the end of the month unnecessarily and order new – no specific figures for care homes but overall waste is estimated at £1.5m in Rotherham

·           A pharmacy technician was to be seconded to work with the CCG for a year to look at the pathways of the hospital and wastage

·           Consideration was being given to having a pharmacy technician work with care homes.  If that resulted in a reduction of waste and saved more than it cost, it may be rolled out across Rotherham

·           Need to ensure that patients had a variety of ways to order their prescriptions e.g. out of hours, on line

·           Branded versus generic medication

·           Consideration given to certain drugs for certain conditions – quality criteria monitoring

·           Data was collected by searching the 2 IT systems

·           Due to European Legislation, medicines could not be re-issued once they had left the control supply chain even if they had not been opened

·           There were very few independent pharmacies in Rotherham – pharmacies were used to competing against each other

·           Sheffield – incentivised non-dispense scheme

·           The Department of Health had no desire to look at the pharmacy contract in England at present

·           Previously if a pharmacy agreed to provide 100 hours a week they would be awarded a pharmacy contract, but now have to prove a need for a pharmacy in a new area

Resolved:-  (1)  That the progress made in Rotherham in reducing costs with regard to pharmaceutical and medical waste be noted.

(2)  That the proposed actions to work towards further reductions in waste be noted.

(3)  That a further update be submitted on the progress of the actions outlined in Appendix 1 of the report submitted.

(4)  That the Cabinet Member for Adult Social Care be requested to ascertain the practice for pharmaceutical and medicines waste in the Local Authority-owned care homes and to consider taking part in a pilot project.