NHS South Norfolk CCG – Waste and Self-Care what’s the fuss all about? Françoise Price Senior Clinical Pharmacist and prescribing adviser

SNCCG Context 24 GP practices 35 number of pharmacies Primary care prescribing 2016-17 FOT £36,177,255 More than 5 million prescriptions dispensed Spend per ASTROPU £38.52 c.f. national £40.33 QIPP for 2017-18 circa £2m Waste estimated at £1.2m Budget QIPP’d i.e. find savings of £1.9m Current performance looks like £375k savings on this budget Helped by category M and drug pricing but also focus on cost effective prescribing

Waste

Not just £s Insulin £384 Cardiovascular £157 Costs: Drugs Disease Family Disposal

It’s not a new problem- returned by one patient August 2011

Hidden costs Returned medicines cannot be reused We have to destroy them Drugs Disease Family Disposal

What’s the most expensive medicine in the NHS? It is the one that is never taken! Remember to ONLY ORDER WHAT YOU NEED and help us to make more of your local NHS resources. NICE Medicines optimisation facts and figures: https://www.nice.org.uk/guidance/ng5/chapter/Introduction Estimated that between 30% and 50% of medicines prescribed for long‑term conditions are not taken as intended (World Health Organization 2003). Data from the Health and Social Care Information Centre (HSCIC) shows that between 2003 and 2013 the average number of prescription items per year for any one person in England increased from 13 (in 2003) to 19 (in 2013).

What can you do? Spread the word Be honest with your healthcare professional with regards to medicines taking Only order what you need Help family and friends with their medication ordering

Self-Care What do we mean by self-care? Self care is about everyone taking responsibility for their own health and wellbeing. This includes keeping both the body and mind fit and healthy. Lifestyle choices – prevention of ill health Expert patients – long term conditions Self management of minor or self limiting conditions http://www.skillsforcare.org.uk/Topics/Self-Care/Self-care.aspx Self care is defined by the Department of Health as a part of daily living. It is the care taken by individuals towards their own health and well-being, and includes the care extended to their children, family, friends and others in neighbourhoods and local communities. Self care includes the actions people take for themselves, their children and their families to stay fit and maintain good physical and mental health; meet social and psychological needs; prevent illness or accidents; care for minor ailments and long-term conditions; and maintain health and well-being after an acute illness or discharge from hospital.

Self Care Nation 92% of people feel it is important to take responsibility for their own health But 34% went to their GP anyway 47% of people would not visit their local pharmacist as first port of call

Why? Pharmacists aren’t as qualified as GPs or hospital staff 18% I have been seeing my GP for many years and do not wish to change I am entitled to free prescriptions so would never pay for OTC medicine I am entitled to see my GP when I want My GP surgery is closer 18% 11% 12% 8% Pharmacist qualifications Consultant level CPD

With the NHS facing unprecedented demand from users while also under pressure to manage costs, health professionals believe that even small changes in behaviour could reduce the burden and free up more money for patient care.

National Context 57 million GP consultations every year are for minor ailments that could be self-treated at home. This takes on average, one hour per day of GP’s time and costs the NHS £2 billion per year. • Additionally minor illness and injuries account for approximately three quarters of A&E attendances of which 15% have the potential to be treated with self care at home. Each A&E attendance costs the NHS £112 Key message – cannot afford to go on like this. Think of films e.g. Suffragettes – people went to see the pharmacist or his wife Edith Ellyn (Helen Bonham Carter)

Local context Nationally, 99% of people are within 20 minutes travel time of a community pharmacy NHS SNCCG spent April – November 2016: Cough mixtures and nasal decongestants £1805 – 864 items Rubs for aches and pains £123,366 – 25,178 items Paracetamol £203,081 – 60,208 items Chloramphenicol eye preparations £7136 – 864 items Moisturisers £162, 420 – 27,027 items

Ask your pharmacist about 1. Low Back Pain 2. Eczema 3. Heartburn and indigestion 4. Fever in children 5. Constipation 6. Headache and migraine 7. Coughs 8. Acne 9. Sprains and strains 10. Sore throat 11. Otitis media 12. Common cold 13. Sinusitis 14. Urine symptoms in men

Communication strategy across Norfolk What we are doing SNCCG Self Care policy Communication strategy across Norfolk Integration with other work streams Education: GPs Pharmacists People Resources: NHS Choices Self care forum 111 Integration: Care homes – Homely remedies Unplanned care Working with LPC; public health; LMC Need your help – spread the word

Support local campaigns What can you do? Lead by example Spread the word Raise awareness Share ideas Support local campaigns

QUESTIONS?