Gastrointestinal (GI) Right Care Optimisation Workshop Tuesday 10 November 2015

GI – Elective Opportunity

GI - Prescribing Opportunity

Deep dive The GI deep dive identified two projects: Review of GI elective / day case activity Reduction of GI primary care prescribing costs

Review of GI elective / day case activity To reduce costs and variation and improve patient experience within GI planned care. Providing financial benefit of around £1,820,000. Scope includes: Hepatobiliary spend Lower GI Other GI.

From deep dive data pack

Discussion questions How can we reduce hepatobiliary outpatient spend? What can be done to reduce variation in referral rates for cholecystectomy and numbers of procedures? What can be done to review coding for HRGs related to inflammatory bowel disease in the lower gastro-intestinal subcategory? And reduce variation in referral rates? How should we improve the value of colonoscopies by reducing the ratio of diagnostic to therapeutic colonoscopies?

Discussion questions continued Would increasing endoscopies, including a biopsy, from 45% to closer to the 65% for the comparator CCGs have any clinical or financial benefit? Why are there a higher proportion of admissions that have complications and comorbidities recorded for cholecystectomies than elsewhere? What can be done? How can we reduce admissions with a zero length of stay where there are no complications?

Reduction of GI primary care prescribing costs To reduce primary care prescribing costs by a total of between £292,000 and £1,880,000. Early implementation will lead to a proportion of savings within 2015/16. Scope highlighted areas for review: Stoma prescribing Upper GI Hepatobiliary Lower GI

From Deep Dive Data pack

Mapping Stoma products cost per 1,000 patients

PrescQIPP Subscribers Stoma cost per 1,000 patients top 50%; Apr - Aug15

PrescQIPP Subscribers Stoma cost per 1,000 patients btm 50%; Apr - Aug15

Stoma: current work streams North and East Stoma Formulary - chapter 19 on formulary website (accessory products) Review of North and East Stoma Formulary Creation of South and West Stoma Formulary Scoping of CCGs - Portsmouth, Oxford, Herts Valley, North East Essex, Nene Review of guidelines for issuing prescriptions for stoma appliances.

Upper GI prescribing Below national median Variance driven by agents for dyspepsia Below median for antisecretory agents Drive to reduce PPI use as part of C. Diff strategy.

Hepatobiliary prescribing Variance driven by immunosuppressants Includes 20% of azathioprine and 25% of mycophenolate prescribing These drugs have different supply mechanisms; may be prescribed in secondary care in some CCGs. Therefore primary care prescribing may not be an appropriate comparison.

Lower GI prescribing Variance driven by: Laxatives High volume, low acquisition cost Antispasmodics Work already underway on switches Treatment for acute diarrhoea Includes 5% codeine Main driver is generic loperamide. Merbentyl – dicycloverine –phase 2 Mebeverine – colofac – pase 1

For consideration: Is a re-procurement project around stoma prescribing, to negotiate a contract with a single supplier to minimise costs and reduce device variance a viable option? What is the best way forward? How can we reduce prescribing volume and costs for primary care prescribing?

Thank you