Prudent Healthcare Prescribing Workshop April 2014 Howard Rowe Clinical Director: head of medicines management

Introduction and Aims Aims Format Set the Scene

Aims Understanding of Prudent Healthcare and its application to Prescribing Produce recommendations for Change in prescribing arrangements Identify where more work is needed Capture lessons on "the workshop process"

Format Presentations Group Work Next Steps Understanding Prudent Healthcare and the underpinning Principles To test the current arrangements for Prescribing against those Principles Patients' perspective Clinicians' perspective Group Work Define "what would good look like?" Test and Prioritise the Ideas that emerge Next Steps

Set the Scene: use of medicines 14,000 prescribed doses in a lifetime Age and Use of Medicines Percentage of adults who reported being on regular prescribed medication (for a year or more), by age and sex

Set the Scene Use of three or more prescription drugs in the past 30 days

Set the Scene 65+ 10% of Population, Account for 30% of Medicines Expenditure in Primary Care

Set the Scene Use of Medicines: Prescribing Volume Primary Care 7.6 million items per annum 200 million doses per annum or 550, 000 doses per day Primary Care: rate of increase Volume: Wales 2.62%, Cwm Taf 1.52 (gold)

Set the Scene Medicines Expenditure Primary Care £56 million per annum £220,000 every working day (like today) Primary Care: rate of increase Spend: Wales 2.05%, Cwm Taf 1.72% (bronze)

Set the Scene Medicines Expenditure Secondary Care (within Cwm Taf) £20 million per annum £6 million arising from NICE/AWMSG 2014-2015 need £1m (26%) to £2.5m (42%) for NICE/AWMSG

Set the Scene Do No Harm “Grandfather wins £1m drug blunder payout” Prescribing: Lithium “Grandfather wins £1m drug blunder payout” (at East Glamorgan Hospital)

Set the Scene Do No Harm Dispensing: Peppermint Water Wednesday, 1 March, 2000, 18:31 GMT “Chemists fined after baby death” Administration: Penicillin Allergy 30th October 2013 “Grandmother, 61, 'died after nurse gave her penicillin despite SEVEN warnings that she was allergic to it‘ “

Set the Scene Culture in the Community

Set the Scene Quality: Prescribing Indicators

Set the Scene Quality Realising potential from being Integrated Health Board Diclofenac