1. Implementation of NHS E guidance
Dr Satvinder Sandilands, Senior GP Partner
Mr Bharat Patel, Clinical Pharmacist
Rushall Medical Centre, Walsall

2. Implementation of NHS E guidance for OTC items not to be prescribed routinely in primary care
Practice demographics
How we implemented guidance
GP perspective
Barriers
Impact – data analysis

3. Rushall Medical Centre
“working in partnership to provide high quality personal medical care in a one stop centre”

4. Practice demographics
Large multi-partner practice
List size approximately 14,700 patients across 2 sites
Large multidisciplinary team with GPs, Nurses, HCAs and Clinical Pharmacist supported by administration staff

5. Implementation plan Review the guidance
Discussion at clinical and admin staff meetings
Staff training
Letter to community pharmacies
Identification of patients
Removal of medicines from medication list by:
admin staff
Clinicians – at point of authorising EPS requests, f-2-f or telephone consultations, CCG pharmacists
Laminated summaries for clinicians
Reinforce self care by use of patient information leaflets

6. GP perspective How to engage with patients
Dealing with patient or representative concerns
Discussion of cost implications with patients
Use of medication review
Repeat medication requests
Liasion with admin team

7. Barriers Consistency of advice from other HCPs – ongoing education
Age restrictions on OTC medicines – may have to prescribe if there is a clinical need
Local commissioned services, e.g. minor ailments, minor eye conditions services – contacted Commissioners and LOC
Demand from schools/nurseries for “labelled” medicines – letter sent
Patient expectations - manage concerns on individual basis

8. Data analysis
Vitamins
Antihistamines
Eye drops
Analgesics

9. Spend on OTC vitamins and minerals (NIC per 1,000 ASTROPU), rolling year trends.

10. Spend on OTC vitamins and minerals by BNF chemical name for Rushall Medical Centre, rolling year trends.
Other category includes: ascorbic acid, calcium supplements, multivitamins, phosphate supplements, pyridoxine hydrochloride, vitamin A, vitamin E and zinc sulfate.

11. Spend on OTC vitamin D (NIC per 1,000 ASTROPU), rolling year trends.

12. Spend on OTC vitamins D by BNF chemical name for Rushall Medical Centre, rolling year trends.

13. Spend on OTC antihistamines (BNF 3. 4
Spend on OTC antihistamines (BNF 3.4.1) NIC per 1,000 ASTROPU, rolling year trends.

14. Spend on OTC antihistamines (BNF 3. 4
Spend on OTC antihistamines (BNF 3.4.1) by chemical name for Rushall Medical Centre, rolling year trends.

15. Spend on OTC eye drops (BNF 11. 8
Spend on OTC eye drops (BNF ) NIC per 1,000 ASTROPU, rolling year trends.

16. Spend on OTC eye drops (BNF 11. 8
Spend on OTC eye drops (BNF ) for selected chemicals for Rushall Medical Centre, rolling year trends.

17. Spend on OTC analgesics (BNF 4. 7. 1, 10. 1. 1 & 10. 3
Spend on OTC analgesics (BNF 4.7.1, & ) NIC per 1,000 ASTROPU, rolling year trends.

18. Spend on OTC analgesics (BNF 4. 7. 1, 10. 1. 1 & 10. 3
Spend on OTC analgesics (BNF 4.7.1, & ) for selected chemicals for Rushall Medical Centre, rolling year trends.
Other category includes: aspirin, benzydamine hydrochloride, diclofenac sodium, diethylamine salicylate, heparinoid and methyl salicylate.

19. Reduce Nic per ASTROPU by:
Spend and volume of selected OTC areas for Rushall medical centre, rolling year trends.
Jun-17
Jul-17
Aug-17
Sep-17
Oct-17
Nov-17
Dec-17
Jan-18
Feb-18
Mar-18
Apr-18
May-18
Jun-18
Analgesics
Spend (NIC)
£55,237
£54,532
£53,925
£52,898
£52,047
£51,088
£50,051
£49,144
£48,240
£46,624
£45,356
£43,502
£41,306
Volume (items)
14,489
14,396
14,356
14,188
14,098
13,909
13,692
13,562
13,411
13,148
13,047
12,836
12,489
Antihistamines
£4,856
£4,880
£4,919
£4,847
£4,879
£4,873
£4,969
£5,025
£5,027
£5,066
£5,100
£4,889
£4,620
3,081
3,039
3,075
2,999
3,058
3,072
3,084
3,128
3,147
3,119
3,138
3,047
2,913
Emollients
£26,822
£27,060
£27,417
£27,045
£26,640
£26,524
£26,615
£26,881
£26,595
£26,313
£27,164
£27,103
£26,910
3,809
3,784
3,777
3,720
3,679
3,621
3,615
3,623
3,606
3,558
3,625
3,619
3,597
Eye drops
£12,555
£12,480
£12,445
£12,319
£12,064
£11,666
£11,180
£10,898
£10,539
£10,149
£9,909
£9,553
£8,887
2,676
2,646
2,611
2,580
2,522
2,438
2,351
2,296
2,231
2,163
2,106
2,016
1,874
Vitamin D
£8,973
£8,779
£9,024
£8,885
£8,829
£8,750
£8,647
£8,712
£8,627
£8,465
£8,431
£8,326
£7,881
1,598
1,631
1,717
1,731
1,768
1,802
1,836
1,872
1,910
1,891
1,930
1,929
Vitamins and Minerals
£17,097
£16,760
£17,103
£17,300
£17,781
£18,072
£18,084
£18,489
£18,685
£18,916
£19,579
£20,316
£20,505
3,633
3,732
3,717
3,724
3,750
3,759
3,796
3,808
3,754
3,812
3,794
Potential annual savings for Walsall CCG.
Reduce Nic per ASTROPU by:
10%
25%
Analgesics
£57,556
£141,288
Antihistamines
£5,612
£16,242
Emollients
£57,477
£143,690
Eye drops
£16,006
£40,023
Vitamin D
£20,123
£50,309
Vitamins and Minerals
£49,996
£124,991