1. Dry Eyes – Lubricant Eye Drops
The future for prescribing of medicines & products with low/no clinical value
Dry Eyes – Lubricant Eye Drops
Introduction- whilst we are focussing on stopping the prescribing of medicines and prescribable products with low/ clinical value, we will also be looking at those medicines and products which although they have a demonstrable clinical effect they cost far more when prescribed on prescription- these are readily available from pharmacies and homecare stores/ supermarkets.

2. Agenda
1. Background
What are we proposing to do and why?
2. NHS England consultation on over the counter items that should not be prescribed on the NHS
3. National consultation responses and proposed local impact for patients
4. Dudley CCG eye lubricants prescribing data
5. Questions?

3. Background
Dudley CCG spends more than £1.8M on prescribing medicines & products which are of no or limited clinical value
The CCG has explored with the public, GP and other stakeholders a policy which would stop this waste
12 week public consultation was set up the 1st February 2017 to the 24th April 2017 to implement the Dudley Prescribing Policy
The CCG has estimated financial savings from this initiative of at least £1.1M which would go towards the efficiency saving required to be made for 2017/18
Link to Policy Dudley CCG Prescribing Policy March 2018

4. What are we proposing?
The prescribing of medicines & products of no or low clinical value is stopped
Patients on medicines classed as not suitable for routine prescribing will be reviewed and no new patient started on them
Patients will be supported to understand more about their medicines and to make choices about prevention, self-care and healthy living, where possible being directed to Community Pharmacy who can provide advice on medicines and supply either over the counter or via the Minor Ailments Scheme
It becomes routine practice to signpost patients to further help with their medicines and to local patient support groups
Dry eyes was included in the latest national consultation for over the counter products that should not be routinely prescribed on the NHS

5. NHS ENGLAND OVER THE COUNTER CONSULTATION
Conditions for which over the counter items should not routinely be prescribed in primary care: A consultation on guidance for CCGs
Source:
A Report was presented to Dudley CCG Prescribing Subcommittee on Dry Eye Treatment – There was agreement at the GP lead committee to consider implementing a change and to reduce inappropriate prescribing of lubricant eye drops for dry eyes following local engagement

6. NHS England Classification
a condition that is a minor illness and is suitable for self-care and treatment with items that can easily be purchased over the counter from a pharmacy: dry eyes/sore (tired) eyes

7. National Consultation on Dry Eyes
2589 responses received by NHS England
75% agreed with the recommendation to advise CCGs to support prescribers in advising patients that a prescription for treatment of dry eyes should not routinely be offered in primary care as the condition is appropriate for self care

8. Dry eye pathway
Dudley Dry Eye Guidance updated (part of this consultation)
Why?
Streamline products
Consistency with prescribing by GPs
Ensure NHS resources are used efficiently
Dry Eye Pathway (See later slide)
To ensure patients are seen by the most appropriate healthcare professional

9. Aug 2017 – Aug 2018
Total spend by Dudley CCG on eye lubricants £472,535
This level of growth in spend each month will be managed by the updated guidance and pathway

10. How do we classify severity of dry eye? Oxford Grading Scale Tool

11. Impact for patients in Dudley
Dependant upon diagnostic classification of Dry Eyes
Mild (Oxford Grade 0 -2)
Self care with signposting to community pharmacy for eye lubricants
Eye lubricants will need to be purchased over the counter
Moderate to Severe (Oxford Grade 3 and above)
Eye lubricants will remain available for NHS prescription

12. Minor Eye Conditions Service
MECS is part of a programme of work to ensure patients are seen at the Right Time, in the Right Place, by the Right Person. There is a need to manage the demands being placed on secondary care ophthalmology services, and recognising the potential to develop the role of Opticians in primary care.
Supports care closer to home for our patients.
Dudley CCG commissioned 1st October 2018
For more details please visit

14. Next steps…
Engagement runs from Monday 18th February until Monday 18th March
Drop in session arranged Thursday 7th March 19
Feedback through drop in session, or telephone
Ringing team on
the CCG:
Feedback from engagement will be considered before a final decision is made by the CCG Commissioning Development Committee (CDC) in April 2019.
Essential there is a unified message and GPs don’t go off and do their own thing

15. Questions?
Thank you expand
Support
Survey
Fortunate position