1. OTC – The prescribing picture for last year - Change in spend Jan 17 to Jan 18
Change from Jan 17 to Jan 18
LE – 13% reduction in spend LW – 9% reduction in spend SL – 11% reduction in spend SWL – 9% reduction in spend
Overall the 4 CCGs reduced spend on OTC products by 11% from Jan 17 to Jan 18

2. Change in spend by therapeutic group – a targeted approach

3. OTC therapeutic drug group - spends and trends
Enteral feeding is by far the largest spend by therapeutic group. The spend has slowly decreased over the year in LE, LW and SWL, but is rising in SL.
A separate project concerning Enteral Feeds is currently in progress, so this is not a priority area for action within the OTC project.
Spend on vitamin D is the second largest spend in all 4 CCGs. The trend is fairly static, apart from SL, where spend is increasing. However, this group contains both Vitamin D alone and Calcium and Vitamin D preparations – this needs further exploration and discussion to ascertain whether the CCG supports patients purchasing all the preparations OTC
The third highest spend in all 4 CCGs is OTC non-opioid analgesia. This spend is slowly decreasing in all 4 CCGs, suggesting that work has already taken place in this area and spend should continue to decrease. It is acknowledged that there are some patients who will need to obtain these medicines by prescription (chronic conditions)
At this point the spend by drug group is much closer and the following 3 groups have similar spends and positions:
Foods for special diets – mainly gluten free products, the spend has decreased overall over the last year, but LW and SWL spend has not significantly decreased
Osmotic laxatives – the spend on this group has remained steady for all but SLCCG
Emollients – again, there has been no significant change in spend for this group over the last year
The last groups to make up the top 9 drug groups by spend for the 4 CCGs have some overlap between the 4 CCGs and include:
Compound alginates and indigestion remedies
Rubifacients and topical NSAIDs
Nicotine replacement therapy
Stimulant laxatives
Drugs used in nasal allergy
The only noticeable change here is for NRT in LE – otherwise these spends have remained steady over the last year.

4. Actions by therapeutic drug group
OTC Vitamin D
Cambridge & Peterborough CCG has a Vitamin D pathway – MMO to review and produce version for our Lincolnshire GPs
MMO to investigate whether initiated by secondary care
Products for this group to be agreed as many are on formulary and should be prescribed as prevention to osteoporosis
Produce practice charts with 25th percentile target – dependent for decision on what preps to include in OTC group
Write a communication (newsletter style with new pathway) to go out to GPs
Write a communication to go out the Community Pharmacies
Quarterly monitoring using ePACT trend in overall spend for this drug group and practice charts

5. Actions by therapeutic drug group
2. Foods for special diets
Requires further analysis to break this down into sub-groups – Gluten-free food and lactose-free baby milks
Gluten-free policy allows prescribing of flour, bread and bread mixes. Other items should not be prescribed. PACEF Bulletin V11 No2 Feb found at
Produce practice charts with 25th percentile target (doesn’t include GF flour, bread and bread mix)
If target levels are reached by M6 (Sep 18) we should see the following savings in :
LE - £60k
LW - £79k
SL - £22k
SWL - £33k
Total Potential Savings in = £194k = £97k for OTC Foods for special diets)
Write a communication to go out to GPs with baby milks document (MMO document)
Re- send the PACEF bulletin to GPs
Quarterly monitor using ePACT2 trend in overall spend for this drug group and practice charts

6. Spend per patient - practice charts

7. Actions by therapeutic drug group
3. Laxatives – Planned for August 2018
Lincolnshire guide for laxatives under development
Leaflet for patient advice Self Care Forum Fact Sheet at
Produce practice charts with 25th percentile target – see next slide
If target levels are reached by M6 (Sep 18) we should see the following savings in :
LE - £41k
LW - £23k
SL - £20k
SWL - £16k
Total Potential Savings in = £100k = £50k for laxatives)
Write a communication (newsletter style with new pathway) to go out to GPs –
Write a communication to go out the Community Pharmacies
Quarterly monitor using ePACT2 trend in overall spend for this drug group and practice charts

8. Spend per patient - practice charts

9. Actions by therapeutic drug group
4. Emollients and bath/shower emollient products
Produce a list of formulary emollients
Produce practice charts with 25th percentile target – see next slide
If target levels are reached by M6 (Dec 18) we should see the following savings in :
LE - £18k
LW - £17k
SL - £16k
SWL - £10k
Total Potential Savings in = £61k = £30k for emollients)
Write a communication (newsletter style with list of formulary emollients) to go out to GPs
Write a communication to go out the Community Pharmacies
Patient leaflet available at by Self Care Forum
Quarterly monitor using ePACT2 trend in overall spend for this drug group and practice charts

10. Spend per patient - practice charts

11. Actions by therapeutic drug group
5. OTC Non-opioid Analgesics
Produce practice charts with 25th percentile target – see next slide
If target levels are reached by M6 (Dec 18) we should see the following savings in :
LE - £34k
LW - £20k
SL - £9k
SWL - £7k
Total Potential Savings in = £66k = £16k for OTC Non-opioid analgesia)
Write a communication newsletter style to go out to GPs
Write a communication to go out the Community Pharmacies
Several patient leaflets available at by Self Care Forum
Low Back Pain
Fever in Children
Headache
Sprains and Strains
Quarterly monitor using ePACT trend in overall spend for this drug group and practice charts

12. Spend per patient - practice charts

13. Actions by therapeutic drug group
6. Antacids, Alginates and indigestion remedies
Produce practice charts with 25th percentile target – see next slide
If target levels are reached by M6 (Dec 18) we should see the following savings in :
LE - £11K
LW - £10k
SL - £5k
SWL - £4k
Total Potential Savings in = £31k = £15k for OTC Alginates and indigestion preparations)
Write a communication to go out to GPs
Write a communication to go out the Community Pharmacies
Several patient leaflets available at by Self Care Forum
Heartburn and Indigestion
- Quarterly monitor using ePACT2 trend in overall spend for this drug group and practice charts

14. Spend per patient - practice charts

15. Actions by therapeutic drug group
7. Rubefacients and topical NSAIDs
Produce practice charts with 25th percentile target – see next slide
If target levels are reached by M6 (Dec 18) we should see the following savings in :
LE - £11K
LW - £10k
SL - £5k
SWL - £5k
Total Potential Savings in = £32k = £16k for OTC Alginates and indigestion preparations)
Write a communication to go out to GPs
Write a communication to go out the Community Pharmacies
Several patient leaflets available at by Self Care Forum
Sprains and Strains
Low Back Pain
Quarterly monitor using ePACT2 trend in overall spend for this drug group and practice charts

16. Spend per patient - practice charts

17. Actions by therapeutic drug group
Next steps NRT – should be no prescribing as patients should be referred to Smoking Cessation Service
9. Drugs used in nasal allergy
Other actions
Produce a summarised version of the Lincolnshire self care policy.
Send out a list of all OTC preparations and ask PACEF/Formulary Pharmacist to change their classification on net formulary from ‘Green’ to ‘Green +’ or ‘Green OTC’