Achieving Clinical Efficiency a practical case study

1
Achieving Clinical Efficiency a practical case
study

• Kate Gill
• Head of Service Development
• East of England SHA

2
Drivers for change

• Severe financial pressures in EoE
• NHS Institute Productivity Metrics
• BMJ article - Simvastatin
• gt10M questions
• Reducing outpatient follow ups 51M
• Reducing excess bed days 13M (25 of
  total)
• Achieving 80 generic statins by 31 March 2007

3
Scoping potential efficiencies

• EoE 2nd lowest generic simvastatin rate
• Annual spend 53M
• EoE PCT simvastatin rates vary from 21 to 72
  (Quarter 4 2005/06 old PCTs)
• 23M efficiencies for current patients
• 18M efficiencies for new primary prevention
  patients

4
Obtaining Advice Engagement

• Key points of contact
• Cardiac networks (3 in EoE)
• Primary and secondary care
• DH Heart Team
• NHS Heart Improvement Programme
• Pharmaceutical advisors
• Dr James Moon
• Advice to the public

5
Cholesterol levels

• National guidance on cholesterol levels versus
  JBSII guidelines
• 5 and 3 remains national policy and EoE policy
• Significant issues of affordability about
  treating to 4 and 2
• Many different clinical opinions
• Only requiring 80 generic statins rate
• Not making one protocol mandatory

6
Cardiac Networks Role

• Invaluable source of knowledge/expertise
• Helping to obtain clinical engagement
• Targeted help to general practices if necessary
• Systems for timely monitoring of switch

7
Producing Guidance

• Written for commissioners
• Directive, but permits local flexibilities
• Reinforces national policy
• Key activities for commissioners
• Example FAQs and primary care switching protocol
• Example of weekly action plan for commissioners
• Careful preparation key to successful
  implementation

8
Key activities for commissioners

• Communication with key stakeholders
• Establish protocols in primary and secondary care
  including primary prevention
• Action plans with general practices to achieve
  switch
• Advance warning to dispensing practices and
  pharmacies
• Advise path labs of increased number of tests
• Monitor progress of individual practices in
  achieving switch

9
Pravastatin yes or no?

• Objective of 80 generic simvastatin
• Number of PCTs with relatively high generic
  pravastatin rates 24 to 76 (combined)
• Close tariff price
• Now including generic pravastatin in overall 80
  generic rate
• Reduces overall efficiency savings from 23M to
  20M

10
Starting implementation

• Each PCT nominating a lead director
• Example of an implementation plan
• Implementation plans to SHA by 31 October for
  sign off
• SHA and Cardiac Networks monitoring progress
  during the switch up to March 2007

11
Monitoring switch rates

• ePACT data
• NHS Institute Productivity Metrics
• Local, more timely, monitoring
• Complexity added by some non generic Simvador
  prescription in some PCTs

12
And finally..

• I very much welcome your support on this as it
  is these sorts of areas that enable us to make
  easy wins on the road to financial balance.
• If we do not seize these easier opportunities
  then solutions are far more problematic.
• EoE PCT Chief Executive
• September 2006

13
Thank You

• kate.gill_at_eoe.nhs.uk