IMPLEMENTING A QUALITY CONTRACT

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IMPLEMENTING A QUALITY CONTRACT
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Lessons from PRICCE

• Linda Dodds
• Specialist Pharmaceutical Adviser
• Ashford PCT, Kent

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• Impact on Prescribing Costs and Quality
• Impact on Secondary Care
• Cultural Changes

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• What is PRICCE?
• Quality contract around 14 disease areas
  initially
• Started 1998
• Gradual uptake
• Still not full engagement

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• Impact on Prescribing Costs
• Significant but surprisingly difficult to
  quantify
• No big bang approach
• Gradual rise in standards
• Most marked around statins/CV prescribing

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Prescribing Quality

• Identify and treat patients systematically
• Treat to agreed standards
• Opportunities to drive evidence-based practice

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Disease Register Data
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Disease Register Data
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Heart Failure Management
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Heart Failure Management
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Impact on Secondary Care

• Improved dialogue overall
• Empowered GPs
• Empowered consultants
• Improved quality of hospital care for patients
• Secondary prevention after MI

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Impact on Secondary Care

• Driven agenda around improving care
• Reports identified inequalities around treatment
  and access to care.
• Project facilitated early response to changes in
  the evidence base.
• Feedback from reviews identified ambiguities in
  standards.
• Identified gaps in services e.g. heart failure

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Impact on Secondary Care (unplanned)

• Pathology tests
• Diagnostic tests (e.g echoes, Dexa scans)
• Referrals

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Cultural Change

• Systematic approach to care
• Evidence-based culture
• Template-based culture
• Thorough versus not patient centred
• Rapid rather than reflective change
• Quality vs. financial issues

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Cultural Change

• Use of IT
• All team members need to be involved.
• Read codes and templates need to be agreed and
  used.
• Practice needs IT support to collect data.

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Cultural Change

• Organisational Change
• Care Manager
• Team based working
• Innovative use of skill mix e.g HA/Receptionists
  doing BP checks
• Modernisation of primary care!

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The Power of Disease Registers

• PCT
• Audit
• Review of drug usage
• Pharmaceutical Industry
• Switching
• Implementing evidence

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Summary

• Benefits
• Promotes evidence-based practice
• Promotes standardised care
• Changes the way GPs work!
• Provides opportunities for improving prescribing
  quality

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Summary

• Drawbacks?
• Increased prescribing costs
• Increased use of secondary care resources
• Opportunities for the pharmaceutical industry

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Summary

• Tips?
• Provide educational support
• Provide organisational support
• Keep open dialogue between primary and secondary
  care
• Provide guidance around help from the
  pharmaceutical industry