Invest to save: provision of a
medicines management service
Beryl Bevan
MSc, MRPharmS, Mohammed Ibrahim BSc, ClinDip, MRPharmS, IPresc and Vanessa Lane BPharm
The authors describe an invest-to-save scheme involving
three London PCTs with the aim of saving between £5 and £7
for every £1 invested in pharmacists working in practices to
make savings on prescribing.

As part of the move towards clinical Each borough was given challenging
targets under the DH Quality, Innovation, the quality of care that the NHS delivers ciency savings by 2014–15, which will bereinvested in frontline care. In 2011/12GP Prescribing Efficiency Savings projects initiatives based on local prescribing pat- terns. The majority of the initiatives were deliver the required prescribing changes.
However there was a significant risk that, without additional support, the full QIPP insufficient capacity within the medicines porting QIPP delivery alongside other com- realised for every £1 invested in practice- based support (there is limited published evidence; however, this is the experienceof many PCTs who have invested to save Figure 1. Proportion of annual savings by therapeutic area
ment programme), so we set out todevelop a scheme that would test this out.
Save’ proposal was developed. Fundingwas secured from the Delivery Support PCT’s return of 2 per cent reserve). In Table 1. Number of practices where work was undertaken in each PCT
August 2011 a paper was presented tothe ONWL executive directors (including strate delivery by the end of the financial year. There is a risk that practices wil leave cists and technicians would not deliver the delivery until later in the year and this will diminish the level of in-year savings.
support the work of the existing MMTs and timescales and tight deadlines, the safest be provided with between 3 and 10 days’ ings up to £1.5 million, ie £1 for every £5 shorter period of time. This new approach resulted in Rx Advisor deploying 22 phar- macists for this project instead of the orig- due to start in their practice. The practice Project aim
deadline for project completion to 31 May The key aim of the project was to test out 2012 so that the existing team of pharma- cists could continue to complete the proj- be saved for every £1 invested in pharma- work within the practice, a GP partner had cists working in practices. This would then realise prescribing efficiency savings iden- tified at GP practices through the borough was the ability to secure GP practice book- macist support from an outside company.
with solutions for any barriers. Ealing PCT that were ‘engaged’ and ‘primed’ based tic areas with the intention of realising sig- 2011 with Rx Advisor pharmacists visiting pharmacists to facilitate the bookings.
method of project delivery underwent sev- changes. Delivery is therefore reliant on to the key challenge of securing potential effective clinical engagement. A range of faced with similar chal enges of GP practice incentives and enablers have been estab-lished to underpin delivery at GP practice formly apply to all savings initiatives andthere is a risk that the practices wil not prioritise therapeutic areas for which they Table 2. Number of days worked at GP practices in each PCT
alised savings at £2.3 million. Each of the wished to have a second visit. Since some tion analyst that aimed to verify the figures Advisor project lead and then verified by practices had opted not to receive a serv- ice, this resulted in extra days being avail- then audited by going back into practices to be able to verify the projected savings.
to see which figure was most accurate.
Two forms were used to col ect data.
ings was found to be in well in excess of that which could be achieved with the resources available under this project. The pharma- made, eg five patients changed from can- cists could not spend more time either help- ing the switches for the ‘quick wins’ or was reached that Rx Advisor would be paid undertaking work on other areas that would for delivering 84 per cent (£1.942 mil ion) of the £2.3 million savings claimed. This that the patient had been changed to. The difference was the annualised savings.
be the one talking to patients as practices were left with much work to do in order to practice. This was left for the GP to sign as Discussion
a record of the savings made and the num- ber of days that the pharmacist had worked ‘quick wins’ in GP surgeries by searching in the practice. The annualised savings on Key learning points
totals calculated from the Patient Report.
manifests itself in several ways. This proj- of the financial year. Both of these periods macist; the GPs undertook the follow-up.
yearly savings attributed to the work.
Rx Advisor did recognise that follow-up of do this but there was insufficient funding Also in large practices it could be diffi- sary. Also once ePACT data were available cult to get hold of the ‘decision maker’ the pharmacist’s figures were monitored by identifying the best person for each prac- ARB vs ACE inhibitor switching. This would tice, which could be a GP or the practice be as expected as they are both evidence- based on-going QIPP target areas that were being looked at prior to the project start.
pharmacist to the practice worked well, but plete the project. Due to a number of rea- they have a proportional y larger team than the other PCTs. It was suggested that a pre- the timescale al owed and the actual num- scribing lead for each practice be identified.
was funded for ‘quick wins’ that involved Table 3. Savings made and fees paid
‘parachuting’ a pharmacist in to under- take searches but then leave these for the together to enable the project to proceed.
practice to action. This caused some prob- All in all the project was a success with support the project was underestimated.
savings of £1,942 million made for a cost and trust that is there when a well-known of £344 000 (approximately £5.60 return on £1 spent). The PCTs are using the les- other initiatives were being undertaken at gested switches. This was in part resolved Declaration of interests
facilitate the work of the Rx Advisor phar- cist, Outer North West London Subcluster, initiatives are being looked at as a bundle Advisor Ltd, and Vanessa Lane is a direc- practice longer in order to undertake the a skill mix of pharmacists and technicians but this had to change in order to realise Beryl Bevan is assistant director for serv- ice delivery at Ealing CCG, Mohammed Ibrahim is managing director/consultant changed its approach in order to meet the pharmacist, Rx Advisor Ltd, and Vanessa tight deadlines required of the project. The Lane is a director of Webstar Lane Ltd


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