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NHS North of England Commissioning Support (NECS) prescribing newsletter - March 2014
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Gateshead CCG

Costs of commonly prescribed medicines…and the potential costs of over-ordering

At the repeat prescribing workshop for admin staff at the November time out event there was some discussion about the costs of routine repeat medication.

Results from the repeat prescribing survey revealed that only 77% of respondents from Gateshead practices would question a request for ‘everything’ on the repeat list.  It is particularly important to check whether patients need ‘when required’ medicines, e.g. if each person in Gateshead with asthma ordered only TWO extra salbutamol inhalers per year they didn’t need this could cost an additional £38,000.

Click here for a list of some of the most common medicines prescribed on repeat which have significant cost implications if over ordered.

New additions to the Gateshead formulary

Resource® ThickenUp Clear has been approved to replace Thick & Easy and Nutilis.

Pivmecillinam, an antibiotic with activity against Gram-negative bacteria including E.coli, klebsiella, enterobacter and salmonellae, has been approved for use only on microbiology advice in uncomplicated UTIs in patients aged over 65 years. 

New guidelines

The following prescribing guidelines for use in Gateshead are now available:

Prescribing cost pressures – senna 7.5mg tablets

The Drug Tariff price for senna 7.5mg tablets has increased by 695% between December 2012 and February 2014.  60 senna 7.5mg tablets now cost £12.64.  Total monthly spend on senna in Gateshead practices is now over £25,000, representing a significant pressure on the prescribing budget.

If patients are ordering senna on repeat, please double check to ensure they really need a repeat supply of these.

Modified release venlafaxine prescribing

An estimated £60,000 of savings have been generated so far in Gateshead by switching to more cost-effective venlafaxine modified release preparations.

Many hospital letters asking GPs to initiate prescribing of venlafaxine do not specify whether the patient should be prescribed capsules or tablets.  Prescribing tablets is significantly more cost-effective than prescribing capsules (e.g. 75mg tablets x 30 = £11.20, 75mg capsules x 30 = £22.08).

Antibiotic prescribing and C.diff risk

A recent meta-analysis of studies on the risk of community-associated C.diff infection in adults using antibiotics concluded that antibiotic exposure was associated with a significantly higher risk of C.diff infection than no exposure to antibioitics (p<0.00001).

The study ranked antibiotics in order of their risk of C.diff infection:

  1. Clindamycin (odds ratio (OR) = 20.43)
  2. Fluoroquinolones (OR = 5.65)
  3. Cephalosporins (OR = 4.47)
  4. Penicillins (OR = 3.25)
  5. Macrolides (OR = 2.55)
  6. Sulfonamides or trimethoprim (OR = 1.84)

Use of lower risk antibiotics in the community, particularly among elderly patients also on PPIs is likely to be of increasing importance in reducing risk of C.diff.

The C.diff risk assessment tool for use in primary care has now been updated to include information on the assessment of severity of a patient’s symptoms.

Factors which indicate an individual may be at greater risk of developing C.diff include:

  • Older patients >65 years
  • High risk environments
    • Contact with other C.diff patients
    • Recent hospital admissions
    • Institutionalised patients
    • High risk antibiotics (especially the 4Cs)
      • Clindamycin
      • Ciprofloxacin and other quinolones
      • Cephalosporins
      • Co-amoxiclav

Co-amoxiclav prescribing

Co-amoxiclav is associated with an increased risk of C.diff and should be reserved for infections likely, or known to be caused by amoxicillin-resistant beta-lactamase producing strains.

As a CCG, Gateshead is currently an outlier for the prescribing of co-amoxiclav, with a ratio of amoxicillin to co-amoxiclav items significantly below other North of England CCGs (where a higher ratio indicates co-amoxiclav is being reserved).

NHS North of England Commissioning Support (NECS)
Tel: 0191 374 4121
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