Download Item 8 - Prescribing Update

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NHS FIFE
Report to the Finance and Resources Committee on 27 November 2012
PRESCRIBING UPDATE
1.
INTRODUCTION
This paper has been prepared to provide an update to the Finance and Resources
Committee on financial performance in Prescribing for the year-to-date in 2012/13.
2.
BACKGROUND
NHS Fife has financial responsibility for managing prescribing expenditure within the Health
Board, despite cost being generated through independent contractors (i.e. GPs). The
influence of GP prescribing behaviour provides an additional challenge to managing the
overall prescribing budget.
NHS Fife has in recent years been a relatively high cost prescriber compared to the rest of
Scotland. An update was provided to the F&R committee in March 2012 on the financial
performance of prescribing.
3.
PERFORMANCE IN 2012/13 YEAR-TO-DATE
At the end of 2011/12, prescribing was overspent in Fife by £3.2m, including an overspend
within GP Prescribing of £2.7m, an overspend against Stoma of £248k, and an overspend
against GPS of £265k.
Table 1 below provides an update on the in-year performance within prescribing after 7
months of this financial year (note due to time delays in collating this information nationally
the information includes five months of actual data and two months of accrued cost based
on the year-to-date trend and other information).
Table 1 – Prescribing Outturn at Period 7, 2011/12
YTD Budget
(£000)
GP Prescribing
GPS Cash Ltd
Stoma
Total
40,859
411
121
41,391
YTD Actual
(£000)
40,258
464
260
40,982
YTD
Overspend/(Underspend)
(£000)
(601)
53
139
(409)
The above shows that NHS Fife has been able to move from a position of overspend in
11/12 to an overall underspend, albeit that this is driven by GP Prescribing with overspends
within GPS and Stoma as before. Notwithstanding, the overall financial performance this
year shows a significant improvement over 11/12.
At the time of planning for this financial year, NHS Fife identified a potential cost reduction
arising from generic savings, based on prescribing behaviour in 2011/12. Just under half of
this benefit was realised as a contribution to the 12/13 efficiency program and budget was
removed. The remainder of the benefit was left within prescribing in order to support
delivery of a breakeven position on the prescribing line. This is now being realised in the
year-to-date financial position.
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4.
NHS FIFE BENCHMARKED PERFORMANCE
Whilst there has been an improvement in the financial position within prescribing, there
remains an outstanding issue for Fife in relation to the overall level of expenditure
committed against this budget heading.
Over the last few years, NHS Fife has become the highest cost prescriber in Scotland
based on the weighted cost per patient measure. The weighted cost per patient recognises
the demographic split of a board’s patient population and considers issues such as age,
deprivation and rurality of the patient population in order to make board by board
comparisons more meaningful.
Table 2 shows the cost per patient in Fife compared to other Scottish territorial boards for
the last two financial years and for the year-to-date to August. This shows that, despite
improvements in financial performance, Fife remains the highest cost health board in
Scotland for the weighted cost per patient. With control now being brought to expenditure
against budget, focus will now turn to driving down expenditure to release resources for
reinvestment in other services.
Table 2 – Prescribing weighted cost per patient
5.
2010/11
2011/12
YTD (2012/13)
NHS AYRSHIRE & ARRAN
186.58
189.49
74.08
NHS BORDERS
185.89
192.39
78.12
NHS DUMFRIES & GALLOWAY
186.83
186.54
72.33
NHS FIFE
212.43
211.46
81.85
NHS FORTH VALLEY
208.35
200.68
77.44
NHS GRAMPIAN
181.73
183.47
74.13
NHS GREATER GLASGOW &
CLYDE
166.18
168.63
67.21
NHS HIGHLAND
185.16
182.77
71.62
NHS LANARKSHIRE
194.47
198.55
78.73
NHS LOTHIAN
170.55
175.56
69.46
NHS ORKNEY
178.83
179.34
71.09
NHS SHETLAND
183.72
187.69
76.23
NHS TAYSIDE
186.09
189.55
75.28
NHS WESTERN ISLES
184.40
181.59
72.08
2012/13 EFFICIENCY PROGRAMME
In order to support high quality, cost effective prescribing across the health board, Practice
Development Pharmacists from NHS Fife work closely with GPs in their Practices to review
current prescribing practice and, where appropriate, to instigate changes to ensure efficient
prescribing is undertaken consistently across Fife.
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The work of Practice Development Pharmacists is multi-faceted, however focus is given to
reviewing current prescribing behaviour and performance against key performance
indicators, set and monitored by NHS Fife. As a result, a number of actions are being
progressed to ensure Fife can deliver a cost-effective and efficient level of prescribing in the
Board.
For 12/13, there are two main areas for efficiency savings delivery within prescribing.
Significant efficiency savings have been identified for the 2012/13 financial year from the
anticipated benefit arising from the generic availability of Atorvastatin and from other
generic savings, as highlighted earlier. In total, £3m has been identified as a cash
releasing saving from generic availability in 2012/13 within the efficiency program, and this
is delivering as planned with full delivery assumed by year-end.
The second element of benefit relates to the national ‘Efficient Prescribing and Purchasing
Programme’ (ePPP) which has reduced the tariff price of generic drugs from the 1st of April
of this year. In addition, a further adjustment has been made to the tariff price via a
discount to recover monies from community pharmacy relating to the 11/12 programme. In
total, £1.8m of cash savings are anticipated from these initiatives in Fife, and are delivering
as planned, with full delivery again assumed by the year-end.
6.
CONCLUSIONS
NHS Fife continues to identify and develop mechanisms to ensure costs associated
with Prescribing can be managed within available resource now and in the future. The inyear performance on prescribing is encouraging in that efficiency savings are delivering as
planned, and the year-to-date prescribing is delivering an underspend on budget.
However, NHS Fife remains the highest cost prescriber in Scotland, and work will continue
to drive costs down in prescribing where this is clinically appropriate in order that this
resource can be reinvested in front-line services across other services within NHS Fife.
7.
RECOMMENDATIONS
The Finance and Resources Committee is asked to:

Note the prescribing position for the year-to-date and the relative performance against
other boards.
CHRIS BOWRING
Director of Finance
ANDREW McCREADIE
Assistant Director of Finance (Mgt Accounting)
27 November 2012
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