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Repeat prescribing through co-design – second Q Exchange project update

The primary care improvement team at 1000 Lives Wales were delighted to receive Q Exchange funding last year for a project focusing on improving repeat prescribing systems and have delivered two workshops of the ‘Opportunity Costing’ method.

The primary care improvement team at 1000 Lives Wales were delighted to receive Q Exchange funding last year for a project focusing on improving repeat prescribing systems. In this update, they describe how the workshops have been going and what activity is currently underway.

What is it?

Delegates from across Wales will be able to attend ‘Opportunity Costing’ and evaluation workshops within the domain of repeat prescribing, to help design and then measure the value of improvements in time, money and efficiency savings. Benefits include releasing GP time, a better patient experience and a more reliable system.

Practice staff will not have had access to them before and will have the opportunity to use a different methodology compared to classic improvement methods or clinical audit. These methods can be used in the future for other areas of development work. The evaluation framework used is called CAREMORE and is an award winning NHS method. Practising what we preach, we have a digital evaluation form for delegates to complete after the event, which we use to improve the workshop.

2 April: Metropole Hotel, Llandrindod Wells (written by Paul Gimson, Programme Lead for Medicines Safety in 1000 Lives & former CEO of Community Pharmacy Wales & former Director at the Royal Pharmaceutical Society Wales, advising a GP & Pharmacy technician in Powys)

In Powys the team ran the first of four Repeat Prescribing Opportunity Costing workshops. The event went well, something that was reflected in the initial event evaluation. With a grand total of £278,991.80 in OC savings for the first workshop, if all projects were implemented, which most delegates predicted is very likely. They range from ‘just do it’s (JDI’s) to requiring a larger business case, which we will be supporting via the future evaluation workshops.

The amount is reflective of the staff time saved within practices, higher value of care, better patient experience & improved safety. It’s not just about the money. We look at the improvements through the lens of ‘savings’, as this creates a common unit of measurement, this shows improvement in GP capacity and the evaluation showed that delegates found the methodology transferable to other areas of work, building on improvement capability within primary care. In fact, some projects hardly save any money, but the improvements in safety and patient experience are so evident, that delegates remarked they would start making these changes the next day. One attendee fedback on the evaluation form: “I found it interesting how stepping back, looking at overall performance and applying very simple yet based on research method can improve productivity, save money and make our days at work more enjoyable. I have nothing negative to say, I found it not only very informative and useful but I have enjoyed myself as well.”

9th April: Botanic Gardens, West Wales (written by Andy Ware, Improvement Manager from 1000 Lives taking delegates through the art of opportunity costing)

In Carmarthen, we ran the second of the four Repeat Prescribing Opportunity Costing workshops, which resulted inith a grand total of £283,400.40 in OC savings. I have offered to meet with some practices like I did last Monday, to work through their projects in more detail, ensuring time series data helps demonstrate the changes are working and devise an improvement plan.

We are seeing some best practice emerge through the work, which we hope to share at a future celebration event for those that couldn’t make the workshops, but are interested in learning what worked and what didn’t. These practices include using some of the behaviour change methodology we advocate, ensuring the right person is seeing the patient at the right time, some classic improvement approaches and using data to compliment the decision making. Some of the issues around data create a challenge for us as these issues haven’t been tackled before (or we haven’t found the people that have solved them… yet). We hope to develop the best measures, and give people a shortcut to what to start with in a final toolkit.

As part of the event evaluation, we asked what they found most useful and received the following responses:

“Giving the opportunity to think”
“It was all really good at getting the main points across”
“Sharing ideas”
“The gradual introduction of the swimlanes, the mix of disciplines attending, the expert help from the facilitators”
“The methodology”

What about the rest of primary care?

The initial workshops will only cover a number of primary care practices. We had some delegates attend without their team due to capacity issues, and we are going to adapt the workshop to make sure that they come away with as much benefit as possible.

After these events and their evaluation, it will be decided whether a further offer is scaled up using lessons learned in national workshops or to primary care clusters.

A special thanks to everyone who has already attended the workshops and to members of Q who have already helped by giving us feedback and support.

Can you help?

We would be interested to hear form anyone else who is attempting to improve repeat prescribing or has had experience in trying to do so, especially what measures they decided to use – please contact me via email.

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