In 2015/16, over 79 million prescriptions were issued from GP practices in Wales at a cost of £593 million, showing an increase of 39% over the last 10 years. It is estimated that around 80% of these are repeat prescriptions (http://gov.wales/statistics-and-research/prescriptions-general-medical-practitioners/?lang=en).
Initial improvement work done by 1000 Lives Improvement, shows there is a huge amount of negative variation in the repeat prescribing processes used by GP practices and they are inherent with failure demand and the generation of unnecessary queries.
They vary in terms of staff involved, the number of hand offs, and the information systems used and missed opportunities to improve prescribing.
Community and practice pharmacists across Wales, stated at the 7th Community of Practice hosted by 1000 Lives Improvement, that they have different degrees of involvement but can see areas to improve. The amount of clinical review incorporated into the process differs and the way the system links with chronic disease management is sparse.
GPs currently spend a lot of time signing prescriptions which is generally regarded as ‘wasted time’. One practices calculated that a GP spends 3 weeks of their working year signing scripts.
GPs and other clinical staff also spend a lot of time managing the ‘failure demand’ generated by the process. This contributes to wasted time, possible harm and financial loss through prescribing budgets.
There are many examples of good practice but it is also clear there is no ‘one size fits all’ solution. Our approach it not to simply offer examples of good practice but instead to offer practices a methodology by which they can, with a little support, help themselves to design the processes with scientific rigour to tailor the service to the practice.
1000 Lives already has experience in using tailored mapping techniques and data analysis to help people gain insight into their work and how to improve it within their practice. This builds improvement capability to then use on other future projects.
The next phase would be to develop a break through collaborative for Wales, so that pharmacists can take the methods back to their practice, map it, analyse it and understand it with hands on support upon request.
The funding will help us with;
Sessional time from clinicians willing to work with us to test the idea
Producing high quality materials support the collaboration
Producing communications material to support to engage clinicians an engage the public
Deliver workshops to co-design solutions.
Our final product will be a Quality Improvement package that can be used by practices anywhere to improve repeat prescribing.
Predicted outcomes include a safer service for patients by reducing the chance to harm, reduce the burden on primary care staff, more opportunities to review patients and releasing GP capacity away from unnecessary administrable tasks.
How you can contribute
- We would like to hear examples of good practice to understand the methods that achieved those results. We would also like to hear form those with experience of quality improvement and process mapping in primary care. We would welcome involvement from Q members who have a role or interest in repeat prescribing.
This is a great project because…
This project focuses on an area with wide applicability and offers the potential to improve processes, workflow and save money. The collaborative approach will facilitate sharing learning across Wales.
By the time of the event we encourage the project team to think more about…
The project team have been thoughtful about how they will share learning within the collaborative but we would like to see how they will share beyond the project and with the Q community more widely.