Overview
This Guidelines summary presents the All Wales Medicines Strategy Group’s (AWMSG) therapeutic priorities for 2020–2021, and highlights opportunities within the CEPP framework where local prescribing initiatives can be undertaken to support these priorities. There is an expectation that prescribing initiatives should address a balance of medicine safety, quality and cost-effectiveness. For further information, please refer to the full guideline.
View this summary online at guidelines.co.uk/455527.article.
Prescribing indicators
AWMSG National Prescribing Indicators (NPIs)
Prescribing indicators are used to highlight therapeutic priorities for NHS Wales and compare the ways in which different prescribers and organisations use particular medicines or groups of medicines.
Prescribing indicators should be evidence-based, clear, easily understood and allow health boards, primary care clusters, GP practices, and prescribers to compare current practice against an agreed standard.
For 2020-2021, the National Prescribing Indicators: Supporting Safe and Optimised Prescribing, have been refreshed with a focus on three priority areas, supported by safety and efficiency domains as listed in Table 1.
Local Comparators
The Local Comparators are former NPIs which have been retired, but which may continue to be useful for some health boards to monitor. Local Comparator data will be available on a quarterly basis via the Server for Prescribing Information Reporting and Analysis (SPIRA) for two years post NPI retirement. The list of Local Comparators and associated drug baskets for 2020–2021 can be found in National Prescribing Indicators 2020–2021 Specifications.
Educational component
Materials to support the educational component, including national guidance, educational modules and National Prescribing Audits are listed in section 4.0 of the full guideline.
Therapeutic update session(s)
Attendance at therapeutic update sessions is recommended, for example:
- attendance of practice prescribing lead at therapeutic update educational event(s)
- evidence of face-to-face feedback and discussion with the primary healthcare team and/or locality cluster groups. Meeting notes to include action points identified. Subsequent meeting to be held in the final quarter, reviewing progress against action points.
National prescribing audits
Completion of one of the AWMSG-endorsed National Prescribing Audits is recommended.
Table 1: National prescribing indicators 2020-2021
| National Prescribing Indicator | Applicable to: | Unit of measure | Target for 2020–2021 | Data source |
|---|---|---|---|---|
| Priority areas | ||||
| Analgesics | Primary care | Opioid burden user defined group (UDG) ADQs per 1,000 patients | Maintain performance levels within the lower quartile, or show a reduction towards the quartile below |
NHS Wales Shared Services Partnership (NWSSP) |
| Tramadol DDDs per 1,000 patients | ||||
| Gabapentin and pregabalin DDDs per 1,000 patients | ||||
| Anticoagulants in atrial fibrillation (AF) | Primary care | The number of patients with AF and a CHA2 DS2 -VASC score of 2 or more who are currently prescribed an anticoagulant, as a percentage of all patients with AF | To increase the number of patients with AF and a CHA2 DS2 -VASC score of 2 or more prescribed an anticoagulant | NHS Wales Informatics Service (NWIS) |
| The number of patients diagnosed with AF who are prescribed an anticoagulant and have received an anticoagulant review within the last 12 months, as a percentage of all patients diagnosed with AF who are prescribed an anticoagulant | To increase the number of patients who are prescribed an anticoagulant and have received an anticoagulant review within the last 12 months | |||
| The number of patients diagnosed with AF who are prescribed antiplatelet monotherapy, as a percentage of all patients diagnosed with AF | To reduce the number of patients with AF prescribed antiplatelet monotherapy | |||
| Antimicrobial stewardship | Primary care | Total antibacterial items per 1,000 STAR-PUs |
Health board target: a quarterly reduction of 5% against a baseline of April 2018–March 2019.
GP practice target: maintain performance levels within the lower quartile, or show a reduction towards the quartile below |
NWSSP |
| Number of 4C antimicrobial (co-amoxiclav, cephalosporins, fluoroquinolones and clindamycin) items per 1,000 patients |
Health board target: a quarterly reduction of 10% against a baseline of April 2018–March 2019.
GP practice target: maintain performance levels within the lower quartile, or show a reduction towards the quartile below |
|||
| Supporting domain: safety | ||||
| Prescribing safety indicators | Primary care | Number of patients identified | No target set | NWIS |
| Proton pump inhibitors | Primary care | PPI DDDs per 1,000 PUs | Maintain performance levels within the lower quartile, or show a reduction towards the quartile below | NWSSP |
| Hypnotics and anxiolytics | Primary care | Hypnotic and anxiolytic UDG ADQs per 1,000 STAR-PUs | Maintain performance levels within the lower quartile, or show a reduction towards the quartile below | NWSSP |
| Yellow Cards | Primary care | Number of Yellow Cards submitted | One Yellow Card per 2,000 GP practice population | MHRA |
| Health board |
One Yellow Card per 2,000 health board population
20% or greater increase from baseline (2019–2020) for Yellow Cards submitted by secondary care
50% or greater increase from baseline (2019–2020) for Yellow Cards submitted by members of the public |
|||
| Community pharmacy |
No target set.
Reported as the number of Yellow Cards submitted by health board |
|||
| Supporting domain: efficiency | ||||
| Best value biological medicines | Primary and secondary care | Quantity of best value biological medicines prescribed as a percentage of total ‘biosimilar’ plus ‘reference’ product | Increase the appropriate use of cost-efficient biological medicines, including biosimilar medicines |
NWSSP NWIS |
| Insulin | Primary and secondary care | Items/number of long-acting insulin analogues as a percentage of total long- and intermediate-acting insulin prescribed | Reduce prescribing of long-acting insulin analogues and achieve prescribing levels below the Welsh average |
NWSSP NWIS |
| Low value for prescribing | Primary care | Low value for prescribing UDG spend per 1,000 patients | Maintain performance levels within the lower quartile or show a reduction towards the quartile below | NWSSP |
Full guideline:
All Wales Medicines Strategy Group. Therapeutic Priorities and Clinical Effectiveness Prescribing Programme Summary 2020–2021. AWMSG, 2020. Available at: awmsg.nhs.wales/files/therapeutic-prioritites-and-cepp/therapeutic-priorities-and-cepp-summary-2020-2021-pdf/
Published date: June 2020.
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