g logo ipb green

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 2020–2021Data 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.