AWMSG therapeutic priorities and CEPP summary

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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
Abbreviations: ADQ=average daily quantity; AF=atrial fibrilation; DDD=defined daily dose; MHRA=Medicines and Healthcare products Regulatory Agency; PPI=proton pump inhibitor; STAR-PU=specific therapeutic group age-sex weighting related prescribing unit; UDG=user defined group
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	Primary care	The number of patients with AF and a CHA₂ DS₂ -VAS_C 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 -VAS_C 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
Antimicrobial stewardship	Primary care	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	NWSSP
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