It felt strange sitting in a workshop within the NHS Alliance conference listening to two talks on medicines management within CCG. The first titled cost and quality felt like I was transported back a decade talking about incentive schemes and performance indicators. Telling practices where they spend their money and how they can spend less. But is this not cost containment rather than quality initiative I asked? No was the robust answer – reducing antibiotic use, particularly the quinolones and cephalosporins is an important quality initiative to recude C. Diff – have to agree on that one – and reducing the use of NSAIDs. Well, I have never been a fan of NSAIDs, but if you tell GPs not to use them what happens? There is an increase in co-prescribing of PPIs (what does that do to your C. Diff strategy) and the GPs prescribe something else. So what do they prescribe then? The patient with chronic pain does not disappear – well it would seem that they refer to a pain specialist or use an opiate such as tramadol on a pathway to morphine, fentanyl and oxycodone. So we possibly prescribe more costly treatments, patients go to hospital for different reasons such as falls and we support misuse through diversion when the patient realised that they have a bottle of pills that sell for a couple of quid each at the pub. So much for the 2006 regulation on controlled drugs (soon to be 2013).
When will we stand back and realise that drugs are a small percentage of the total costs – less than 10% the drive to cost contain medicines may be an outdated strategy in the new world of clinical commissioning.
The second talk was on hypoglycemia in diabetes. An interesting review on the incidence and impact of hypoglycemia in patients with both type 1 and 2 diabetes and hot it leads to increased complications and poor patient experience and compliance. An interesting concept that meant that an increased cost of medicines would payback in 5 years and be ‘in profit’ in 10. Now if the objective is reducing complications and improving patient experience and quality of life he is speaking my language. If CCGs embrace the medicines management QIPP metrics for diabetes then they may be driving cost containment rather than quality outcomes for patients.
My favourite quote of the day – “if we focus on quality then costs will contain themselves. “