Tracy Savage is a Health Foundation Leadership Fellow who uses NICE guidance to advise GPs in Shropshire on appropriate prescribing practice.
The ‘postcode lottery’ is a tabloid way of describing how prescribing practices can vary across the country, with GPs in one area prescribing expensive drugs on the NHS, while those in another don’t. This can lead to variations in care for patients and strained medicines budgets.
The National Institute for Health and Clinical Excellence (NICE) was set up to address this problem. NICE advises which drugs and treatments should be available on the NHS and on best practice in prescribing. Tracy Savage is a Health Foundation Leadership Fellow who uses NICE guidance to advise GPs in Shropshire on appropriate prescribing practice.
The Leadership Fellows scheme aims to develop people who have the potential to become future leaders of healthcare. Through an individualised programme of personal and professional development, participants develop leadership skills to improve the quality of healthcare in their field or area. They work with peers from a range of clinical backgrounds within a stimulating learning environment.
Tracy’s roles at Shropshire County PCT and Keele University
Tracy has two roles, both of which deal with prescribing practice. These are joint Head of Medicines Management at Shropshire County Primary Care Trust (PCT) and lead of a service level agreement at Keele University with all PCTs in the West Midlands to provide information about prescribing and medicines management.
‘As a head of medicines management, we have to balance the books for a £50 million prescribing budget,’ Tracy says. ‘We need to ensure appropriate and safe medicines management in different environments, from GP practices to community services, prisons, GP practices and community pharmacies.’
‘At Keele, I lead a service that gives advice to people like myself,’ she continues. ‘We provide each PCT in the West Midlands with prescribing data and evidence-based advice, and produce comparative prescribing data in areas such as the Quality and Outcomes Framework, which is a reflection of GP activity and hospital episode statistics. We pull all this data together to make the difficult information easier to understand and hard decisions easier to make.’
One of Tracy’s key challenges across both roles is persuading healthcare professionals to change their prescribing behaviour. This can be an issue if, for instance, one practice in a PCT is prescribing an expensive new drug and drawing funds away from other areas.
Prescribing drugs for cardiovascular disease
Tracy cites the example of cardiovascular disease. ‘There are four common drugs that you can use to treat these conditions, all with an excellent evidence base and which cost around £50 per patient, per year,’ she says. ‘Whereas if the new costly medicines which are still patented are prescribed and without such a robust evidence base, the cost per patient, per year could be as much as £900. Across the West Midlands, that could mean millions of pounds could be freed up to spend on other areas of patient care,’ she adds.
Tracy finds that comparative data is usually the best tool for influencing practitioners. ‘We could just go to a practice and say ‘Look I’m sorry but you’re prescribing too much of this and it’s very costly’, which can undermine or even alienate people,’ she says. ‘But if you take comparative data and suggest ‘this practice-based commissioning group is doing X and Y, let’s look at who’s doing what within the group’, the information tells its own story. People can see where they are the outliers, take that on board and change their own behaviour.’
'Across the West Midlands, that could mean millions of pounds could be freed up to spend on other areas of patient care.'
13 June 2008