Practice Based Commissioning (PBC) Cluster Update

(Published January 2007)

PBC Cluster Update

Health Direction have identified 1105 PBC Clusters in England. This consists of 618 Clusters (containing more than one practice), 463 Individual Commissioning Practices and 24 PCO Commissioning Clusters. There are currently 68 Clusters still finalising their membership.

This is a very fluid situation and requires constant dialogue with PCTs, PBC Clusters and Practices. Health Direction, in partnership with the NHS Alliance, is at the forefront of mapping these changes, so crucial to understanding how commissioning is developing in the England NHS.

Prescribing Performance

Sue Knox, the Business Development Director at Health Direction and a current prescribing advisor to a Gloucestershire practice looks at Prescribing Performance In Terms Of Potential Statin Savings And Forecast Outturn On Prescribing Budget

The NHS Institute for Innovation and Improvement (1) via its NHS Indicator Explorer web tool has made available for each (old) PCT comparative information for the percentage of statins which are prescribed as low cost statins (generic simvastatin and pravastatin) and the potential cost savings if a PCT was to switch 69% of all statin prescribing to low cost statins.

All PCTs are tasked with making savings against the prescribing budget as this has been factored into the PCTs Financial Recovery Plan and so it is interesting to look at the potential for a particular PCT to save money by changing statin prescribing in conjunction with its forecast prescribing outturn and its overall financial performance.

There are 44 PCTs whose forecast outturn against the prescribing budget for 2006/07 is likely to be an overspend or breakeven position (based on prescribing budget outturn data aggregated for the component (old) PCTs for 2005/06) Of these, 36 PCTs have potential to make enormous annual savings by switching to low cost statins.

Conversely, PCTs who have already achieved savings from switching to low cost statins will need to pursue alternative strategies to release cash savings from prescribing, particualrly if they are forecast to overspend against their prescribing budget in 2006/07.

Case Study 1: Lincolnshire Teaching PCT
(pre October 2006: West Lincolnshire PCT, East Lincolnshire PCT and Lincolnshire South West PCT)
Lincolnshire Teaching PCT is likely to overspend against the prescribing budget for 2006/07 but could make £2,360,000 annual savings if 69% of statin prescribing is changed to low cost statins. This is likely to be a key component of any prescribing action plan for the remainder of the current financial year and beyond. In terms of overall financial performance, (old) East Lincolnshire PCT, one of the component PCTs of the Lincolnshire Teaching PCT was one of the Trusts with the worst financial performance who received a letter from the Secretary of State for Health or from the NHS Chief Executive regarding its financial management for the year 2005/6. Lincolnshire PCT is forecast a deficit for 2006/07 although expects to breakeven by 2007/08.

However, achievement of cost savings through implementation of statin prescribing changes is also influenced by other factors within the Medicines Management Team, such as cohesiveness of the Team under the new structure. The component PCTs of the new Lincolnshire Teaching PCT worked well together before structural changes and so are starting to move forward with a cohesive approach to medicines management.

Case Study 2:Middlesbrough PCT
(structure unchanged post October 2006)
Middlesbrough PCT overspent against its prescribing budget in 2005/06 and is likely to overspend in 2006/07 but has no potential to make any savings from switching to low cost statins as this work has already been done. Although the financial performance during 2005/06 was an overall small underspend, against a total budget of £234.214m, cost pressures from the £243,600 prescribing overspend and £186,000 primary care overspend will be key targets for cash savings in 2006/07.

As the structure of Middlesbrough PCT remained unchanged post October 2006, the effectiveness of the Medicines Management Team can be assumed to be as it was pre October 2006 and therefore will continue its input into implementing prescribing change, which, whilst to date has not achieved financial savings, has achieved the prescribing indicator target for statin prescribing as defined by the NHS Institute for Innovation and Improvement.

In conclusion, to effectively target resources and create beneficial partnerships with PCTs, Pharma companies need to fully understand the interaction between forecast prescribing budget outturn, forecast overall financial performance and any cost saving measures that may be included in prescribing action plans and prescribing incentive schemes and use this knowledge to develop personalised strategies.

(1) NHS Institute for Innovation and Improvement at http://www.institute.nhs.uk/ accessed 22 January 2006.