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A NICE APPROVED QIPP PROJECT WHICH HAS BEEN
ROLLED OUT BY SOUTH WORCESTERSHIRE CCG HAS
RESULTED IN COST SAVINGS, GP DR DAVID FARMER
TELLS THE COMMISSIONING SHOW.
The QIPP approved case study was
conducted in the arena of Ulcerative
Colitis, a long term remitting and
relapsing disease which can seriously
impact on the patient’s health, social
and employment opportunities and
overall quality of life.
A major part of treatment of UC centres
around effective disease management,
including adherence to drug therapy with the
specific aims of inducing and maintaining
disease remission, reducing steroid intake
and minimising, hospital outpatient and
inpatient treatment,’ explains Dr Farmer.
‘Conversely poor disease management and
low adherence to drug therapy is closely
associated with poor outcomes and high
costs. Indeed 75% of all NHS spend is on UC
patients who are inadequately controlled and
go on to require intensive medical or surgical
intervention.
‘As a GP I know just how this disease impacts
not just on the patient but also on family
members and the toll it can take on every area
of daily life.’
The QIPP pilot project, which was supported
by Dr Falk Pharma UK but independently
designed and managed by Medicines
Management Solutions (MMS)
initially
reviewed 363 patients with UC across 11 GP
practices in Leicestershire, recommended a
change in 130 and actioned change in 87,
including changing from multiple daily
medication to once a day Salofalk 1.5g
Granules.
Six months after the changes, routine hospital
visits were down by 47%, hospital visits due to
flare-ups were down by 60%, GP visits due to
flare up down by 44% and there was a 50%
reduction in steroid courses prescribed.
Overall the cost saving was conservatively
estimated at £30,000. The figures were later
presented to and accepted by NICE as a QIPP
case study.
‘When we in South Worcester CCG were
offered this QIPP case study for consideration
for roll out, it seemed like an excellent
opportunity,’ says Dr Farmer.
‘Firstly we are always looking for value for
money and the pilot already provided quite
stunning figures to support this. In addition,
the methodology had clearly been very well
thought out and showed in-depth knowledge
of the issues surrounding UC, such as flare
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ups and hospital visits, and drug nonadherence. We were delighted too, to receive
the support of MMS, although we note that
this may not always be practicable or
desirable for CCG’s in other regions.’
The project was rolled out across 32 South
Worcestershire GP practices early this
year, (with another 2 local CCGs to
follow later this year). In total 481
patients were reviewed, 279 were
invited to clinic and interventions
were made in 76 patients with an
estimated cost saving of
£27,027.’
Dr Farmer is extremely
pleased with these early
results.
‘GP’s are very busy people
and although we may
have good ideas for
saving money and
improving
patient
quality of life, actually
getting these ideas put
into practise is often
very time consuming
and expensive. So to
be able to take an ‘off
the peg’ study like this,
where there was
already an established
structure
and
methodology
and
proven
cost
effectiveness was a joy.
‘Apart from the cost
savings, the study also
promoted
excellent
medical practise even
before being implemented.
We all know how easy it is for
some patients to fall through
the gaps of our busy healthcare
services and perhaps not be
reviewed as often as they should.
Often the very act of reviewing a
patient, and spending time discussing
with them how best to manage their
condition including adherence to therapy
empowers and encourages them to self
manage in a more effective way.
‘In supporting and encouraging thorough
review, intervention and patient engagement,
this study is actually a template for very good
medicine which could be used for other
chronic and costly disease such as diabetes
and heart disease.’