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Please contact your locality manager for Emis searches that will help with scorecard work.

1. Antimicrobial prescribing targets and has a sepsis lead

Target yes

This is measured monthly using two indicators. The quantity of all antibiotics must be within the national target and reducing trimethoprim items for patients aged ≥70 years. To be green practices will need to achieve both parts of the indicator and have a practice sepsis lead.

Antibiotic prescribing data is sent to practices each month.

Please visit our Infection Management page for more information.

2. Reduction in radar red and amber alerts

Target <0.5 per 1000 Astro Pu

Eclipse is the best risk reduction tool available to practices.

Medicines Safety Improvement Programme

Please note: any patients excluded from these searches will still count towards the indicator calculation.

3. Percentage LD and Dementia patients prescribed antipsychotics

Target <8%

This indicator measures the number of patients with learning difficulties and/or dementia that are prescribed antipsychotic medication but have no diagnosis of psychosis. People with dementia who are receiving antipsychotic medication should have their prescriptions reviewed at least every 6 weeks.

STOMP stands for stopping over medication of people with a learning disability, autism or both with psychotropic medicines. It is a national project involving many different organisations which are helping to stop the over use of these medicines.

The WHELD programme supports care home staff to deliver patient-centred interventions for residents with dementia. It seeks to reduce the use of antipsychotic drugs in dementia care home residents.

Please note: any patients excluded from these searches will still count towards the indicator calculation.

4. Reduction in anticholinergic burden prescribing

Target <0.76% of patients with an anticholinergic burden of 6 or more

An increasing number of systematic reviews and meta-analyses report that medicines with anticholinergic effects are associated with an increased risk of cognitive impairment, falls and all-cause mortality in older people.

The term anticholinergic burden refers to the cumulative effect of using multiple medications with anticholinergic properties concomitantly.

5. Solifenacin or oxybutynin tablets as a percentage of all anticholinergic incontinence drugs

Target >65%

It is now nearly two years since solifenacin lost its patent and it is now the most cost effective anticholinergic incontinence drug alongside immediate release oxybutynin. All patients should be regularly reviewed for any anti-cholingeric side effects which may mean they have better outcomes with no prescribing, but if they experience minimal side effects and benefits which warrant continued prescribing of an anti-cholinergic incontinence drug we now recommend a switch to solifenacin. Patients with incontinence problems may restrict fluid intake which could be harmful so please refer them to the Somerset hydration leaflet.

Please note this indicator excludes mirabegron and oxybutynin oral solution.

6. Reduction of patients on mixed inhalers

Target 50% reduction

This measures the number of patients on mixed pathways. The aim is to have patients on either MDI or DPI inhalers.

Please note: any patients excluded from these searches will still count towards the indicator calculation.

Please visit our Respiratory page.

7. Cost effective DPI combo/single inhalers

Target >60%

For an up to date list of Project Positive items please contact your locality manager.

Please see our Respiratory page for more resources.

8. Cost effective MDI combo/single inhalers

Target >60%

For an up to date list of Project Positive items please contact your locality manager.

Please see our Respiratory page for more resources.

9. Blood glucose test strips £9.25 or less per pack of 50

Target >75%

Do not routinely offer self-monitoring of blood glucose levels for adults with type 2 diabetes unless: the person is on insulin or there is evidence of hypoglycaemic episodes or the person is on oral medication that may increase their risk of hypoglycaemia while driving or operating machinery or the person is pregnant, or is planning to become pregnant.

For an up to date list of Project Positive items please contact your locality medicines manager.

Please visit our Diabetes page for the most up to date information on test strip prices.

10. Gliflozins as a percentage of all gliflozins+gliptins

Target >60%

This measures SGLT-2 as a percentage of all SGLT-2 and gliptins.

This includes nondiabetic patients who may have dapagliflozin recommended for initiation for chronic heart failure as per NICE TA679. Prescribing of both a gliflozin and gliptin is not recommended and given the growing cardiovascular outcome data for gliflozins in patients with diabetes they should now be favoured ahead of gliptins and suitable patients should be switched to a gliflozin with CVD evidence.

For an up to date list of Project Positive items please contact your locality medicines manager.

11. Diabetes patients with all 8 care processes completed

Target >70% of all 8 care processes undertaken in the last twelve months

The tests are HbA1c, blood pressure, cholesterol, weight/BMI, eGFR, microalbuminuria, smoking and foot screening.

12. Reduce morphine solution prescribing

Target <150ml per 1000 analgesic Star Pu

Liquid morphine has a high sugar and alcohol content.

Please see our Pain Management page for more resources

13. CCG Formulary preferred opiate formulations

Target >80%

As a system we try to keep to specific cost effective branded opiate prescribing as this reduces the risk as patients move across boundaries between primary and secondary.

For an up to date list of Project Positive items please contact your locality medicines manager.

Please see the Pain Management page for more resources.

14. Reduce opiate prescribing (excluding injectables)

Target <43 opiate ADQ per 1000 Astro Pu (or Jan -March 2023 data has reduced by 10% compared to baseline)

The volume of prescribing is measured in Average Daily Quantities. For a given drug, the Average Daily Quantity is a value calculated to reflect the daily dose typically prescribed to individual patients within UK General Practices.

NICE guidelines Chronic pain in over 16s: assessment of all chronic pain and management of chronic primary pain

Please see the Pain Management page for more resources.

15. Reduction in hypnotic and anxiolytic prescribing

Target <215 ADQ per 1000 patients

Anxiolytics and Hypnotics are drugs that are prescribed for short-term treatment of conditions such as anxiety and sleep problems. The Royal College of Psychiatrists states that “around 4 in every 10 people who take them every day for more than 6 weeks will become addicted” and therefore they should not be prescribed for longer than 4 weeks. This measure shows the mean Average Daily Quantity (ADQ) given per prescription, for both the older benzodiazepines, such as diazepam and temazepam, and the newer “Z-drugs”, such as zopiclone.

NICE advice Hypnotics

Please see our Hypnotics and Anxiolytics page for more resources.

16. Potential generic savings

Target <0.25% per quarter

Savings that could be achieved by changing from proprietary to generic prescribing for drugs identified at a national level as having the greatest potential to release additional resources. This is sent out quarterly in an email from the Medicines Management team. Please review and make the suggested switches.

Somerset CCG could save £300k each year by switching expensive brands to generic.

17. NHSE over the counter selfcare indicators

Target <£375 per 1000 patients

The GMC says ‘Prescribing’ is used to describe many related activities, including advising patients on the purchase of over the counter medicines and other remedies.

The NHS has produced a document which lists the conditions which should be classed as self care.

Please see the Self Care page for more resources.

18. Sip feed spend

Target <£500 per 1000 patients over 3 months or reduce spend by 10%

This can be best achieved by

  • recommending a food first approach – including care home residents and prescribing sip feeds only as per the formulary.
  • Only using compact sip feeds in those patients who are clinically fluid restricted
  • Setting a weight stabilisation target as per MUST
  • Reviewing all sip feed patients regularly and only putting sip feeds on acute prescription

Please see the Nutrition page for more information.

19. Spend on preferred products as a percentage of all emollients

Target >40%

Please see our Dermatology page for more resources.

For an up to date list of Project Positive items please contact your locality medicines manager.

20. Reduction in vitamin D and calcium prescribing with no bone sparing agent

Target <4.05 per 1000 Astro Pu

Patients prescribed a bone sparing agent such as a bisphosphonate will need calcium with vitamin D prescribed as part of their treatment regime. Those who are not on a bone sparing medication are not indicated for calcium or vitamin D alone or in combination.

Patients deficient in vitamin D are eligible for self-care.

NICE guidance Bisphosphonates for treating osteoporosis

Please note: any patients excluded from these searches will still count towards the indicator calculation.