Scorecard 2024/25

We have retired the trimethoprim in over 70yrs component of the indicator.
We have introduced two new measures - the duration of courses of amoxicillin 500mg capsules and doxycycline 100mg capsules. These antimicrobials will be monitored for five day prescribing in accordance with the infection management guidance.

The antibiotic duration of therapy workstream is one of 16 national medicines optimisation opportunities. “Research increasingly demonstrates that short courses of antibiotics are as effective as longer courses in treating patients with uncomplicated infection (Lee et al, 2023), (Garwan et al, 2023). Reflecting this evidence, NICE guidance for common infections routinely recommends the shortest effective course of treatment, to reduce selection pressure for antimicrobial resistance and inadvertent patient harm from antibiotic treatment. Five-day courses are recommended when antibiotics are indicated for sinusitis, sore throat, COPD infective exacerbation, cough (acute), pneumonia (community-acquired) and otitis media.”
Resources to support the work on the amoxicillin and doxycycline work can be found under the Shorter is Better banner on the ICB Antimicrobials webpage, with a helpful one minute video explaining the rationale.

Antimicrobial targets

We continue to include the NHSE target for the overall quantity of antimicrobial prescriptions. (This is currently <0.871 Antibacterial Items per STAR-PU.
Five day prescribing for amoxicillin target ≥ 75%
Five day prescribing for doxycycline target ≥ 50%

Practices will need to achieve all three parts of the indicator and have a practice sepsis lead in order to be green on this scorecard indicator.

ICB Infection Management Guidance should be used to guide prescribing decisions. Please visit our Infection Management page for more information.

We will continue to monitor recommended prescribing practice including but not limited to avoiding trimethoprim in patients over 70 years, broad spectrum antibiotic prescribing, quinolones and unusual antibiotics outside of the scorecard indicator monitoring.

Antibiotic prescribing data is sent to practices each month, contact your locality manager if you have any questions.

2. Reduction in radar red and amber alerts

3. Percentage LD and Dementia patients prescribed antipsychotics

Target <7%

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.

Appropriate prescribing of antipsychotic medication in dementia provides guidance and information on uses, risks and alternatives to antipsychotic medication, risk reduction in antipsychotic prescribing, and support for local systems to deliver best practice in antipsychotic prescribing and de-prescribing where appropriate.

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

See our Dementia page and Deprescribing page for more information. See the NHS Somerset ICB - STOMP section to find out more about the Somerset Foundation Trust pathway for support from their Learning Disability Nurse Prescribers in reviewing LD patients taking antipsychotics.

4. Reduction in anticholinergic burden prescribing

Target <0.70% 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.

Please see our Deprescribing page for more information.

5. Antimuscarinic incontinence drugs

6. Reduction of patients on mixed inhalers

7. Cost effective DPI combo/single inhalers

8. Cost effective MDI combo/single inhalers

9. Reducing inhaler carbon footprint indicator

10. Reduction in medications which are high risk in pregnancy prescribed without contraception

Target <15 per 1000 patient list size

Please see the updated Eclipse search 2024 NEW April Scorecard 24-25 - Medications which require contraception/ avoidance of pregnancy - Planning ahead of pregnancy needed

The list of medication includes: warfarin, rivaroxaban, apixaban, dabigatran, carbimazole, modafinil, chlordiazepoxide, topiramate, pregabalin, zonisimide, valproate, valproic acid, carbamazepine, phenytoin, phenobarbital, atorvastatin, fluvastatin, pravastatin sodium, rosuvastatin, simvastatin, ezetimibe, bempedoic acid, methotrexate, isotretinoin, epiduo or differin, GLP1s, GLP2s, DPP4s, tirzepatide.

This is not an exhaustive list, refer to individual SPCs, MHRA warnings and Pregnancy Prevention Programmes. Searches exclude patients coded as infertile (such as hysterectomy), post menopausal, fitted with a LARC or on oral contraceptive and those with counselling on the risks of their medication to a foetus.

This indicator aims to improve pregnancy planning, support families to stay well and improve information on access to contraception and taking medications while having potential to become pregnant.

For helpful resources please see our Pregnancy Planning with Long Term Conditions - NHS Somerset ICB, Medicines used in pregnancy and Medication safety pages.

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

11. Generic Sitagliptin as a % all Gliptins

12. Reduction in H2RA prescribing

Reducing expensive H2RA prescribing, in the last 12 months Somerset has spent ~£900k on H2RAs.

H2RAs are not licensed for use in healing or prevention of NSAID related ulcers, only PPIs have that licensed indication.

H2RAs licensed uses are limited to 8 – 12 weeks of treatment after which step down to sodium alginate suspension would be recommended.

Target <6 packs per 1000 patients (or Jan-March 2025 data has reduced by 20% compared to baseline).

See formulary chapter 1.6

13. Diabetes patients with all 8 care processes completed

14. Reduce opiate prescribing (excluding injectables)

Target <39 opiate ADQ per 1000 Astro Pu (or Jan - March 2025 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 our 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.

NHS Somerset could save over £450k each year by switching expensive brands to generic.

17. NHSE over the counter selfcare indicators including hayfever

18. Sip feed spend

Target <£500 per 1000 patients over 3 months (or Jan to March 2025 data has reduced by 10% compared to baseline)

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 including resources for the Food First Approach.

19. Cost-effective HRT prescribing

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

Target <4.00 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.

No vitamin D or combination vitamin D and calcium product is licensed for fracture prevention when used without
a bone sparing agent.

Patients who are deficient in vitamin D (<25nmol/l) should be prescribed a fixed loading dose as advised in formulary chapter 9.3. Patients with insufficient vitamin D levels should be signposted to self-care.

NICE guidance Bisphosphonates for treating osteoporosis

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