DEVENISH PRACTICE 

PRESCRIBING EFFICIENCY PLAN.

PATIENT INFORMATION

INFORMATION FOR PATIENTS REGARDING CHANGES TO PRESCRIBING FROM APRIL 2011

From 1st July 2010, the HSC Board became responsible for the management of a cash-limited budget for medicines used in primary care. This is a significant additional Board responsibility with an associated budget of circa £400m. It is essential that the Board takes all appropriate steps to ensure the effective management of this resource.

It is evident that previous controls on prescribing spend has not managed to maintain spend below that of other comparators:

Country	Prescribing cost per head of population	
Northern Ireland	£224.96	
Wales	£194.24	
Scotland	£187.91	
England	£162.95	

As you can see from the table above Northern Ireland spends far more on prescribed drugs per head of population than the other 3 areas of the United Kingdom.

Due to the current economic climate and pressures on the healthcare funding, all GP practices in Northern Ireland have to make savings on their drugs budget to free up money for other essential services such as home helps, reducing hospital waiting lists, essential surgery, cancer care etc.

All GP practices in Northern Ireland are reviewing their prescribing patterns and trying to reduce costs where possible. This will mean that we may not prescribe the brand of medications you are currently getting but will give you a generic alternative which should be as effective.

We can appreciate that nobody likes to change from a brand of medication that they are happy and comfortable with but due to the cost restrictions placed on our practice we would ask you to give your new medication a fair trial (at least 3 months) before we would try an alternative medication.

What are Generic Drugs?
A generic drug is a copy that is the same as a brand-name drug in dosage, safety, strength, how it is taken quality, performance and intended use.  Generic drugs do not take longer to work in the body.  Generic drugs are less expensive because generic manufacturers don't have the investment costs that the developer of a new drug has.  New drugs are developed under patent protection.  The patent protects the investment; including research, development, marketing, and promotion by giving the company the sole right to sell the drug.  As patents near expiration, manufacturers can apply to sell generic versions. Because those manufacturers don’t have the same development costs, they can sell their product at substantial discounts.  Also, greater competition will help to keep the prices down.

DRUGS/ITEMS WE ARE STOPPING

We are stopping prescribing certain items unless there are strong clinical reasons for continuing to prescribe them, initially we will stop all of these items and we would ask patients to make an appointment to see the doctor if they feel that they have good clinical reasons for having them. Patients may find that the amount of these items will be restricted or the brand prescribed may be different from what they have had in the past.

Most of these items can also be bought over the counter.

•	Stockings – where medically indicated patients will be allowed 3pairs every 6 months (1 pr to wear, 1 to wash & 1 to dry)  
•	Mouthwashes 
•	Sudocream & Other Barrier Creams 
•	Bath Emollients – only prescribed if pt diagnosed with severe skin condition.
•	Shampoos – only Polytar shampoo will be issued 
•	Baby food – unless recommended by dietician/consultant: Pt on this should be reviewed regularly and stopped when baby is over 6 months. 
•	Vitamins – just multivitamin capsules will be prescribed
•	Evening Primrose Oil 
•	Cod Liver Oil 
•	Sun Creams – unless there are medically indicated reasons for protecting your skin
•	Cough Bottles – Honey and hot lemon most effective remedy for coughs 
•	Rubs for soft tissue inflammation – we will only prescribe Algesal or Ketoprofen rubs
•	Ensure and other energy drinks – We will only prescribe these if clinically indicated using MUST guidelines, stop any prescribing to patients with no indications. 
•	Versatis Patches will only be used short term for post herpetic neuralgia
•	Test strips and lancets for all diabetics not on insulin. 
•	Gaviscon – we will only prescribe Peptac.
•	Pain relief capsules and dissolving tablets such as Paracetamol or Co-Codamol will only be prescribed in tablet form.

MEDICATION SWITCHES WE PLAN TO MAKE.

•	Cardura to Doxazosin:  
•	Fosamax Once Weekly to Risedronate or Alendronate 
•	Plavix to Clopidrogel 75mg 
•	Lustral to Sertraline 100mg
•	Pepcid PM to Famotidine
•	Istin to Amlodipine 10mg
•	Opticrom to Sodium Cromoglicate
•	Zydol to Tramadol
•	Solpadol caps to Co-codamol tabs: 
•	Cipramil to Citalopram
•	Flixonase to Rhinocert Aqua
•	Sopladol Eff to Co-Codamol tabs
•	Loceryl to Amorolfine
•	Lyrica to Gabapentin
•	Omeprazole 1 x 40mg to 2 x 20mg  
•	Nexium to Lansoprazole 30mg
•	Seretide 125 Evohaler to Fostair
•	Cipralex to Citalopram
•	Bonviva to Alendronic Acid
•	Prednisolone 5mg EC to non EC
•	Etizimibe to Statin
•	Felodipine to Amlodipine
•	Avamys to Beconase
•	Duac to Quinoderm

LOCAL PHARMACY MINOR AILMENTS SCHEME

All of our local pharmacies participate in a minor ailments scheme; if you suffer from any of the ailments listed below you do not have to see your doctor but can go to your local pharmacy to get medication.

THRUSH

HEADLICE

DHOBIE ITCH

DIARRHOEA

THREADWORMS

ATHLETES FOOT

Most local pharmacies also offer additional services for smoking cessation, weight loss and some offer Blood pressure and cholesterol checks.

Protect Antibiotics so they can protect you!

"Against colds and flu, there's nothing antibiotics can do"

Antibiotics are important medicines that help fight serious infections caused by bacteria, such as kidney infections, meningitis, pneumonia and blood poisoning. But they don't cure infections caused by viruses (viral infections), like the flu and the common cold. 
The more antibiotics you take the less effective they become at fighting more serious infections as the bacteria in your body builds up resistance against them. By taking antibiotics only when you need them, you can help ensure they remain effective. 

If you are prescribed an antibiotic, be sure to finish the whole course even if your symptoms have gone. If treatment finishes too soon some bacteria may still survive. Antibiotics are less likely to work if taken just when you remember, or in too low a dose. 

VIRAL INFECTIONS
Many common infections of the nose, throat, sinuses, ears, and chest are caused by viruses. Flu-like illnesses are also caused by viruses. Diarrhoea and/or vomiting are often due to a viral infection of the gut. If you are normally well, your immune (defence) system is good at fighting off many types of viral infection. An antibiotic is not needed if a virus is causing an infection. This is because:
•	Antibiotics do not kill viruses. Antibiotics only kill bacteria. 
•	Antibiotics may cause side-effects such as diarrhoea, rashes, feeling sick, etc. 
•	Overuse of antibiotics when they have not been necessary has led to some bacteria becoming resistant to them. This means that some antibiotics might not be as effective when they are really needed.

You may feel unwell for several days or more until a viral infection clears. Treatment aims to ease symptoms. Treatments that are commonly advised for viral infections include the following.
•	Paracetamol or ibuprofen to reduce a high temperature (fever), and to ease aches, pains, and headaches. 
•	Make sure you drink enough to prevent mild dehydration. Dehydration may develop if you have a high temperature, and it can make a headache and tiredness much worse. 
•	Do not wrap up, but try to cool down if you have a high temperature. This is particularly important in children. If a child has a high temperature, then take their clothes off (in a warm, but not hot, room) and consider giving some paracetamol or ibuprofen. 
•	Other advice may be given for specific symptoms. For example, decongestants for a blocked nose, etc. Ask a pharmacist for advice.

What if symptoms change?
Occasionally, a viral infection or minor bacterial infection develops into a more serious infection. See a doctor to review the situation if the illness appears to change, becomes worse, does not go after a few days, or if you are worried about any new symptom that develops.