Primary Care Commissioning Committee

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Compassionate – Inclusive – Honest – Ambitious – Fair

Primary Care Commissioning Committee

Date of meeting

_{25 June 20202}

Agenda item

8 Paper No

PCCC20/041

Primary Care Prescribing – June 2020

Key issues This paper summarises CCG and individual practice

performance for total prescribing and for a number of key interventions contained within the QIPP plan and medicines optimisation incentive scheme (MOIS), including antimicrobial stewardship.

Strategic objectives / perspectives

This paper addresses the following CCG strategic objectives:

 Ensure safe and sustainable high quality services - improved medication review and deprescribing of problematic medicines and antimicrobial stewardship

 Establish local delivery systems (the integrated pharmacy service is a high priority within the LDS)

 Develop the CCG workforce (the development of a more clinical role for pharmacists is in line with the national direction of travel and supports the sustainability of primary care)

Actions requested / recommendation

The Primary Care Commissioning Committee is asked to note and comment on this report.

Principal risk(s) relating to this paper

There are no risks in relation to this paper.

Other committees / groups where evidence supporting this paper has been

considered

None

Financial and resource implications / impact

There are no financial implications arising from this paper.

Legal implications / impact There are no legal implications arising from this paper.

Privacy impact assessment required

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Public / stakeholder

involvement – activity taken or planned

Not applicable.

Equality and diversity – implications / impact

Not applicable.

Report author Dr Emma Harris, Clinical Director – Prescribing

Neil Hardy, Associate Director Medicines Optimisation

Sponsoring director Ellen McNicholas, Director of Quality and Board Nurse /

Caldicott Guardian

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Primary Care Prescribing – Report to Primary Care Committee – June 2020

1. Introduction

This paper summarises CCG and individual practice performance for total

prescribing and for a number of key interventions contained within the QIPP plan and medicines optimisation incentive scheme (MOIS), including antimicrobial

stewardship.

Prescribing data are available from the NHS BSA for the financial year 2019/20. April 2020 data have just been released therefore for some graphs the April data has been included.

The report also summarises the medicines optimisation response to COVID-19.

2. CCG and Practice Performance

The following table shows the change in prescribing spend and prescription items for 2018/19 and 2019/20: WHCCG England Spend 2018/19 £86.44M £7,989M Spend 2019/20 £91.44M £8,411M Difference £ (%) £5.0M (5.8%) £422M (5.3%) Items 2018/19 9,691,135 1,095M Items 2019/20 10,007,371 1,118M Change in Items +316,236 (+3.3%) +23.1M (+2.1%)

The following graph shows the spend and prescription items for primary care prescribing for the CCG (note April 2020 data is included). There was a significant increase in items and costs in March 2020 due, in part, to patients ordering

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2018/19 Actual Cost (£) 2019/20 Actual Cost (£) Percentage Increase (%)

FAREHAM AND GOSPORT CCG 31,261,063 32,958,049 5.43 ISLE OF WIGHT CCG 23,497,602 24,090,733 2.52 NORTH HAMPSHIRE CCG 30,038,536 31,960,863 6.40 PORTSMOUTH CCG 29,583,305 31,469,937 6.38 SOUTH EASTERN HAMPSHIRE CCG

33,948,923 36,165,211 6.53 SOUTHAMPTON CCG 35,400,577 37,821,503 6.84 WEST HAMPSHIRE CCG 86,438,075 91,438,189 5.78 TOTAL 270,168,081 285,904,484 5.82

The lower increase for the Isle of Wight CCG is due to the following BNF Chapter areas:

 Appliances (11.2% increase vs HIOW mean of 16.2%)

 Central Nervous System (-6.9% vs. 0.5% increase)

 Endocrine System (2.3% vs 8.1% increase)

A summary of individual practice performance is shown in Appendix One. This report is sent to GP practice prescribing leads each month and discussed at the Locality Medicines Optimisation Group meetings.

3. Medicines Optimisation Incentive Scheme (MOIS)

The CCG approved a revised MOIS for the period July 2019 to March 2020. The key interventions in the MOIS were:

 Implementing the national guidance on items less suitable for prescribing in

primary care including those new items published in June 2019.

 Implementing the national guidance on prescribing of over the counter

medicines.

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 Maximising potential savings due to patent losses (for example atomoxetine and solifenacin). Note solifenacin reduced in price in October 2019 which saved the CCG £391K during the remainder of 2019/20.

 Supporting practices to Implement PRIMIS PINCER3 as a way of identifying

and reviewing patients on problematic medicines combinations (this is now included in the new GP contractual requirements).

 Running the WHCCG Polypharmacy Risk Identifier Tool (PRIT) in practices to

identify frail elderly patients at high-risk of medication-related harm and inappropriate polypharmacy with a view to carrying out comprehensive medication review by a clinical pharmacist. This tool and PINCER are being used to support the identification of high risk residents in care homes.

 Continuing the work to improve the treatment of patients with atrial fibrillation using the PRIMIS GRASP-AF and Warfarin Patient Safety Audit tools to ensure that patients on an oral anticoagulant are on the correct dose (of Direct Oral Anticoagulant – DOAC) or well-controlled (with warfarin).

 Antimicrobial stewardship – supporting practices to implement their agreed

action plans.

 Working with care homes to improve the management of medicines in this

setting – now a priority as part of the medicines optimisation response to COVID-19 and included in the PCN DES.

3.1 Cost orientated interventions

The Medicines Optimisation QIPP dashboard contains data for all the items less suitable for prescribing in primary care at CCG and individual practice level. The dashboard has been further developed and now includes data on over the counter medicines (at CCG and practice level) and data at CCG level for therapeutic areas (using BNF Chapter level data).

The dashboard also contains the data for the Isle of Wight, North Hampshire and Southampton City CCGs and there is agreement to extend the dashboard to include all HIOW CCGs.

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Year Spend (£) Saving compared to previous year (£) 2017/18 2,128,198 2018/19 1,714,468 413,730 2019/20 1,176,105 538,363

The following screenshots shows the reduction in spend for two of the highest priority interventions:

 Lidocaine plasters

 Lutein and antioxidants (including Viteyes).

Items That Should Not Routinely Be Prescribed - Actual Cost (£)

As at March 2020 (M12) Data Source: ePACT2

-100,000 -50,000 0 50,000 100,000 150,000 A p r M a y Ju n _Jul A u g Se p O ct N o v De c Ja n Fe b M a r A ct ua l C os t (£ )

By Month and Change from Last Year

Latest Year Change

-1,000,000 -500,000 0 500,000 1,000,000 1,500,000 2,000,000 A p r M a y Ju n _Jul A u g Se p O ct N o v De c Ja n Fe b M a r A ct u al C o st ( £ )

Cumulative and Change from Last Year

Latest Year Change Last Year

-600,000 -500,000 -400,000 -300,000 -200,000 -100,000 0 A p r M a y Ju n _Jul A u g Se p O ct N o v De c Ja n Fe b M a r A ct ua l C os t (£ )

Cumulative Change from Last Year

0 50,000 100,000 150,000 200,000 250,000 A p r-1 7 Ju n -1 7 A u g-1 7 O ct -1 7 De c-17 Fe b -1 8 A p r-1 8 Ju n -1 8 A u g-1 8 O ct -1 8 De c-18 Fe b -1 9 A p r-1 9 Ju n -1 9 A u g-1 9 O ct -1 9 De c-19 Fe b -2 0 A ct ua l C os t (£ ) By Month 2 ,1 2 8 ,1 98 1 ,7 1 4 ,4 68 1 ,1 7 6 ,1 05 0 500,000 1,000,000 1,500,000 2,000,000 2,500,000 2017/18 2018/19 2019/20 A ct ua l C os t (£ ) Year-to-date Medicine Category

Paracetamol and Tramadol Co... Perindopril Arginine Prolonged-release Doxazosin Rubefacients (excluding topic... Silk garments [NEW 2019] Travel Vaccines Trimipramine

Metric

Actual Cost (£) Items

Net Ingredient Cost (£) No. of identifiable patients

Practice Name

ABBEYWELL SURGERY (J82145) ADELAIDE MEDICAL CENTRE (J... ALMA ROAD SURGERY (J82074) ALRESFORD SURGERY (J82124) ARCHERS PRACTICE (J82020) BARTON WEBB-PEPLOE PART... BARTON WEBB-PEPLOE PART... BISHOPS WALTHAM SURGERY ...

CCG

ISLE OF WIGHT CCG NORTH HAMPSHIRE CCG SOUTHAMPTON CCG WEST HAMPSHIRE CCG

Primary Care Network

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The dashboard also allows analysis of prescribing by BNF Chapter:

-15,000 -10,000 -5,000 0 5,000 10,000 15,000 20,000 A p r M a y Ju n _Jul A u g Se p O ct N o v De c Ja n Fe b M a r A ct ua l C os t (£ )

Latest Year Change

-150,000 -100,000 -50,000 0 50,000 100,000 150,000 200,000 250,000 A p r M a y Ju n _Jul A u g Se p O ct N o v De c Ja n Fe b M a r A ct u al C o st ( £ )

-100,000 -90,000 -80,000 -70,000 -60,000 -50,000 -40,000 -30,000 -20,000 -10,000 0 A p r M a y Ju n _Jul A u g Se p O ct N o v De c Ja n Fe b M a r A ct ua l C os t (£ )

0 5,000 10,000 15,000 20,000 25,000 30,000 A p r-1 7 Ju n -1 7 A u g-1 7 O ct -1 7 De c-17 Fe b -1 8 A p r-1 8 Ju n -1 8 A u g-1 8 O ct -1 8 De c-18 Fe b -1 9 A p r-1 9 Ju n -1 9 A u g-1 9 O ct -1 9 De c-19 Fe b -2 0 A ct ua l C os t (£ ) By Month 2 4 5 ,3 6 5 2 2 3 ,5 3 0 1 3 4 ,4 7 0 0 50,000 100,000 150,000 200,000 250,000 300,000 2017/18 2018/19 2019/20 A ct ua l C os t (£ ) Year-to-date Medicine Category Dosulepin Dronedarone [NEW 2019] Glucosamine and Chondroitin Herbal Medicines Homeopathy

Immediate Release Fentanyl Lidocaine Plasters Liothyronine

Metric

Practice Name

ABBEYWELL SURGERY (J82145) ADELAIDE MEDICAL CENTRE (J... ALMA ROAD SURGERY (J82074) ALRESFORD SURGERY (J82124) ARCHERS PRACTICE (J82020) BARTON WEBB-PEPLOE PART... BARTON WEBB-PEPLOE PART... BISHOPS WALTHAM SURGERY ...

CCG

Andover Avon Valley Chandlers Ford Coastal (WH) Eastleigh Health

-7,000 -6,000 -5,000 -4,000 -3,000 -2,000 -1,000 0 1,000 A p r M a y Ju n _Jul A u g Se p O ct N o v De c Ja n Fe b M a r A ct ua l C os t (£ )

Latest Year Change

-15,000 -10,000 -5,000 0 5,000 10,000 15,000 A p r M a y Ju n _Jul A u g Se p O ct N o v De c Ja n Fe b M a r A ct u al C o st ( £ )

-12,000 -10,000 -8,000 -6,000 -4,000 -2,000 0 A p r M a y Ju n _Jul A u g Se p O ct N o v De c Ja n Fe b M a r A ct ua l C os t (£ )

0 5,000 10,000 15,000 20,000 25,000 A p r-1 7 Ju n -1 7 A u g-1 7 O ct -1 7 De c-17 Fe b -1 8 A p r-1 8 Ju n -1 8 A u g-1 8 O ct -1 8 De c-18 Fe b -1 9 A p r-1 9 Ju n -1 9 A u g-1 9 O ct -1 9 De c-19 Fe b -2 0 A ct ua l C os t (£ ) By Month 2 3 2 ,5 5 5 1 0 ,3 9 0 827 0 50,000 100,000 150,000 200,000 250,000 2017/18 2018/19 2019/20 A ct ua l C os t (£ ) Year-to-date Medicine Category Homeopathy

Immediate Release Fentanyl Lidocaine Plasters Liothyronine Lutein and Antioxidants Minocycline for acne [NEW 20... Needles five pounds or more ... Omega-3 Fatty Acid Compounds

Metric

Practice Name

ABBEYWELL SURGERY (J82145) ADELAIDE MEDICAL CENTRE (J... ALMA ROAD SURGERY (J82074) ALRESFORD SURGERY (J82124) ARCHERS PRACTICE (J82020) BARTON WEBB-PEPLOE PART... BISHOPS WALTHAM SURGERY ... BLACKTHORN HEALTH CENTRE ...

CCG

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 The increased spend in cardiovascular system is largely due to the continued increase in the use of the direct acting oral anticoagulants (DOACs) for the prevention of stroke in people with atrial fibrillation. As part of the response to COVID-19 the medicines optimisation team supported practices to switch suitable patients from warfarin to a DOAC so as to avoid the need for INR testing. Spend on DOACs in 2019/20 was £7.8m an increase of £1.2M on the 2018/19 spend.

 The increase in endocrine is largely driven by increased prescribing of

medicines for the treatment of diabetes.

 The increase in gastro-intestinal is a combination of increased items and also

an increase in the unit cost of a number of the generic medicines used in this therapeutic area. The availability of ranitidine has been affected by a number of product withdrawals which has meant that patients have needed to be switched to alternative products.

 Appliances – this section includes the new blood glucose testing device

Freestyle Libre. The CCG has received additional funding for this device in the 2019/20 financial year. In March 2020, 773 patients were prescribed Freestyle Libre.

 Respiratory – there was a significant increase in the number of items (and

therefore the cost) of respiratory inhalers in March 2020. This was due to patients who suffer from respiratory diseases (or who had previously suffered)

Medicines Optimisation QIPP Reporting - BNF Chapters - Yearly Comparison West Hampshire CCG

Comparison of Rolling 12 Month Periods

BNF Chapter

Apr-18 to Mar-19

Apr-19 to

Mar-20 Change % Change

Apr-18 to Mar-19

Apr-19 to

Mar-20 Change % Change

Anaesthesia (15) 20,109 17,890 -2,219 -11.0% £281,232 £192,637 -£88,595 -31.5%

Appliances (21) 311,128 327,056 15,928 5.1% £4,090,077 £4,790,818 £700,741 17.1%

Cardiovascular System (02) 2,743,065 2,833,753 90,688 3.3% £13,433,746 £15,139,257 £1,705,511 12.7% Central Nervous System (04) 1,759,824 1,822,065 62,241 3.5% £13,230,371 £13,375,804 £145,433 1.1%

Dressings (20) 94,028 86,280 -7,748 -8.2% £1,534,353 £1,434,539 -£99,814 -6.5%

Ear, Nose and Oropharynx (12) 114,160 115,652 1,492 1.3% £724,921 £785,091 £60,169 8.3% Endocrine System (06) 907,965 952,065 44,100 4.9% £13,401,599 £14,434,932 £1,033,333 7.7%

Eye (11) 208,734 208,567 -167 -0.1% £2,047,791 £2,085,482 £37,691 1.8%

Gastro-Intestinal System (01) 888,161 930,230 42,069 4.7% £4,322,343 £4,882,827 £560,483 13.0% Immunological Products and Vaccines (14) 154,859 154,819 -40 0.0% £1,443,785 £1,482,937 £39,152 2.7%

Incontinence Appliances (22) 29,535 30,389 854 2.9% £703,272 £726,001 £22,729 3.2%

Infections (05) 334,858 330,509 -4,349 -1.3% £1,774,285 £1,910,070 £135,784 7.7%

Malignant Disease and Immunosuppression (08) 52,675 54,251 1,576 3.0% £1,897,456 £1,935,687 £38,231 2.0% Musculoskeletal and Joint Diseases (10) 281,878 283,658 1,780 0.6% £2,075,665 £2,348,950 £273,285 13.2% Nutrition and Blood (09) 493,698 516,901 23,203 4.7% £6,117,692 £6,270,488 £152,796 2.5% Obstetrics, Gynaecology and Urinary-Tract Disorders (07)325,969 338,524 12,555 3.9% £4,019,036 £3,662,689 -£356,347 -8.9% Other Drugs and Preparations (19) 12,807 12,422 -385 -3.0% £326,972 £326,915 -£57 0.0%

Preparations used in Diagnosis (18) 3 8 5 166.7% £487 £2,846 £2,359 484.2%

Respiratory System (03) 597,775 634,070 36,295 6.1% £9,545,801 £9,950,464 £404,663 4.2% Skin (13) 281,415 275,717 -5,698 -2.0% £2,489,202 £2,554,018 £64,816 2.6% Stoma Appliances (23) 78,489 82,545 4,056 5.2% £2,977,989 £3,145,738 £167,749 5.6% Total 9,691,135 10,007,371 316,236 3.3% £86,438,075 £91,438,189 £5,000,114 5.8% Items Cost CCG

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requesting a prescription because of concerns around COVID-19. Note April 2020 data is included.

3.2 Antimicrobial stewardship

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4. Medicines Safety and Controlled Drugs

The Hampshire Medicines Safety Group is a sub-group of the Basingstoke,

Southampton and Winchester District Prescribing Committee (which is administered by the CCG).

Implementation of the national ‘Pregnancy Prevention Programme’ in all females of childbearing potential prescribed sodium valproate is a priority. One aspect of the programme is an annual patient review with a specialist (where other less hazardous treatments should be considered). It is encouraging that the number of females in the at risk age group being prescribed sodium valproate continues to reduce.

5. Polypharmacy and Deprescribing

One of the key roles of the medicines optimisation team is to support GPs to

undertake medication reviews of patients on problematic medicines. As part of the COVID-19 support to care homes there is a requirement to provide clinical pharmacy support to PCNs and practices to undertake structured medication review. The CCG medicines optimisation team is working with PCNs and their clinical pharmacists to deliver this requirement as a single virtual team.

The West Hampshire position regarding the percentage of older people on multiple medicines is encouraging. For example the following graph (taken from the

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6. Digital Initiatives

The transfer of all suitable patients to EPS (Electronic Prescribing Service) was an early priority as part of the response to COVID-19 so as to avoid paper prescriptions and the need for patients to attend the surgery to collect prescriptions.

Percentage of EPS items out of all items for WEST HAMPSHIRE CCG compared to all CCGs in England for April 2020

It is important to note that EPS is not currently available for use by dispensing practices for those patients that they dispense to.

The implementation of electronic Repeat Dispensing (eRD) is another priority as part of COVID-19 so as to reduce the need for repeat prescription requests. The

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Percentage of eRD items out of EPS items for WEST HAMPSHIRE CCG compared to all CCGs in England for April 2020

7. Medicines Optimisation Response to COVID-19

This is a summary of the work of the medicines optimisation / pharmacy teams across HIOW in response to COVID-19:

 Work stream established to lead the work (reporting into the Health and Social

Care Cell). Includes CCG Lead Pharmacists, Provider Chief Pharmacists, Chief Officer HIOW LPC and the Medicines Optimisation Lead for Wessex AHSN.

 Primary care prescribing work included dealing with medicines shortages,

supporting greater use of EPS/eRD, supporting switches from warfarin to a DOAC, promulgating guidance via a HIOW wide bulletin.

 A significant piece of work was to ensure the timely availability of medicines required as part of end of life care. This involved working with palliative care specialists, hospices, GPs and community pharmacists.

 Working with the LPC Chief Officer to support community pharmacy issues

including workload, queuing, use of volunteers and the implementation of a national delivery service for shielded patients.

 For acute providers a high priority was to ensure supplies of medicines used

in critical care including fluids used in renal dialysis and haemofiltration. This required changes to medication regimens and support to clinical trials.

 Implementation of the medicines optimisation requirements within the national

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homes, structured medication review including those residents newly admitted or discharged from hospital and dealing with stock shortages. A HIOW care home sub-group has been established to share good practice.

 Workforce – including offers of ‘mutual aid’ across organisations and the placement of returning pharmacists and pharmacy technicians.

8. Conclusions

There has been good progress in implementing the majority of the interventions within the 2019/20 medicines optimisation incentive scheme.

The COVID-19 pandemic meant that the priorities of the medicines optimisation team necessarily shifted to support GPs, pharmacists and patients during this time. This work was coordinated and agreed across HIOW.

9. Actions Requested

The CCG Primary Care Committee is asked to note and comment on this report.

Dr Emma Harris, Clinical Director – Prescribing

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APPENDIX ONE Practice PCN 2018/19 Spend (£) 2019/20 Spend (£) Increase over 2018/19 Spend (£) Increase over 2018/19 Spend (%) Change in ASTRO PUs (%) Change in Patients (%) 2019/20 Spend per Weighted Pop (using Prescribing Need Index) (%) Change in Items (percent) % of EPS Items out of all Items

% of eRD Items out of

EPS Items

Note 1 4 5 6 11 14 19 22 23 24

ADELAIDE MEDICAL CENTRE Andover £1,361,305 £1,434,804 £73,500 5.4 0.8 0.9 96 5.4 81.1 0.6 CHARLTON HILL SURGERY Andover £1,903,643 £2,013,535 £109,891 5.8 1.8 2.1 101 4.5 62.1 0.3 SHEPHERDS SPRING MEDICAL CENTRE Andover £1,603,714 £1,737,732 £134,018 8.4 5.2 3.8 107 7.3 87.6 0.0 ST MARY'S SURGERY Andover £1,653,205 £1,795,917 £142,712 8.6 1.6 0.6 92 3.9 78.0 0.0 THE ANDOVER HEALTH CENTRE MEDICAL PRACT Andover £2,200,446 £2,252,693 £52,247 2.4 1.5 1.4 102 0.3 87.8 0.0 CORNERWAYS MEDICAL CENTRE Avon Valley £2,011,519 £2,020,580 £9,061 0.5 1.2 0.0 91 -1.6 78.1 0.0 FORDINGBRIDGE SURGERY Avon Valley £2,166,588 £2,200,462 £33,875 1.6 2.0 0.0 97 0.0 59.5 16.3 RINGWOOD MEDICAL CENTRE Avon Valley £1,992,686 £2,053,291 £60,606 3.0 0.4 0.2 96 0.9 93.6 0.0 TWIN OAKS MEDICAL CENTRE Avon Valley £738,853 £805,490 £66,637 9.0 4.0 1.4 97 4.1 59.1 0.0 PARK SURGERY Chandlers Ford £2,220,196 £2,326,978 £106,782 4.8 1.1 -0.6 100 2.5 84.8 0.4 THE FRYERN SURGERY Chandlers Ford £1,899,047 £2,059,027 £159,981 8.4 1.4 1.0 93 4.2 87.5 0.1 BARTON Webb-Peploe Partnership Coastal Med Group £2,341,208 £2,441,882 £100,674 4.3 0.8 -0.1 102 2.3 84.9 9.6 NEW MILTON HEALTH CENTRE Coastal Med Group £1,886,017 £1,986,216 £100,199 5.3 0.4 -0.4 99 3.4 87.0 4.9 THE ARNEWOOD PRACTICE MILTON MEDICAL CEN Coastal Med Group £2,518,019 £2,633,743 £115,723 4.6 0.0 -0.3 100 2.9 86.9 3.8 ARCHERS PRACTICE Eastleigh £845,418 £902,636 £57,218 6.8 -1.7 -1.7 93 2.5 81.6 0.0 BOYATT WOOD SURGERY Eastleigh £857,096 £947,311 £90,215 10.5 4.9 4.2 92 7.7 83.4 0.1 PARKSIDE PRACTICE Eastleigh £1,302,532 £1,436,791 £134,259 10.3 1.1 0.1 114 3.9 75.2 0.0 ST.ANDREW'S SURGERY Eastleigh £1,316,700 £1,431,771 £115,071 8.7 3.6 3.3 97 9.9 88.7 0.0 BLACKTHORN HEALTH CENTRE ESP £2,080,099 £2,251,239 £171,141 8.2 2.5 1.4 108 5.8 93.6 39.6 BURSLEDON SURGERY ESP £539,297 £578,888 £39,591 7.3 4.9 5.6 93 0.8 90.4 29.4 HEDGE END MEDICAL CENTRE ESP £2,151,801 £2,468,250 £316,449 14.7 7.2 8.8 95 11.1 92.4 7.2 ST LUKES SURGERY ESP £1,492,803 £1,435,811 -£56,992 -3.8 -3.1 -3.1 103 -4.5 95.2 5.3 WEST END SURGERY ESP £1,321,692 £1,473,201 £151,509 11.5 3.0 2.5 110 5.6 72.0 0.0 CHAWTON HOUSE SURGERY New Forest £1,164,341 £1,273,221 £108,879 9.4 1.1 -0.3 92 2.6 89.1 0.2 LYNDHURST SURGERY New Forest £905,615 £942,638 £37,023 4.1 1.9 0.5 91 -10.9 77.4 3.3 NEW FOREST MEDICAL GROUP New Forest £1,202,126 £1,268,750 £66,624 5.5 0.7 0.8 86 3.4 89.8 4.2 WISTARIA & MILFORD SURGERIES New Forest £3,055,114 £3,263,086 £207,972 6.8 0.9 0.0 100 -0.6 88.1 19.3 ABBEYWELL SURGERY Romsey £2,967,696 £3,096,178 £128,482 4.3 0.5 -0.4 99 0.0 70.1 0.0 ALMA ROAD SURGERY Romsey £2,155,176 £2,296,765 £141,589 6.6 2.7 2.5 93 19.1 66.4 0.1 NORTH BADDESLEY SURGERY Romsey £1,418,855 £1,559,677 £140,822 9.9 2.0 1.2 107 3.1 69.1 0.2 NEW HORIZONS MEDICAL PARTNERSHIP Totton £4,087,137 £4,215,046 £127,909 3.1 0.3 -0.7 108 1.4 94.1 0.1 TESTVALE SURGERY Totton £2,281,930 £2,440,710 £158,780 7.0 0.9 0.3 113 4.5 80.3 0.3 FORESTSIDE MEDICAL PRACTICE Waterside £1,854,264 £1,975,420 £121,156 6.5 2.4 1.0 109 7.5 82.7 5.1 RED AND GREEN PRACTICE Waterside £3,937,075 £4,089,564 £152,489 3.9 0.3 -0.9 100 1.3 77.7 9.0 WATERFRONT AND SOLENT SURGERY Waterside £1,241,736 £1,302,447 £60,711 4.9 1.5 -0.5 97 4.3 82.2 0.0 ALRESFORD SURGERY Win Rural N+E £1,389,785 £1,522,241 £132,456 9.5 2.7 1.0 93 4.3 56.1 4.1 GRATTON SURGERY Win Rural N+E £899,132 £984,126 £84,994 9.5 1.7 0.7 96 4.8 8.2 0.0 STOCKBRIDGE SURGERY Win Rural N+E £1,317,328 £1,429,741 £112,413 8.5 0.2 -0.7 92 3.2 15.8 0.2 THE WATERCRESS MEDICAL GROUP Win Rural N+E £1,061,102 £1,136,256 £75,154 7.1 1.0 -0.3 104 3.2 66.4 1.3 TWO RIVERS PARTNERSHIP Win Rural N+E £1,088,623 £1,193,020 £104,397 9.6 2.5 3.1 85 4.9 60.4 1.6 WEST MEON SURGERY Win Rural N+E £330,545 £345,273 £14,728 4.5 1.6 0.8 77 6.9 2.9 0.0 BISHOPS WALTHAM SURGERY Win Rural South £1,923,709 £2,048,932 £125,223 6.5 2.0 0.6 101 6.9 47.0 0.0 STOKEWOOD SURGERY Win Rural South £2,727,044 £2,876,541 £149,497 5.5 2.8 2.2 111 2.0 78.1 1.4 TWYFORD SURGERY Win Rural South £1,283,044 £1,349,692 £66,648 5.2 1.4 0.8 94 2.1 55.9 0.1 WICKHAM SURGERY Win Rural South £2,194,539 £2,275,336 £80,796 3.7 2.0 2.0 104 4.1 28.7 0.0 FRIARSGATE PRACTICE Winch City £2,955,979 £3,058,582 £102,604 3.5 1.4 -0.3 91 0.2 92.1 0.3 ST CLEMENTS PARTNERSHIP Winch City £2,444,245 £2,482,940 £38,695 1.6 -1.1 -0.3 91 2.2 81.9 0.1 ST PAUL'S SURGERY Winch City £1,835,330 £2,015,350 £180,020 9.8 4.5 4.0 79 5.2 87.5 0.1

TOTAL £86,399,215 £91,359,829 £4,960,614 5.7 1.6 0.9 100 3.2 63.7 5.2

Notes

1 - Practice prescribing spend in 2018/19 2 - Practice indicative prescribing budget for 2019/20 3 - Actual spend April - Mar 2020

4 - Forecast Outturn spend for 2019/20

5 - Forecast increase in spend 2019/20 compared to actual 2018/19 spend (column F minus column C) 6 - Forecast increase in spend expressed as a percentage

7 - Forecast Budget over/underspend (column F minus column D) 8 - Forecast Budget over/underspend expressed as a percentage 9 - Practice ASTRO PU count (weighted population) for the month of March 2019 10 - Practice ASTRO PU count (weighted population) for the month of March 2020

11- Change in ASTRO PU count latest month vs. the same month one year ago - this gives an indication of the practices list size and age demography change over the last year 12 - Patient count for the month of March 2019

13 - Patient Count for the month of March 2020

14- Change in Patient count latest month vs. the same month one year ago - this gives an indication of the practices list size and age demography change over the last year 15 - Practice spend (2019/20) per ASTRO PU

16 - Practice spend (2019/20) per ASTRO PU expressed as a percentage (CCG mean = 100%) 17 - Prescribing Need Index

18 - Practice spend (2019/20) per weighted patient (using list size adjusted with prescribing need index) 19 - Practice spend (2019/20) per weighted patient expressed as a percentage (CCG mean = 100%) 20 - Total prescription items (April 18 to March 19)