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​SPOTLIGHT - Primary care wound care formulary and guide


Find out how development of the Lewisham CCG primary care wound care formulary and guide led to implementing a centralised wound care dressings procurement service across Lewisham GP practices resulting in standardisation of clinical practice, cost savings and improved patient care.

Background

All Lewisham GP practice nurses daily treat wound care needs of our diverse population including children, the elderly and disabled, people with diabetic ulcers and post surgery patients. Analysis of Jan 2016 electronic NHSBSA prescribing data revealed Lewisham CCG’s consistent high expenditure of approximately £600k per annum on wound care dressings over the last 3 financial years. In spite this high cost, wound healing outcomes for this group of patients was frequently delayed. As a consequence, ensuring all patients who need wound care in primary care have appropriate timely access to high quality wound healing management with excellent patient outcomes was highlighted by the CCG prescribing and nurse advisers teams as an urgent need.

The Challenge

There was no standard practice in wound dressing amongst practice nurses across Lewisham CCG practices as dressing choice was largely based on a wide personal preference rather than cost effective evidence base.

Difficulties in the FP10 prescription supply route was leading to frustrated practice nurses and patients because patients had to collect their dressings from a pharmacy and return to the GP practice for their wound to be dressed. This was presenting a major inconvenience for elderly and disabled patients.

Furthermore, delays in dressing wounds due to not having the appropriate dressings for the wound type at the time the patient presents was leading to poor patient care.

In addition, wasted dressings were stockpiling in patient homes due to incompletely used packs that cannot be used for other patients.


The Need
The need to redesign wound management services in Lewisham GP practices so that all patients who present with wound care needs have appropriate, timely access to high quality of care with excellent patient outcomes was identified by the Lewisham CCG pharmacist and nurse advisor teams.

The Solution:

Wound care formulary and guide development

The CCG senior prescribing advisor and practice nurse, Shelpa Parmar worked with Accelerate CIC, specialist tissue viability nurses who have specialist knowledge and expertise in wound care management to develop a Lewisham primary care bespoke wound care formulary and guide. 

Training

All Lewisham practice nurses received educational training from Accelarate CIC specialist nurses on the use of the newly developed CCG formulary and guide. This ensured all nurses are working towards standardisation of practice across the organisation by using a range of first line dressing products on the basis of clinical need, cost effectiveness and best available evidence.

Accessible dressing supply via the NHS supply chain

GP practice dressing ordering and supply method was subsequently changed from prescribing dressings on FP10 prescriptions for individual patients to procurement through an online centralised ordering and supply system via the NHS supply chain. This enabled practices to hold stocks of formulary dressings hence resulting in improved timely access to wound dressings when needed.

Outcome

The implementation of the Lewisham CCG wound care formulary in August 2017 and change in order and supply through an online centralised wound care dressings procurement service across 38 Lewisham GP practices in September 2018 has resulted in:
  • Rationalised nurse choice of evidence based cost effective wound care dressings to support better healing outcomes.
  • Standardised nursing clinical practice across Lewisham GP Practices.
  • Elimination of dressings waste associated with oversupply hence improved budgetary control. 
  • Reduced workload burden on GPs managing prescription requests for dressings. 
  • Quicker access to dressing supplies hence improved patient experience.

Feedback – Practice Nurse & Patient Testamonials

Practice Nurse  

“Having a stock of dressings enables me to treat wounds in the first instance and not delay treatment waiting for a prescription to be signed by a GP then patient having to collect from pharmacist followed by another appointment” 

83 year old female patient 

“Ooh so much better now the right dressings are always with the nurse, I don’t have to make two trips in cab”

22 year old male patient

“Brilliant service, this is my second pilonidal abscess and this time it’s only cost me time to get to surgery not  trips to the chemist and buying dressings, thank you” 

Overall the move to an online centralised wound care procurement service has enabled quicker access to dressings resulting in better overall patient care, reduction in wasted GP and nurse time as well as a reduced financial burden as a result of £100K savings realised the first year of the launch of the Lewisham primary care wound care formulary.

Next steps

We are evaluating patient satisfaction and cost reduction as well as looking to include a review of the wider community dressings service. 

Project team:

Lewisham CCG medicines management team - Project lead, Shelpa Parmar, Senior Prescribing Adviser 
Lewisham CCG Practice advisors – Lewisham CCG Lead Nurse Advisor, Debbie Brown
Accelerate (CIC) Community Interest Company – Alison Hopkins, Director
NEL Commissioning support unit procurement team – Head of eProcurement Team, Fleur Mathurin-Boucher