North East London Prescribing Efficiency Scheme 2025/26

The ICB Medicines Optimisation Team (MOT) has recently released the NEL Prescribing Efficiency Scheme.

The Londonwide LMCs team, Daniele Serdoz (Interim Director of Primary Care) and Dr Shabnam Quraishi (Associate Medical Director); alongside Dr Emma Radcliffe (Vice-Chair Tower Hamlets LMC) have been involved in discussions with the ICB Medicines Optimisation Team, on behalf of all the NEL LMCs.

These discussions have resulted in several improvements to the PES scheme:

• Removal of PCN level target, Full payment of £450/1000 patients paid to practices for practice level achievement, as PES is Practice level work
• Sliding scale payment has been confirmed (% achievement from baseline = % payment towards target).
• Alternative practice Improvement targets added, in view of the significant intra-borough variation which would otherwise potentially have disadvantaged some practices
• Reduction in overall number of workstreams from 8 workstreams initially presented to LMC, down to 5 workstreams
• (Workstreams removed from PES as per the recommendations of LMC were: Electronic Repeat Dispensing, Vitamin D, Sitagliptin)
• DOAC indicator has been amended, so that it is now for new initiations only.

LMC has also received the following responses to additional concerns we have raised:

• Reduction in financial envelope of £500/1000 patients compared to PES 2024/25- “This is the budget allocation for PES 2025/26. PES 2025/26 has fewer workstreams than PES 2024/25 …  Improvement targets will enable more practices to achieve full payment.”
• BGTS and waste- “There are some options for recycling old meters and options for donating non formulary unopened machines for use in Ukraine.  There is also the option to review patients who have their machine > 5 years and may need replacement.”
• ONS and patient factors including frailty, issues with manual dexterity or cognition- “NEL ONS formulary has ready to drink options …  same nutritional content as non-formulary options and are more cost-effective.”
• Delay between the practice prescribing dashboard data and actual performance—ICB MOT acknowledge that there is time lag of two full calendar months. They have advised the LMC that this is “set nationally” and that the PES has factored this in.
• Request for real time data- “Real-time data is available via clinical system searches”, which the ICB MOT will provide for practices to use. “These searches will help practices identify and target prescribing against scheme indicators”.
• Accessibility of Prescribing Dashboard: While ICB MOT “understand that the prescribing dashboard requires multiple clicks to access initially, each practice’s link is a direct weblink. The recommended approach has always been to save this locally in their web browser for easier access … Additionally, to simplify access, the practice dashboard links for both PQS and PES remain the same as those for the 2024/25 PES”.

Unfortunately, the LMC still has the following concern with regards to the PES:

Practices should be mindful that despite LMC’s requests, there is no exception coding for PES.  LMC recommends that practices keep records for clinical reasons for exclusions to indicators/areas of work and then present these records to the ICB MOT at the end of the scheme, to raise challenges, if needed, where failure to achieve targets has been due to warranted clinical reasons.  The ICB MOT has assured the LMC that “there will be a transparent process for managing such cases”.

LMC recommendation

Overall, the LMC advises individual practices look at their current achievement for each of the PES areas and the individual indicators within each area, to assess the workload required to meet the targets and then determine whether these targets are achievable in the funding envelope offered.

Please see summary below, to assist your practice.

Funding summary

The scheme runs for 12-months and is valued at £0.45 per patient.

Practice allocation of the total sum is distributed according to practice list size.

For a list size of 10,000 patients the overall value of the scheme is £4,500, which buys approximately 30 hours of GP time or 102 hours of pharmacist time.

Total 100 points for full achievement, so for an average list of 10,000 patients, the value of a point is £45.

BGTS-   Blood Glucose Testing Strips

ONS- Oral Nutritional Supplements

DOLCV- Drugs of Limited Clinical Value