NHS Forth Valley

An anxiolytic and hypnotic workstream medicines management target was introduced in 2014/15 and continued in 2015/16. Practices could choose to participate as one of the three prescribing options, which were incentivised via the general practice contract and Quality and Outcomes Framework (QOF).

The anxiolytic and hypnotic workstream required three practice actions:

1. Draw up a practice policy on the prescribing of anxiolytics and hypnotics. All partners in the practice were to be in agreement with the policy and have read the Forth Valley Primary Care Guidance on benzodiazepines. All locums and reception staff made aware of the policy.
2. Ensure that individuals know about the new practice policy for prescribing of anxiolytics and hypnotics. Practices were advised to identify all people who had received the following medicines in the previous three months: diazepam, lorazepam, loprazolam, lormetazepam, oxazepam, nitrazepam, temazepam, zopiclone, zolpidem and zaleplon for review, with suggestions given on prioritisation. Individuals were contacted by the practice and appropriately informed of the risks associated with hypnotic/anxiolytics and the new practice policy.
3. Make a ≥20% reduction in DDDs/1000 people (from an Oct-Dec 2013 baseline). This was to be achieved through flexible reduction regimes and no new people were to be started on a hypnotic or anxiolytic unless they met the licensed indications. New people were informed that they would receive a short-term course, that would not be repeated. The ≥20% reduction would be achieved by Oct-Dec 2014.

Practices were provided with an anxiolytic and hypnotic pack containing sample patient information leaflets, practice policy, poster, a reviewing B-Z flowchart, link to the local primary care benzodiazepine guidelines, invite letters and a management plan agreement. The National Therapeutic Indicator (NTI) data was provided to practices and used to monitor the outcomes. Baseline starting points were as below:

NTI monitoring data for NHS Forth Valley