NHS Greater Glasgow and Clyde

2002 saw the introduction of general practice clinical pharmacist-led interventions. Initially facilitation involved baseline audits; developing, agreeing and implementing practice B-Z prescribing policy; identifying people for review; creating individualised B-Z reduction schedules; updating and educating prescribers; re-auditing, monitoring and feedback on B-Z prescribing achieved. Then in 2004 prescribing pharmacist-led face-to-face clinics with people. Both methods have proved to be effective. However, pharmacist-led clinics have demonstrated to more reluctant prescribers that a reduction in inappropriate B-Z prescribing can be achieved. For people that are identified as appropriate for review, a third continue their current B-Z and dose, a third reduce their dose, and a third stop treatment. Referrals to specialist Alcohol and Drug Recovery Services were not required.

General practice clinical pharmacists who piloted the initial work supported and mentored their pharmacist and pharmacy technician colleagues. Cascading and sharing their experiences enabled more than 40 general practice pharmacists to deliver B-Z reduction clinics in numerous practices, by 2014.

Pharmacist prescribers who worked in general practice and community pharmacies located close to practices started the review process and continued to manage reviews and reductions with individuals that routinely attended their pharmacies. This was well received by people prescribed B-Z therapy, as it saved them time making appointments at their general practice.

2013 saw the introduction of board wide B-Z review quality prescribing indicators:

1. Preferred preparation - 2mg diazepam tablets instead of 5mg/10mg tablets.
2. Review and potential reduction targets.
3. Board wide voluntary ban on the prescribing of diazepam 10mg tablets (‘blues’) in primary and secondary care due to their street value and abuse potential.

The indicator work was incentivised and funded via the Quality and Outcomes Framework (QOF) general practice contract; however, many practices were interested and willing to review their B-Z prescribing and wanted to understand and share in the successes that neighbouring practices achieved.

Locality work took place with 11 general practices (the Dumbarton corridor project) February to May 2013. In February 2013, 15 GPs from the practices attended a workshop. Backfill was paid to allow attendance. A brief presentation was given by the HSCP lead pharmacist outlining current B-Z prescribing, guidelines, best practice and long-term risks associated with B-Z use. GPs were then given the opportunity to reflect on the content of the presentation. This was followed by discussion on:

1. When it is appropriate to prescribe short-term
2. Possible responses to individuals when a B-Z is not indicated
3. Approaches to reducing and/or stopping B-Z
4. Alternative pharmaceutical options

GPs then discussed recommending their next steps in practice and their immediate actions. Practices then contributed to an evaluation of this workshop and its early outcomes, by the end of May 2013. This achieved an overall reduction in B-Z prescribing (reduction in defined daily doses per 1000 individuals).

Opportunistically, in 2016, the central prescribing team encouraged practices and HSCP to review B-Z use due to cost-efficiency work to address the extreme price hikes for lormetazepam, nitrazepam liquid and temazepam.

The general practice clinical pharmacists have shared their learning and experiences with practice pharmacists and primary care teams working in other Scottish health boards and at national events and workshops within boards.