Leicester, Leicestershire & Rutland Local Medical Committee Ltd.

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Optum

Following our previous communications in the LMC September newsletter around the concerns raised about the Optum element of the Medicines Optimisation Framework (MOF), we have since discussed these concerns with the ICB on behalf of practices.

To outline, Optum sits within an element of the CBS contract under Medicines Optimisation Framework (MOF). SEE ATTACHED DOCUMENT. This is paid to practices at the rate of £1.15per registered patient, however this is split into several sections, but Optum sits within this element.

We have included below the relevant section from the CBS and the criteria:

Optum	Engagement with Optum and sign up to the Accelerate programme.	July-Aug 24
Insulin biosimilar	25% formulary alignment.	Oct-24
	50% formulary alignment.	Mar-25
Repeat prescription training	Completion of the training by a minimum of one member of the prescription clerk/ admin team.	July 24
Dressings off script	ePACT2 data . Aristotle Dashboard	Sep-24

 

 

 

 

 

 

 

 

 

 

 

 

The Optum proportion has 30% of funding associated with this element, which equates to 34.5 pence per registered patient.

In order for practices to receive the full 30% of funding, practices are required to:

Sign up to Optum and complete repeat prescription training, 'dressings off script' and achieve 50% Trurapi alignment.

If a practice achieves between 40-49% Trurapi alignment by the end of March 2025, practices will be made a 25% payment.

When we recently met with the ICB Medicines team, we raised several concerns specifically around the sheer workload that Optum could potentially cause practices, especially as there are several script switches that will be undertaken and there is only a confirmed 2 months of support from the Optum team.

We have received further information from the team at the ICB and we have also been informed that practices are being put under pressure to sign up to Optum, so the LMC would propose that all practices look at this carefully and decide if it is something you wish to engage with from your practice perspective.

The following is the response from the ICB:

1. Number of switches

Many of the switches listed have been included in previous incentive schemes as part of house-keeping.

Whilst the number of switches looks high, once the list is filtered to remove different strengths of the same medicines, the number of original products involved is greatly reduced.

2. Dosage changes

None of the switches involve a change in dosage. The following categories are included:

The vast majority of these are substituting an existing prescription medicine with a lower cost version of the same medicine e.g., switching from brand to generic.

There are two switches that involve a Dose optimisation i.e., ensuring the dose of medication is prescribed in the most cost-effective way e.g., prescribing 1x 20mg tablet rather than 2 x 10mg tablets.

There are 9 switches that involve a change in formulation.

3. Issues with changing to a capsule containing gelatine.

This includes a total of 6 switches. The SOP excludes patients who have a documented objection to taking products that include gelatine. Patient records will be checked to identify patients to see if they are taking capsules or have done in the past. However, it would be reasonable for practices who feel that this would involve significant issues in their patient population to decline these few switches.

4. Support with complaints

Optum will contact each patient to advise that their medication will be changed. They have also agreed to have patient queries directed to them for 2 months after leaving the practice.

The information in the table below shows the maximum number of switches that could potentially be undertaken. However, this will vary between practices depending on prescribing choices and formulary compliance.

Number of switches	489
Number of original products	153
Number of replacement products	81
Number of switches that involve a change in formulation	9
Number of switches that involve a change in formulation to a capsule	6
Number of switches that involve a dose optimisation	2

 

If practices do not sign up to Optum they will lose 30% of the total payment (34.5 pence per patient), but this will have no negative effect on achievement of the other parts of the Medicines Optimisation Framework (80.5 pence per patient)