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The benefits of this project
Benefits for Your Patients
- Reduced waste to dispose of
- The satisfaction of minimising environmental impact
Benefits for Your Practice
- Financial savings
Benefits for The Planet
- Reduced plastic pollution
Opportunity for improvement
- Plastic waste is an important topic as billions of items of plastic waste are choking our oceans, lakes, and rivers as well as piling up on land which is unsightly and harmful to plants and wildlife. 79% of plastic that has ever been made still sits in landfills or the natural environment. When plastics end up in landfills, they break down into tiny toxic particles that contaminate the soil and waterways and enter the food chain when animals accidentally ingest them. This could ultimately have adverse health effects on humans and animals.
- Reduction of plastic and waste is part of the NHS Long Term Plan. Reduction in single use plastics, throughout the NHS supply chain are needed to help reduce NHS waste.
- Many women are prescribed topical vaginal estradiol 10mcg pessaries to help with postmenopausal vaginitis and recurrent urinary tract infections. The packs come with a plastic pessary inserter.
- Some brands e.g. Vagifem and Gina, come with preloaded individual daily disposable applicators with each inserter wrapped in its own disposable plastic bag. If generic estradiol is prescribed, it is up to the pharmacist to issue what they have in stock. However, an alternative brand called Vagirux comes with a reusable applicator which is washed in warm soapy water and air dried between use. This is to reduce disposable plastic. The inserter can be used 24 times. The price of the different brands varies from year to year. Vagirux is currently £11.34 for 24 pessaries and Vagifem is £16.72.
- This project outlines how to switch to prescribing Vagirux in your GP practice (see disclaimers).
- You might like to create SMART goals for your project. This month hold a training session for prescribers on topical oestrogens, run a search for patients with vaginal estradiol on repeat prescription and switch >90% to Vagirux brand if not already on this.
How to carry out this project
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Investigate
Check local prescribing guidelines and chat to your practice pharmacist to ensure Vagirux is an option in your area.
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Check in with community pharmacists
Chat with local community pharmacists so they are aware of the project and can support with consistent messaging to patients.
They will also be able to advise if there are any supply issues with Vagirux.
Your practice pharmacist will likely know how best to get in touch with the community pharmacists.
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Data collection
Run an IT search to find all patients prescribed vaginal oestrogen. Record how many patients are prescribed generic, Vagirux or other brands.
We hope to provide downloadable IT searches for EMIS & System 1 soon. In the meantime, you could use our EMIS and SystmOne search guides to create your own.
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Training for prescribers
Run an education session for clinicians on the benefits of prescribing Vagirux brand and encourage them to do this for new prescriptions. This could be via an online training session and email communications.
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Switch
Change all patients prescribed vaginal estradiol to Vagirux brand and send them a text message:
Resource: Vagirux
We are changing your vaginal estradiol pessary to the Vagirux brand. This is the same pessary but it uses a reusable applicator instead of a daily disposable plastic applicator. This is to reduce waste. Please let us know if you have any questions or concerns.
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Study
Review the results, summarise learning, share with practice team + decide if any changes are needed to improve the process.
Decide when to re-audit again to ensure the change has lasted e.g. 2-3 months and use the Project Monitoring form to keep track.
Many practices run automatic searches at regular intervals – speak to your practice team about including this project in those searches.
Top tip
You might need to repeat the advice to prescribe Vagirux quite a few times before everyone adopts this change.
We found it helpful to chat directly to the clinicians who kept prescribing generic estradiol or other branded pessaries to change prescribing practice across the board.
How to scale this project up or down
| Please note - Use of this project requires NetworkPLUS membership. If you would like to share this project with others, please invite them to purchase their own membership—access must not be shared with non-members. |
Share this QIP and your experience with your wider organisation e.g. PCN / Cluster / ICB so other practices can follow your process.
You could let your ICB / Health Board pharmacy team know about the possible savings to see if this can be added to their medicines optimisation software for wider savings and environmental effects.
Case study
This was a straightforward project completed by a GP registrar.
This audit was performed in Brighton in 2021.
16 women were on repeat Vagifem vaginal tablets
A further 36 women were using generic Estradiol 10mcg vaginal pessaries.
There were 0 patients using Vagirux
0 patients complained about being moved to Vagirux which suggests this is an acceptable change for women.
Dr Sarah Ali, Mile Oak Medical Centre, Brighton
Have you completed this QIP?
Tell us a little about your project and enter your data in order to generate a certificate showing the probable cost savings and other benefits. This project may help with CQC evidence submission (see disclaimers).
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