Background
The StoMap Report (2019) summarised the Hub’s research on the supply and procurement of stoma and continence products in the East of England. It showed that costs for these appliances were rising unsustainably at about 10% per year.
In response, the Hub’s Pharmacy and Healthcare team developed an innovative suite of procurement solutions including the Appliance Prescribing Management Service (APMS) framework*, a national agreement available to NHS organisations across the UK.
The goal was to redesign the service to support sustainable models, helping trusts and ICBs provide enhanced patient-focused services, improve care and reduce waste from overprescribing and overordering stoma and continence products.
The APMS framework offers:
- Reliable appliance prescription services and advice hubs with specialised clinical input for stoma and continence appliances prescribed under Part IXC of the Drug Tariff.
- Flexibility to accommodate any suitable appliance-based services.
- A reasonable choice of products for patients, who remain central to decision-making.
- Four awarded suppliers.
The project
Three ICBs in the East of England are being supported by the Hub to use the APMS framework and are contracting suppliers to run their appliance prescribing management services. They are:
- Bedford, Luton and Milton Keynes ICB (BLMK): Full service for stoma products, contracted with Bullen Healthcare Group. NB: BLMK ICB already has the lowest stoma product spend per patient in the region, which may be partly explained by patient demographics.
- Suffolk and North East Essex ICB: Service for continence products only, contracted with Coloplast (from 1 April 2025).
- Norfolk and Waveney ICB: Stoma product pilot project with 12 GP practices, contracted with Bullen Healthcare Group. If proven successful, the intention is to extend the pilot to more practices, followed by full implementation across all practices in the region. The ICB spent about £7M in 2019 and about £9M in 2024 on stoma appliance products.
Prior to the pilot, a review of the prescribing patterns in Norfolk and Waveney, revealed the total prescribing cost per thousand patients for primary care FP10 prescriptions is approximately 30% higher than the regional average for the East of England. This difference is likely due to factors including over-prescribing, excessive ordering, insufficient prescription control, and process inefficiencies – issues the APMS framework is designed to address.
BLMK and Norfolk and Waveney ICBs conducted appliance user reviews, which revealed many patients were overdue for assessment, with some not having been reviewed by a nurse for 10 years or more.
Although primarily a cost optimisation project, these appliance user reviews significantly improved patients’ quality of life by:
- Resolving issues
- Reviewing and changing products where appropriate
- Advising on technique, fluid intake and lifestyle management strategies.
The outcome
By conducting reviews and using the APMS framework, Norfolk and Waveney ICB could achieve a 10% cost avoidance saving by not paying the typical annual cost increases of 10%. This could amount to a cost avoidance efficiency saving of £900,000.
The effectiveness of these reviews may not be measured in cost efficiencies alone. Following reviews, favourable feedback highlighted quality-of-life enhancements for individual patients, including:
- Reducing time spent on changing appliances by switching from drainable to closed pouches, reducing the number of appliances used daily.
- Improving sore peristomal skin through correct use of stoma powder, following education by a specialist nurse, resulting in no further overordering of powder on prescription.
- Saving time by eliminating the use of multiple barrier sprays, wipes, and gloves when not clinically needed, following education by a specialist nurse.
- Offering confidence and reassurance. No change to the patient’s catheter prescription was made, but the review itself, after the absence of one for years, provided reassurance: “This service is just so efficient and just knowing there is a nurse that I can speak to if needed is a great reassurance.”
- Providing comfort, ease of use and reassurance. The patient was pleased to speak to a specialist nurse and preferred switching to a formulary product, which suited them better and offered better value for the ICB.
- Enhancing comfort and ease of use by switching to a different type of catheter to overcome a ‘cutting feeling’, following advice from the specialist nurse.
Contact us
If you would like more information about the APMS framework, please visit the framework page on our website. Alternatively, please contact [email protected] or [email protected] in our Pharmacy and Healthcare Services team.
*The Stoma Care Nurse Sponsorship Service and Wound Imaging Solutions frameworks were also developed as a result of the Hub’s Stomap Research project and can be used for stoma pathways.