Abstract

Background
Doncaster ranks among England's top 20–30 most deprived local authorities (IMD 2025),
with smoking prevalence ~22–25% (1.7xnational average) and baseline asthma
exacerbation admissions 1.5–2x England rates (~150–200/100k vs 80–100/100k). National
trends show rises (+9.5% 2022/23; +18.8% 2023/24). Previous national Investment and
Impact Fund 2022/2023 incentives achieved modest salbutamol (SABA) reductions
(13% vs Doncaster's incentive scheme SABA reduction 16–31%), underscoring need for
targeted local approaches amid patchy guideline uptake. This high-risk context highlights DIBS' role in accelerating maintenance and reliever therapy/reliever therapy implementation over SABA use in combination with inhaled corticosteroids.
Aims and Objectives
Evaluate Doncaster Indicative Budget Scheme (DIBS)- locally commissioned prescribing
incentive—impact on implementing guidelines versus previous 2022/2023 national IIF schemes. Specific objectives:
quantify SABA reduction speed/outcomes (2024/25–2025/26), assess ICS adherence, high
dose ICS prescribing shifts, measure dry powder inhaler adoption for greener prescribing, and demonstrate cost savings/equity.
Method
Retrospective analysis of DIBS data for asthma patients ≥5 years (excluding COPD). 2024/25
thresholds: <27.52% receiving ≥5 SABA inhalers/12 months; <30.89% with <3 ICS inhalers
(36 practices). 2025/26 tightened SABA to <20% or ≥7.5% reduction from March
2025 baseline. Monthly clinical system searches captured prescribing %;
statistical analysis on baseline-to-February 2026 trends. Outcomes compared to national 2022/2023 IIF (13% SABA drop).
Results
DIBS exceeded national benchmarks: 2024/25 salbutamol (SABA) reduced 16% (vs IIF 13%),
27 practices met targets (13,990 fewer items; £21,000 saved). 2025/26 accelerated this
reduction - mean SABA 22.94% baseline (March 2025) fell to 15.79% February 2026 (-30.9%
overall), 31/36 practices achieved <20% or >7.5% threshold. ICS metric was met by 36
practices in 2024/2025, curbing high-dose corticosteroid reliance; DPI shifts aligned with
greener agenda (100–200x lower carbon vs pMDIs).
Discussion
Local DIBS outperformed national 2022/2023 IIF by enforcing tighter thresholds/monthly
tracking, driving faster guideline uptake in deprived Doncaster—where deprivation/smoking
amplify risks. Studies affirm local incentives enhance adherence/outcomes vs national
efforts. DIBS provides scalable blueprint for high-burden regions, enabling an effective implementation of GINA/NICE
guidelines.
NHS Digital. (2025). Respiratory disease profile: Statistical commentary, June 2025.
Global Initiative for Asthma. (2025). GINA 2025 summary guide for primary care.
NICE. (2024). Asthma: Diagnosis, monitoring and chronic asthma management.