Medicines optimisation is about making sure we offer our patients the most cost and clinically effective medicines while ensuring that you have the right choice about the medicines you might take and at the right time.
Medicines represent the second largest spend in the NHS at £17.4 billion a year. With £1 in every £7 of this currently spent on medicines they are the most common intervention given to patients. Read more here [https://www.england.nhs.uk/blog/breaking-down-the-barriers/]
As an Integrated Care System (ICS) we are looking at how we can work together to ensure that our investment in medicines is put to best use and are maximising outcomes for patients. Part of this work involves reducing current spend on medicines where it is safe and clinically appropriate to do so.
We are working at scale on a range of initiatives to try and achieve this. These initiatives are themed under the following headings:
Prescribing Cost Reductions
In line with national initatives around wasteful and ineffective drug prescriptions we are seeking to generate direct savings linked specifically to medicine costs. This is by asking doctors and other healthcare prescribers to use the lowet cost type of a medicine wher it is safe to do so.
We are working hard to ensure these savings are made without compromising patient care or worsening and the avoidable differences in people’s health across
The aim is to improve the patient experience by placing the prescribing and supply of products such as nutritional supplements, continence and stoma appliances with the most appropriate health care professional rather than the patients GP.
Experience from around the country demonstrates improved patient care if dietitians manage the complete patient pathway. By not only recommending a product for a patient but also prescribing and supplying the product directly to the patient, the service is more integrated. Patients are not lost in the system and will remain connected to the clinician that made the initial clinical intervention.
The same is true in continence and stoma care, if the ongoing prescribing of the appliance resides with the specialist nurse that as assessed the patient rather than passed to the patients GP the patient benefits from a more holistic service that is able to provide a greater continuity of care.
In these areas the GP is usually acting only as a mechanism for supplying the product. In the traditional model patients can get caught between the GP and the specialist service and left ensure who is responsible for managing their ongoing care.
Also having clinical and financial responsibility residing with the same service has proved to deliver financial savings due to improved product choice and less waste.
We aim to identify medicines/conditions suitable for common prescriber guidance that should only be prescribed (on prescription) when necessary. This work will ensure a consistent approach across all areas in South Yorkshire and Bassetlaw. By curbing prescriptions for ‘over the counter’ and low cost medicines such as those for constipation and athletes foot we can save the NHS millions of pounds.
NHS England undertook a consultation in 2017 regarding the prescribing of medicines that can be bought over the counter at local shop or pharmacy. They then produced guidance to CCGs on 33 conditions that are either self-limiting and does not require medical advice or minor and can be treated by items purchased from a pharmacy. They also identified some medicines considered to be of low clinical effectiveness, such as vitamins, minerals and probiotics.
In 2018 we launched our 569millions reasons campaign. Ultimately by spending less money on treating conditions that will get better by themselves, or can be easily treated by you, at home, we will have more money to spend on maintaining the services we have and investing in new ones. Read more here.
Effective use of medicines related NHS resources
Wasted or unused medicine is a serious problem within the NHS. It is estimated that as much as £300million is wasted every year on unused or partially used medication and is an issue we are keen to address in South Yorkshire and Bassetlaw.
We aim to review and improve medicines related resources for example medicines safety ordering and waste. This patient story explains what can happen when a repeat prescription ordering system don’t work very well. This causes waste and can be unsafe for patients. We will be looking at ways in which we can help improve systems and staff training to help reduce problems such as this occurring.
Optimise the management of the interface between primary and secondary care
The aim is to maximise the use of systems designed to improve efficiencies across the healthcare system.
We realise that the health care system does not function as a whole and more people need coordinated care from both sides of the primary/secondary interface, good communication between the sectors becomes a crucial factor in the delivery of good quality health care.
We are doing this in the following ways:
· CCGs are responsible for paying for some of the medicines used in hospitals; some of these can be very expensive. One such example is a class of medicines known as biosimilars. We will be working with all the hospitals in South Yorkshire and Bassetlaw to ensure that the biosimilars they use are the lowest cost. This means that we can make the money we have go further to treat more patients.
· NICE is responsible for producing specific guidance for some new and expensive medicines that are used in hospitals which CCGs are responsible for paying for. We are working collaboratively to ensure that the hospitals only use the medicines in accordance with the criteria set by NICE.
Medicines Optimisation in Care Homes
This is a national initiative by NHS England which the ICS will be delivering for South Yorkshire and Bassetlaw. We will be recruiting pharmacists and pharmacy technicians to begin providing a service to care homes, working with health and social care colleagues, care homes staff, patients and their families. This has been undertaken elsewhere and will provide a number of benefits for patients, including:
· Optimising medicines (stopping inappropriate or unsafe medicines, and ensuring medicines add value to patient’s health and well-being)
· Patient centred care (shared decision making about which medicines care home residents take and stop)
· Creating better medicines systems for care homes to reduce waste and inefficiency
· Training and supporting care home staff to enhance safer administration of medicines.