Following national policies and legislation
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.
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:
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.
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.
Recent NICE guidance (7 April 2021) advises that chronic primary pain can be managed with exercise programmes, CBT, acceptance and commitment therapy, and acupuncture.
The South Yorkshire and Bassetlaw (SYB) ICS is collaborating with the West Yorkshire Research and Development (WYR&D) to carry out a CROP study across the SYB CCGs aiming to help prescribers reflect on previous practice and implement the NICE Chronic pain guidance
The CROP audit has been previously conducted across CCGs in West Yorkshire, and proved to be very successful in helping prescribers manage their prescribing of opioid analgesics and significantly reduce opioid analgesic prescribing across West Yorkshire.
CCG’s across SYB are working with GP practises and care homes to set up proxy access for care home staff.
Proxy access provides access to people nominated by the patient to manage aspects of the patient’s GP online services account e.g. to order repeat prescriptions.
Once set up for proxy ordering, care home staff will able to order repeat medicines on behalf of their residents through the GP system by using Proxy access. Staff get their own account to login to the GP system. The access will be limited and Care home staff will not be given access to the GP clinical system or the patient’s full record.
Discharge from hospital can be associated with increased risk of avoidable medication related harm. NICE guideline NG056 included the following recommendations to be considered as part of patient discharge process from the hospital.
a) Medicines-related communication systems should be in place when patients move from one care setting to another.
b) Medicines reconciliation processes should be in place for all persons discharged from a hospital or another care setting back into primary care and the act of reconciling the medicines should happen within a week of the patient being discharged.
Implementation of these recommendations requires pharmacy professionals and their teams across hospitals, primary care networks (PCNs) and community pharmacy to work together much more effectively. Improving medicines safety at transfers of care forms part of our Medicines Safety Improvement Programme. ((Discharge Medicines Service Tool kit, NHS England).
NHS England published its guidance on Leading Integrated Pharmacy and Medicines Optimisation in September 2020. ipmo-programme-briefing.pdf (england.nhs.uk)
Following this, SYB ICS is working to take it forward and develop an IPMO transformation programme plan that will deliver optimal use of medicines to improve patient outcomes across the ICS footprint. This will be done through strong collaborative working with partners across organisations to improve, integrate and innovate pharmacy services across all sectors – to deliver high quality, sustainable services as efficiently as possible.