Medicines Optimisation

Chaired by Heidi Wright, Practice and Policy lead for

England, Royal Pharmaceutical Society

What is medicines optimisation? Dr Keith Ridge

Chief Pharmaceutical Officer

NHS England

Medicines:

• Prevent life-threatening diseases

• Help to change previously life-threatening illnesses to long-term

conditions eg HIV

• Improve the quality of life for people with long-term conditions

• Reduce mortality across a wide range of diseases and thereby help

increase life expectancy

Medicines have a vital role to play

Medicines Optimisation in practice

Medicines are still the most common therapeutic intervention and

the biggest NHS cost after staff, but there are some fundamental

issues that need to be addressed.

Patients report have insufficient supporting information

UK Literature suggests 5 to 8% of hospital admissions due to preventable adverse effects of medicines

Medicines wastage in primary care: £300M pa with £150M pa avoidable

The threat of antimicrobial resistance

Appropriate vs. inappropriate polypharmacy. Multi-morbidity and polypharmacy increase clinical workload

30 - 50% of medicines not taken as intended

Medication errors across all sectors and age groups at unacceptable levels

Uptake of newer medicines can be patchy and unwarranted variation in use of medicines

Relatively little effort towards understanding clinical effectiveness of medicines in real practice

£14.4 billion spend each year on medicines by NHS England (15% of entire NHS Budget)

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Harnessing this opportunity The Rt Hon Jeremy Hunt MP, the Secretary of State for

Health wrote to ABPI & NHS England in April and asked that

they work together….

“to agree and carry through a solution for accelerating uptake of clinically and cost effective medicines which maximises the benefits of the PPRS within the current financial situation. This means an end to cost containment measures on branded medicines which will not in the long run save the NHS any money. It also means creating a real clinical pull for innovative and cost effective medicines, replacing costly non drug treatments by a programme of cultural change led jointly by NHS England and the industry using all the management levers available”.

The principles of Medicines Optimisation are supported by

NHS England, through Sir Bruce Keogh, Jane Cummings and

Keith Ridge. It also has support from the highest levels

through the Ministerial Industry Strategy Group.

High level support

“Medicines optimisation is about ensuring the

right patients, get the right choice of medicine at

the right time”

RPS, Medicines Optimisation: Helping patients to make the most of

medicines, May 2013

NHS England and ABPI PPRS/Medicines Optimisation Programme

NHS England and ABPI have

embarked on a joint programme of

work, guided by the Principles of Medicines Optimisation that were

published by the Royal

Pharmaceutical Society in May

2013.

Medicines optimisation looks beyond the cost of medicines to the value they deliver and recognises

medicines as an investment in patient outcomes.

The goal is to help patients to:

• Improve their outcomes, including better monitoring and metrics

• Have access to an evidence-based choice of medicine

• Improve adherence and take medicines correctly

• Avoid taking unnecessary medicines

• Reduce wastage of medicines

• And improve medicines safety

The goal of medicines optimisation

“Where a medicine or technology is clinically sound and cost effective for the NHS, patients should have access to it – no question, no qualification.”

Baroness Barbara Young, Chair, Diabetes UK

• Identifying the role MO has to play in local system redesign

and integrated care

• A move from the ‘cost’ to the ‘value’ discussion

• Identification of the role MO has to play in defining what the

next 5 years looks like

• A new approach of value in system redesign rather than doing things as we have done for the past 20 years

• Commissioning of innovative medicines where they show

overall value

• Identifying the role of MO in delivering £22bn system

efficiencies over the 5year Forward View

What does PPRS/MO facilitate?

• Establishing meaningful patient engagement on medicines optimisation

• Further developing the medicines optimisation dashboard

• Specialised commissioning: utilisation of “commissioning through evaluation”

• NICE Clinical Guideline on medicines optimisation (March 2015) and implementation support workshops

• Developing medicines optimisation strategy and best practice resource

• Winning hearts and minds:

– Joint NHS England/ABPI roadshows with AHSNs

– Working with senior clinical leaders

– Engaging NHS finance professionals

– Strategic communications plan

Outline work programme

Medicines Optimisation

NHSE

NICE

AHSN

HCP

Patients

ABPI

Examples of Medicines Optimisation in

practice

Andrew Cooke MRPharmS

Assistant Director

Head of Medicines Optimisation

Bedfordshire CCG

Optimising the use of inhalers in

Bedfordshire care homes

• Reviewed and supported 191 patients prescribed inhalers within 59 care homes

• Provided training workshops for care home staff

• On site pharmacy technician review of care home drug rounds

• 14% fewer reliever inhalers

• Fewer patients requiring oxygen

• Patients:

– Are more mobile (less breathless)

– Have improved well-being

– Have improved mood

– Are more engaged in activities

– Have improved appetite.

All set out as objectives at outset and recorded, however these are subjective measures, so cannot be considered conclusive

Medicines Optimisation Pharmacy

Service (MOPS)

Aim:

• To provide a full clinical medication review service by a specialist pharmacist

to Community patients 75yrs+, assessed at risk of hospital admission and

having complex medication needs

1. Full clinical medication reviews completed by clinical

pharmacists in patients homes across 3 CCGs:

• Check clinical appropriateness of prescribed medication, i.e. doses, duration, frequency.

• Review of long term medication.

• Management of adverse drug reactions and side effects.

• Adherence assessment, e.g. day to day management of medicines, inhaler technique.

2. Pharmaceutical care plan agreed with patient

• Recommendations made to GP & multidisciplinary team.

• Support provided to help with medication administration.

• Communication/referral to district nurses, community pharmacists

(MUR/NMS), specialist nursing teams (COPD, heart failure, diabetes).

Results

• A full clinical medication review was conducted on 387 patients

across three CCGs.

• In summary, of the 1,799 interventions made:

Cost per patient (average) • Table 4 – Cost sav ings (£) per patient Av erage

Comparing the costs of medicines stopped and the cost of the

pharmacist, the service is cost neutral, at 6 month post review

Fewer non-elective hospital

admissions (6 month data (N=353))

Statistical analysis using Wilcoxon signed rank test with continuity correction.

p-value = 0.03096, suggests a significant change after pharmacist reviews.

Stakeholder feedback

West London CCG have commissioned the service since April 2015