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Medicines optimisation, pop up uni, 9am, 3 september 2015


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Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.

Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.

This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.

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Medicines optimisation, pop up uni, 9am, 3 september 2015

  1. 1. Medicines Optimisation Chaired by Heidi Wright, Practice and Policy lead for England, Royal Pharmaceutical Society
  2. 2. What is medicines optimisation? Dr Keith Ridge Chief Pharmaceutical Officer NHS England
  3. 3. 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 acrossa wide range of diseases and thereby help increase life expectancy Medicines have a vital role to play
  4. 4. Medicines Optimisation in practice Medicines are still the most common therapeuticintervention and the biggest NHS cost after staff, but there are some fundamental issues that need to be addressed.
  5. 5. Patients report haveinsufficient supportinginformation 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 ofantimicrobial resistance Appropriate vs.inappropriate polypharmacy. Multi-morbidityand polypharmacyincrease 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 patchyand unwarranted variation in use of medicines Relativelylittle effort towards understandingclinicaleffectiveness of medicines in real practice £14.4 billion spend each year on medicines by NHS England (15% of entire NHS Budget) i £ £
  6. 6. 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 foracceleratinguptake of clinicallyand cost effectivemedicines which maximises the benefits of the PPRS within the current financial situation.This means an end to cost containment measureson branded medicines which will not in the long run save the NHS anymoney.It also means creatinga real clinical pull forinnovativeand cost effectivemedicines,replacing costlynon drug treatments bya programmeof cultural change led jointlybyNHS England and the industryusingall the management levers available”.
  7. 7. 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
  8. 8. “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
  9. 9. NHS England and ABPI PPRS/Medicines Optimisation Programme
  10. 10. 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.
  11. 11. 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 patientsto: • 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 forthe NHS,patients should have access to it – no question, no qualification.” Baroness Barbara Young, Chair, Diabetes UK
  12. 12. • 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?
  13. 13. • 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/ABPIroadshows 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
  14. 14. Examples of Medicines Optimisation in practice Andrew Cooke MRPharmS Assistant Director Head of Medicines Optimisation Bedfordshire CCG
  15. 15. 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
  16. 16. • 14% fewer reliever inhalers • Fewer patients requiring oxygen
  17. 17. • 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
  18. 18. 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
  19. 19. 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).
  20. 20. Results • A full clinical medication review was conducted on 387 patients across three CCGs. • In summary, of the 1,799 interventions made:
  21. 21. Cost per patient (average) • Table 4 – Cost savings (£) per patient Average Comparing the costs of medicines stopped and the cost of the pharmacist, the service is cost neutral, at 6 month post review
  22. 22. 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.
  23. 23. Stakeholder feedback West London CCG have commissioned the service since April 2015