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1. Medicines Optimisation
Chaired by Heidi Wright, Practice and Policy lead for
England, Royal Pharmaceutical Society

2. What is medicines optimisation?
Dr Keith Ridge
Chief Pharmaceutical Officer
NHS England

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. 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. 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. 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. 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. “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. NHS England and ABPI
PPRS/Medicines Optimisation
Programme

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. 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. • 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. • 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. Examples of Medicines Optimisation in
practice
Andrew Cooke MRPharmS
Assistant Director
Head of Medicines Optimisation
Bedfordshire CCG

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. • 14% fewer reliever inhalers
• Fewer patients requiring oxygen

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. 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. 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. Results
• A full clinical medication review was conducted on 387 patients
across three CCGs.
• In summary, of the 1,799 interventions made:

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. 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. Stakeholder feedback
West London CCG have commissioned the service since April
2015