By Maddie Tudor on September 20, 2023
Business Development Manager, Richard Chrystal shares his insights and perspective on NHS England’s medicines optimisation opportunities 2023/24.
It’s no secret that the NHS is under pressure right now.
There are stories on every news channel in what seems like a 24/7 attempt to remind you that waiting lists are too high, and that strike action is happening. Things don’t necessarily sound great on the surface.
However, what the public don’t often hear about is the ‘behind-the-scenes’ work that goes on to improve healthcare for each of us when we’re not attending our local GP surgery or Hospital. The pills we take, the devices we use, the technology we have access to whilst at home.
Medicines Optimisation (MO) teams play a massive part in this, acting as the driving force behind the year-on-year change that makes every prescription both safer and more effective for the patient population, whilst aiming to retain money within the NHS.
That includes your local Pharmacists, who are also going through a massive period of change at present. New initiatives are being born to empower them within the prescribing process; aiming to reduce the time the average patient will need to spend speaking to their GP. If done correctly, this initiative is expected to be largely welcomed as it should lead to a higher quality of patient interaction and hopefully a more accurate following of local formulary & guidance.
So, what comes next?
Medicines optimisation teams spent the first quarter of the calendar year deciding their QIPP work plans and should now be well underway to delivering against them. As you’d expect, these plans will contain medicines programmes of varying nature; from smaller-scale patient quality initiatives to system-wide cost-saving measures. Importantly, no regional plan will look the same.
However, as of August 2023, the NHS is now being tasked with selecting five additional medicines optimisation ‘opportunities’ to focus on for the remainder of the 23/24 financial year.
With 16 opportunities to choose from (six concern appropriate use of medicines, whereas the remaining ten are focused on set clinical areas) it will be particularly interesting to see which of them will take the bulk of national choice. Many of the suggestions will have already been under consideration by ICB teams due to them being existing national medicines priorities.
How will a mid-year recommendation of new MO programmes be prioritised against existing workloads?
ICB Medicines Optimisation teams are no strangers to working to concurrent schedules.
Since the emergence of COVID this has only increased, with MO teams being tasked with management of various new immunisation policies, as well as their delivery plans. Add the formation of ICSs into the mix, and you’ve got many MO teams now responsible for regions that have at least doubled in size and population.
It will therefore be ever more important to maximise existing resource and look at new options for external assistance. With all the recent advancements in digital healthcare, the NHS will need to weigh up all the tools available to them in order to maximise the forward momentum.
After all, with added demand comes a necessity to fit more into the working day. Will ICBs be in a position to free up both staff and time in order to start additional programme implementation?
After all, the NHS is currently at capacity? Right?
From the view of an optimist, I hope that this initiative will open new doors and enable discussion around national best practice in implementing specific clinical change. Whether that be a new strategy, an innovative technology that has come to market, or simply freshly written internal guidance that can adapted for use cross-system(s). With limited options to choose from, there surely comes a natural overlap of objectives around delivery – nobody will want to choose an MO opportunity area with the intent to make things worse, after all.
Whilst it’s unrealistic to expect ICBs to suddenly start working in exactly the same way, consistency in approach should prove the key to getting it right within each region itself. Especially as many ICBs are still figuring out how each internal ‘Place’ (previously CCG) area can work in further harmony.
We need to be thinking about how success can be effectively replicated considering the high degree of variation within our population; to what degree would a process need to be tailored to deliver the same positive outcomes but, still provide the flexibility to suit the local demographic?
Two objectives that feature heavily within the NHSE recommendations are reducing medicine usage and ensuring the correct drug choice for high-risk patients. In other words, how can we help people to reduce the quantity of pills they take, whilst ensuring that medicine is the correct one in the first place?
When it comes to deprescribing, there’s no set method for success – every case is different. It’s a time-consuming process that involves a high degree of effort from both patient and health care professional (HCP). However, it’s an area where ICBs will need to be taking steps forward, given it makes up a quarter of the total 16 opportunities:
– Option 1 – Addressing problematic polypharmacy.
– Option 7 – Addressing inappropriate antidepressant prescribing.
– Option 14 – Reducing course length of antimicrobial prescribing.
– Option 15 – Reducing opioid use in chronic non-cancer patients.
I’d expect many ICBs to take on at least one of the above within their five choices, especially as the management of both mental health and pain prescribing has come to the forefront over the past decade. Programmes like these offer a massive quality of life improvement to what is, unfortunately, a growing patient population.
MO teams will therefore need to have every available tool stored within their arsenal in order to ensure these clinical areas can start to be tackled effectively and within a relatively short period of time.
Spirit Health has been delivering optimisation programmes within the NHS for many years, reviewing the drugs and devices prescribed to patients and evaluating where a higher-quality and/or cost-effective alternative can be offered. It’s a win-win.
However, deprescribing an alternative drug isn’t what’s needed. We need to see a controlled and medically appropriate reduction in usage. In doing so, we also have to enable both the patient and HCP to take control of a tapering regime without adding to the stress the NHS is already under.
In an ideal world, we develop a process that reduces both the drug use and the workload, whilst remaining flexible enough to be delivered across all individual UK demographics.
What’s next?
To find out how Spirit Health can support you in meeting your chosen NHS England medicines optimisation opportunities, click here.
