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Improving Prescribing and Medicines Management

Prescribing is one of the most common interventions in healthcare and accounts for over £12bn (over 12%) of the NHS budget and nearly £1bn of expenditure in East Midlands.  Patients aged 65 years and over (18% of the population) account for 45% of this drug spend.

There is wide, and often unnecessary variation across the region in prescribing practice and how medicines are used.  Pharmacists and clinicians are developing more standardised approaches they can all adopt so that the same decisions are being made about which drugs to purchase and prescribe for different conditions.

We also want to empower patients to take more control of their medication regime, so that they are more involved in decisions about what medicines they should be taking and when; that they have a proper medicines management plan, understand the importance of following it and don’t waste the medicines that are prescribed to them. 

 

Background

Prescribing is one of the most common interventions in healthcare. In 2009, it accounted for 12% (£12.3bn) of the total NHS budget

In 2009, NHS East Midlands expenditure on medicines was £935m

  • £226m in hospitals, an increase of 15.1%

  • £693m in Primary Care, an increase of 2.6%

 

Costs of medicines increased by 5.6%, 13.2% in hospitals, and 2.6% in Primary Care.

In addition, unused prescription medicines lead to £15m medicines waste each year in East Midlands, and it is estimated that 50% of patients do not take their medicines as prescribed resulting in reduced health gain. It is estimated that up to 10% of patients are admitted to hospital due to problems with their medicines.

 

Aims & Scope

The aim of the project is to maximise the clinical and cost effective purchase & use of medicines in the East Midlands without adverse impact on quality and safety, using projects to improve consistency and promote the best use of medicines. 

The National medicines use and procurement workstream provides a framework for the SHA workstream.

 

Objectives

The NHS East Midlands prescribing and medicines QIPP workstream aims to reduce variation in prescribing and medicines use, and disinvest in medicines and activities of limited clinical value, with no loss in quality i.e. better care at better value. This cross-cutting workstream has a range of clearly defined projects under three themes and five broad objectives, which align closely with the national QIPP programme:

 National QIPP Programme

  • Cost-effective procurement and commissioning

  • Clinical and cost effective prescribing

  • Reducing waste and improving concordance

 

NHS East Midlands

  1. To review medicines procurement opportunities within Primary and Secondary care to increase efficiency

  2. To realise cost savings from improving performance against the BCBV and other local prescribing efficiency measures

  3. To improve the commissioning of medicines services to ensure medicines are used in line with the standards set by NICE and local commissioning policy

  4. To deliver a patient engagement programme to encourage self-care, improve concordance and reduce the amount of medicines wasted across hospital and community settings

  5. To develop joint medicines commissioning policies to improve consistent high quality use of medicines

 

A bottom up approach is being taken to deliver these objectives at organisational level through engagement of pharmacy leads and teams in primary and secondary care.  A joint collaborative Pharmacy network, supported by regional specialists, meets quarterly to augment existing regional meetings and to share best practice and take forward each of the project objectives.

 

Benefits & Outcomes

Patient Experience:

  • Improved patient satisfaction  as a result of increased concordance

  • Maintain or improve outcomes from medicines through improved patient concordance

  • Improved patient experience as a result of implementing recommendations in the review of medicines use & services

 

Patient Safety:

  • Increased patient safety by improving quality and consistency of prescribing medicines

 

Effectiveness:

  • Improved quality of prescribing by promoting evidenced based, clinical & cost-effective medicines use

  • Increased consistency of prescribing by promoting evidenced based, clinical & cost-effective medicines use

  • Improve health through the use of medicines e.g. maximising numbers receiving preventative treatment

 

Productivity & Efficiency:

  • Reduction in expenditure on medicines within the East Midlands including:

  • Reduction in the amount of medicines waste through engagement with patients, carers and clinicians

  • Reduced hospital admissions related to the adverse effects of medicines

  • Improved performance management of commissioning policies will ensure medicines are used within the indications agreed through NICE / local agreements.

Prescribing photo

Other useful links:

NPC 15 Key therapeutic topics 2010/11 (updated February 2011) – an initial list of therapeutic topics which offers opportunities for maintaining or improving quality

Evaluation of the Scale, Causes and Costs of Waste Medicines

Department of Health's checklist of 50 efficiency measures to help deliver safer, more cost effective prescribing