Care home pharmacists to help cut overmedication and unnecessary hospital stays for frail older patients

NHS England has today announced plans to recruit and deploy hundreds of pharmacists into care homes to help reduce overmedication and cut unnecessary hospital stays.

Around 180,000 people living in nursing or residential homes will have their prescriptions and medicines reviewed by the new pharmacists and pharmacy technicians.

Elderly care home residents often have one or more long-term health conditions, such as dementia, hypertension, diabetes or heart disease, and on average are being prescribed seven medicines daily, but it can be more, with around 10 per cent of people aged 75 and over currently being prescribed 10 or more medicines.

This is significant as studies suggest up to one in 12 of all hospital admissions are medicines-related and two thirds of these are preventable.

NHS trials show pharmacists reviewing medicines improved patients’ quality of life by reducing unnecessary use and bringing down emergency admissions, with less time spent in hospitals. This approach also led to meaningful savings in unnecessary prescribing costs of £249 per patient in one pilot over a year.

NHS England will roll out the approach by funding recruitment of 240 pharmacists and pharmacy technicians. The reviews will be done in coordination with GPs and practice-based clinical pharmacists to ensure people are prescribed the right medicines, at the right time, in the right way to improve their health and overall quality of life.

Simon Stevens, chief executive of NHS England, said: “There’s increasing evidence that our parents and their friends – a whole generation of people in their 70s, 80s and 90s – are being overmedicated in care homes, with bad results. Let’s face it- the policy of ‘a pill for every ill’ is often causing frail older people more health problems than it’s solving. So expert pharmacists are now going to offer practical NHS support and medicines reviews in care homes across England.”

The use of clinical pharmacists and pharmacy technicians to undertake structured medicines reviews of all new and discharged care home residents in Northumberland showed that one hospital readmission could be avoided for every 12 residents reviewed.

In East and North Hertfordshire, where this model was applied across 37 care homes, an annual drug cost saving of £249 per patient was seen.

Results from the six NHS England care homes vanguard sites piloting this approach show:

  • Reduced reported emergency hospital admissions by 21 per cent
  • Reduced oral nutritional support usage by 7 per cent
  • Reduced ambulance call out by up to 30 per cent
  • Made drug cost savings of £125-305 per resident.

The roll-out of pharmacists and pharmacy technicians into care homes is part of the NHS England plan – Refreshing NHS Plans for 2018/19 – which sets out measures to provide joined-up services for patients to ensure they receive care in the most appropriate place.

Healthwatch England National Director Imelda Redmond, said: “We know from our work on hospital discharge that pharmacy and effective links with care services are key to helping people get home and stay home after receiving treatment. We also know from Healthwatch visits to care homes that at the moment it can be hard for residents to get access to pharmacists, GPs, dentists and other vital services.”

“So this initiative from NHS England, as the health service and local government look to work more closely together on these issues, is a welcome move and we at Healthwatch look forward to following up to see the difference it makes to care home residents.”

Sandra Gidley, chair of the Royal Pharmaceutical Society’s English Board, said: “This significant investment highlights the growing recognition that pharmacists who support care home residents can reduce medicines waste, improve efficiency and provide better health outcomes.

“Many pharmacists already play a vital role in care homes, including through supporting other staff as part of a multi-disciplinary team, and we know that our members will welcome the opportunity to get more involved in providing direct patient care.

“In order to make the most out of this chance to improve health outcomes, commissioners can also better co-ordinate and integrate patient care by drawing on the expertise and knowledge of pharmacists wherever they are based.”