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A revolution is just around the corner

With schemes for medicine optimisation in care homes due to be launched in October, NHS England’s national lead reflects on progress so far and examines the integrated models of care which are being developed to help residents:

All parts of the NHS in England – the 44 sustainability and transformation partnerships (STPs) and integrated care systems (ICSs) – will shortly receive Pharmacy Integration Fund money.

This will be used to deploy pharmacists and pharmacy technicians into care homes to ensure this vulnerable group of patients get better outcomes from medicines.

Adverts for care home pharmacists and pharmacy technicians are already appearing on NHS Jobs and we anticipate that the 240 people will be starting their exciting roles by October.

The aim is to improve the lives of people in care homes who are frequently prescribed too many medicines, often not given an opportunity to be involved in decisions about their medicines, and who, in many cases, don’t get detailed and timely medicines reviews.

Medicines optimisation in care homes has been happening in parts of the country for some time, with clinical pharmacy teams based in a variety of care settings. Evaluation of these services – including the Care Home Vanguards – has consistently shown that detailed medicines reviews improve quality of life, reduce risk of medicines related harm and make significant savings.

The STP and ICS schemes will not only review existing residents, but crucially, will prioritise rapid review of residents as they move into a care home, either for the first time or on discharge from hospital.  This ensures that residents don’t remain on medicines that are unnecessary or even harmful. Existing patients will be seen based on need, with those requiring a medicines review being stratified and referred into pharmacy caseloads.

Three of the STPs have decided to target care homes for residents with learning disabilities.  Research has shown that this population are often prescribed inappropriate medicines such as anti-hypnotics and anti-psychotics.  Given the complexity of their care, general practice can sometimes find it difficult to undertake a full medication review and initiatives such as Stopping Over Medication of People with a learning disability, autism or both (STOMP) have shown that pharmacy teams can help reduce the burden of inappropriate medication.

Community pharmacy as a partner in delivering good care for care home residents has featured in many of the STP and ICS plans.  In one system in the West Midlands, some community pharmacists will be employed in the scheme and undertake the 18-month training pathway and training as independent prescribers to enable them to work alongside an existing care homes pharmacy team of pharmacists and pharmacy technicians. The newly trained community pharmacists will then work as part of the multidisciplinary team to help optimise medicines. ​

It is the vision of this programme that all conversations with residents and their families/carers form part of genuine shared decisions about medicines. The bespoke Health Education England training pathway to support people on this programme – including a qualification for pharmacists as independent prescribers – will teach patient-centred consultations using the principle that the final decision should be based on the evidence base, practitioners’ knowledge and experience and the patient’s values, in equal measures.

The programme is funded by the Pharmacy Integration Fund and delivered at STP/ICS level so that we can drive integrated working.  We are asking for this not to be a stand-alone service, but to be embedded into the local Enhanced Health in Care Homes framework which is being rolled out locally.  The care home vanguards demonstrated the wider benefits of different teams working together; for example, some areas have pharmacy technicians and dieticians working together to ensure good nutrition and hydration leading to reduced prescribing of expensive sip feed products.

Good relationships with general practice are also vital to ensuring that pharmacy teams make good clinical interventions. The patient’s GP record holds vital information to allow a good quality medicines review and is where any interventions are recorded. We also wish to see better integration of pharmacy across the care system, with pharmacy teams from all sectors – hospital, community, general practice and primary care – emerging primary care networks and social care colleagues coming together to agree a shared purpose, reduce duplication, increase efficiency and deploy the best skill mix for the locality.

The programme is being evaluated to produce good quality evidence to help commissioners make decisions about sustaining services, and national metrics are being developed for this purpose.

I am excited at the response so far to this programme; openness to new integrated ways of working and testing new models that add in sustainability, and a real willingness to make patient centred care and shared decision making the norm.

The programme, through the hard work and dedication of local STP/ICS teams, is poised to deliver better quality of life and a reduction in medicines related harm for our care home residents and, by doing so, save significant money for the NHS.

Dr Wasim Baqir

Dr Wasim Baqir is currently on secondment to NHS England to lead the care homes medicines optimisation scheme.

He was the lead pharmacist for the Northumberland PACS Vanguard where he led an integrated team of pharmacists and pharmacy technicians, working collaboratively with doctors, nurses, social care and other professionals to develop and test services for patients across Northumberland.

Before this, he was the R&D and quality improvement pharmacist, leading on several projects including the Shine project; optimising medicines in care homes.

He has a passion for quality improvement and sits on the Trust Quality Laboratory and recently was successful in joining the Health Foundation’s Generation Q Network. Nationally, he is a member of the Royal Pharmaceutical Society Innovators’ Forum and the Guild of Healthcare Pharmacists’ National Professional Committee.

Follow Wasim on Twitter: @wasimbaqir.

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