Making more of medicines: medicines optimisation opportunities

It’s been just over a year since integrated care boards (ICBs) took on their statutory functions, and progress through collaboration in the area of medicines and pharmacy has been very positive. The publication in March 2023 of the new action plan on prescribed medicines associated with dependence or withdrawal symptoms was the culmination of close working between national, regional and local teams with a shared aim to improve patient care and outcomes and a great example of collaboration in action. Co-produced with local health and care systems, the plan shares learning and best practice to provide integrated care systems (ICSs) across the country with a resource that can be tailored to the needs of local people.

Today, we’re delighted to publish the National medicines optimisation opportunities for 2023/24. This guidance sets out 16 national medicines optimisation opportunities and signposts to resources to support ICBs to choose at least five to deliver alongside their local medicines optimisation priorities.

The list of 16 is not provided in any priority order and reflects the breadth of opportunities that can be selected by ICBs to best reflect the needs of their population and expertise of health and care providers.

The list in full reflects the extent of the potential improvements in patient outcomes and financial savings that can be realised, with almost all of the 16 representing the opportunity to do both in tandem:

  • addressing problematic polypharmacy can reduce adverse drug reactions, and in doing so prevent avoidable, expensive hospital admissions
  • detecting people living with undiagnosed or untreated atrial fibrillation and using a best value direct-acting oral anticoagulant (DOAC) could avert thousands of potentially fatal stroke events across the country and deliver immediate savings in medicines costs and long-term savings arising from the treatment required after a cardiovascular event
  • switching from intravenous to oral antibiotics improves patient experience (75% of patients prefer oral antibiotics) and also saves millions of pounds in medicines expenditure.

This is just a snapshot of three of the 16 opportunities in the new guidance that all support ICBs four key objectives covering outcomes, inequalities, value, and socioeconomic development.

Whilst we are recommending at least five are selected by each ICB, systems can explore all the opportunities to secure improvements for their populations, tailoring local implementation accordingly: we know what’s right for Penrith, may not be right for Penzance.

Looking ahead to 2024/25, we are already encouraging potential future medicines optimisation opportunities to be shared with regional chief pharmacists and by contacting the NHS England medicines policy and analysis unit at

Some future priorities that may be considered for 2024/25 are also listed in the document.

Responsibilities and accountabilities for delivery of the opportunities are set out in the separate Regional arrangements for medicines optimisation guidance, which has also been published today. In practice, regional teams will support ICB leaders to select at least five of these 16 national medicines optimisation opportunities, and NHS England will use available data to review progress against the chosen opportunities. These arrangements sit alongside implementation guidance that underlines the importance of shared decision-making, between professionals and patient, which is fundamental to the success of these opportunities.

Today’s publications are the latest developments in the delivery of a comprehensive NHS medicines optimisation strategy, that will be delivered through the collective efforts of a host of organisations and individuals. It is a strategy that seeks to utilise all the resources and strengths available and provides the best opportunity for success.

As a single payer health system, the NHS is in a strong position to negotiate nationally for access to new medicines at prices that represent value for taxpayers. NHS networks including our regional chief pharmacists can enable shared learning across regions and ICBs and health and care professionals in surgeries, hospitals and specialist clinics across the country have the day-to-day patient interactions that can shape how to adapt to meet patient needs and improve outcomes and experiences.

Working national to regional to local; local to regional to national and shaped by frontline staff and the experiences of patients, we can collectively develop and implement solutions that can improve patient outcomes and deliver value for money for taxpayers.

Medicines are the most common therapeutic intervention in healthcare. I’d encourage all colleagues to read these new publications to shape a tailored approach to medicines optimisation throughout the NHS.

Claire Foreman is Director of Medicines Policy and Strategy for NHS England.

Claire has worked in the NHS for over 20 years, leading work to improve patient access, experience and outcomes in care and treatments. Over the last decade, Claire has focused on developing medicines policy and strategy in specialised commissioning in regional and national roles. Claire joined the Commercial Medicines Directorate in the summer of 2021 to lead our policy, strategy and analysis work, helping drive our efforts on medicines access including innovative treatments, on optimisation and value programmes, and on medicines sustainability and Net Zero. Claire is passionate about the role of medicines in improving patient outcomes and reducing health inequalities and has a particular interest in innovative medicines.