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The NHS RightCare team has made significant progress on a number of pharmacy and medicine optimisation related initiative, as Jas Khambh explains in more detail.
Talking about medicines in the context of a whole pathway rather than in isolation
We have presented at various forums and conferences over the last few months and I think it would be reasonable to say that a larger proportion of pharmacists now understand the NHS RightCare approach and methodology. The resources allow us to look at medicines as part of a whole pathway rather than in isolation.
Secondary care medicines data
At present, NHS RightCare data predominantly focuses on primary care. The data for medicines is provided by the Business Services Authority (BSA) at Clinical Commissioning Group (CCG) and practice level which can then be manipulated and presented in data packs for practices, CCGs or Sustainability and Transformation Partnerships (STPs).
NHS RightCare does not currently provide data for medicines use in secondary care. However, if NHS RightCare were to have access to medicines data for secondary care then this could potentially be included within our data packs. NHS RightCare considers clinical pathways from start to finish, and therefore secondary care medicines data would be particularly useful in providing some context on what is happening within the entire pathway and within local health economies. It would enable us to get a clearer understanding of where medicines are possibly being initiated, and to what degree secondary care prescribing is influencing medicines use in primary care and vice versa. It will also allow more informed discussions within STPs and the emerging Accountable Care Systems (ACSs) that include both primary and secondary care. For this reason, we are exploring the possibility of including secondary care medicines data in our future materials.
Consultant pharmacists’ map
We have been working with the Specialist Pharmacy Service to help them map out consultant pharmacist posts across the country. A draft map has been produced, and we hope to develop this further to incorporate the specialty of those pharmacists into an instant atlas showing variation in the national distribution, any possible links to medicines used, and clinical outcomes.
Collaboration with the BSA
We have worked in collaboration with the BSA on its generics dashboard which is available on EPACT2 (a platform with dashboards on primary care prescription data). Working in collaboration with the BSA and the NHS London Procurement Partnership (LPP) responsible respiratory prescribing group, we have produced a national respiratory dashboard which will be available in the next few months.
Expert input from pharmacy colleagues
In some of the recent materials published by NHS RightCare, we have sought expert pharmacist input on the medicines data where possible. We are continuing to seek pharmacist input to sense check medicines related metrics and measures. I would like to encourage my pharmacy colleagues to provide feedback where relevant.
Apportioning medicines usage to different indications
I have had several emails over the last few months asking me about how the spend/usage of medicines are apportioned against different budgets, where they may be used for more than one indication.
Many medicines have more than one clinical indication. Where a medicine is only indicated for one single clinical indication it is reasonable to assume that the majority of usage would be assigned to that one particular clinical area of prescribing e.g. pain. And in this case, the spend on that medicine can be assigned entirely to that one particular programme budget.
However, we realise that a large proportion of medicines are used for more than one clinical indication, and therefore usage of those medicines cannot always be assigned to one clinical area, especially where the two indications could be very different e.g. neuropathic pain and epilepsy.
In the NHS RightCare packs, where there are medicines that are used for more than one indication, we have tried to assign a very rough estimated proportion of usage against those particular clinical indications to align with the programme budgeting methodology. Please note that there is no evidence base around how these apportions have been assigned, but have been provided to account for the fact that those particular medicines have more than one clinical indication and therefore usage cannot be assigned to any one particular programme budget in its entirety. We encourage CCGs to use the approximate apportioned values as a rough estimate and to revise or adapt the figures at local level based on local intelligence.