A significant amount of money is spent on medicines in the NHS – around £17.4 billion per year, and they are the most common treatment used. Jas Khambh, national pharmacy adviser for RightCare at NHS England, explains how it can support the Medicines Value Programme.

The growth in medicines spend is increasing year on year, mainly due to an ageing population, more complex and innovative medicines being available and an increase in the number being used. We know that medicines help a lot of people to get better and that the development, production and supply are key to the UK’s future economic growth.  But while the benefits of medicines are clear, we’re not always so aware of the issues:

Safety:

• Around five – eight per cent of hospital admissions are medicines related, many of which are preventable.
• Bacteria are becoming resistant to antibiotics through overuse, which is a global issue.

Clinical effectiveness:

• Up to 50 per cent of patients don’t take their medicines as intended, meaning their health is affected.
• Use of multiple medicines is increasing – over one million people now take eight or more medicines a day, many are older people.

Cost:

• The NHS drugs bill is currently £17.4 billion a year – or £1 in every £7 that the NHS spends. This has increased by one-third since 2010/11.
• The cost of medicines used in hospitals has doubled in the last six years.

How can we continue to give people the medicines they need and want, make best use of the NHS’s budget, and ensure the NHS remains a world leader in the use of medicines?

The Medicines Value Programme (MVP) has been set up by NHS England to address the challenges. Its aim is to:

• Ensure patients get access to and a choice of the most effective treatments, and the outcomes that matter to them.
• Improve the quality (safety, clinical effectiveness, patient experience) of prescribing and medicines use.
• Make how we purchase and supply medicines more efficiently, while ensuring the NHS retains its position as a world-leader in medicines.

The NHS RightCare (RC) programme helps to identify variation in healthcare in populations. This helps us to pick out the unwarranted variation –the bits we cannot explain through evidence base, illness or patient preference. Once a local health economy has picked out the unwarranted variation using the RC methodology, it can work out why unwarranted variation may exist, and if it is appropriate for it to exist.

Used this way the RC methodology supports the effective delivery of medicines optimisation and the aims of the MVP. With this in mind, we will try to align certain elements of the two programmes over the next few months. There are several potential ways this alignment can take place. A few specific examples of how RC may support the medicines optimisation agenda are:

1. Instant atlases of variation – Highlighting variation on selected topics related to medicines such as medication errors.
2. Pathways on a page – RC has an established process that demonstrates what is happening in a particular pathway of care using an approach called a pathway on a page. We could utilise this approach to look at how medicines are used in more detail.
3. Transfer across care settings – Since many medicines errors occur during transfer of care, this would be a very useful link to consider, and should be picked up as part of any joint work between the Getting It Right First Time programme (part of NHS Improvement and aimed at secondary care), NHS Digital and RC.
4. Analysing Hospital Episode Statistics (HES) and Secondary Uses Services (SUS) – RC already has access to HES and SUS data. This provides RC with useful information on the care that is being provided from hospitals, and on which we base some of our data such as the focus packs and pathways on a page. Since RC is already familiar with using and interpreting this data, there may be the potential to provide analysis of variation in admissions, for example in those involving adverse drug reactions (ADRs).
   We know that five-eight per cent of hospital admissions are medicine related many preventable. This number is one in ten for older people. RC has excellent data and examples of optimal pathway solutions that may support discussions about the unwarranted variation in hospital admissions.
5. Shared decision making – there is an established arm of work within RC dedicated to shared decision making. This could support clinical and patient engagement to drive behaviour change. NICE tells us 30-50 per cent of patients don’t take medicines as intended and it is likely that a large proportion of medication safety issues occur as a direct result of this. We could look at using some of the learning and expertise from the shared decision making work within RC to help address some of these issues through patient empowerment.