National Programmes of Care and Clinical Reference Groups

Medicines Optimisation Clinical Reference Group

Scope and service

The Specialised Commissioning Medicines Optimisation CRG works across all the service-specific CRGs. One of its key roles, working with experts from around the country, is to ensure that the systems and levers currently in place for the procurement, selection and use of medicines in secondary care are as effective as possible in supporting patients to take their medicines; in reducing harm from medicines while ensuring best value.

Medicines play a crucial role in maintaining health, preventing illness, managing long-term conditions and curing disease. In an era of significant economic, demographic and technological challenge, it is vital that patients get the best quality outcomes from medicines.

The NHS faces unprecedented change in terms of patients living longer with long-term, sometimes complex conditions; increasing demands on NHS funding, and the wider global economic situation.

Against this background, it is known that:

  • up to 50 per cent of patients do not take their medicines as intended;
  • between 5 and 8 per cent of all unplanned hospital admissions are due to medication issues;
  • medicines waste is a significant, and largely untackled, issue;
  • according to medication safety data, the NHS could do much better at reporting and preventing avoidable harm from medicines;
  • resistance to antimicrobials presents a very real and significant threat to modern health care.

The Specialised Commissioning Medicines Optimisation Clinical Reference Group (CRG) supports NHS England’s specialised commissioning function by providing advice in the form of a national expert forum on high cost medicines.

The CRG works across all service-specific CRGs and its main objectives are:

  • to provide a forum for commissioners, providers and procurement pharmacists to share ideas about optimising the use of medicines included in the specialised commissioning ‘high cost drugs list’;
  • to engage with clinical commissioning groups (CCGs), procurement, providers and the Commercial Medicines Unit in the development and delivery of a work plan for high cost medicines;
  • to work in collaboration with national medicines procurement groups, National Pharmaceutical Supply Group (NPSG) and Pharmaceutical Market Strategy Group (PMSG);
  • to provide a forum to debate and reach consensus on issues such as the repatriation of patients to secondary care, rebate and gain share arrangements;
  • to support the on-going implementation of home care reforms.

Chair and membership

A voluntary Chair is appointed for a three-year term. Members are drawn from the 7 NHSE/I regions in England and are voluntary appointments. Up to three patient body representatives and up to three representatives from affiliated bodies are eligible to join the CRG membership. There will also be one accountable lead commissioner from NHS England.

Charlotte Skitterall, Chair, NHS England Medicines Optimisation Clinical Reference Group | Group Chief Pharmacist for Manchester University Foundation Trust:

Charlotte Skitterall was appointed to the role of Group Chief Pharmacist for Manchester University Foundation Trust, a group of nine hospitals and community services in October 2018. Prior to that she has was Chief pharmacist and Head of Medicines Management for Trafford Health Ecomomy and more latterly Chief Pharmacist at the University Hospitals of South Manchester.

Her interest started in the optimisation of high cost drugs following the publication of NICE guidance for the use of Infliximab back in 2002.

Charlotte has held a number of roles across Greater Manchester and the North West including Chair of the Greater Manchester Medicines Management Group, Chair of the GM Formulary Group, Professional Secretary and deputy Chair for the North West Chief Pharmacist Network. She is currently Chair of the GM High Cost Drugs group and NW Quality Assurance Oversight Committee.

She has close working relationships with the University of Manchester, overseeing the pharmaceutical support to the Clinical Trials Unit and a member of the Advisory Board for the Division of Pharmacy.


Forname Surname Job title
Charlotte Skitterall Chair
Malcolm Qualie CRG commissioning lead
Vanessa Burgess CCG representative
Debbie Campbell CCG representative
Gaye Lewington CCG representative
Claire Vaughan CCG representative
Mary Weatherstone CCG representative
Simon Badcott Chief Pharmacist
Nicola Berns Chief Pharmacist
Damian Child Chief Pharmacist
Jane Coleborn Chief Pharmacist
Rob Duncombe Chief Pharmacist
Judith Gregory Chief Pharmacist
David Miller Chief Pharmacist
Susan Tomson Chief Pharmacist
barbara Sly CMU representative
Lynne Richley Hub pharmacist
Stephen Brown NHSE/I regional lead
Sue Dimmock PPV representative
Elizabeth Macartney PPV representative
Katherine White PPV representative
James Kent Regional Pharmacy Procurement Specialist, SPS
Mark Jackson Regional Quality Assurance Specialist, SPS
Helen Thorp Trust representative
Helen Davis Director NW Medicines Information Centre, SPS

Further reading