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Breaking down the barriers

The current Chief Pharmaceutical Officer’s Clinical Fellow at NHS England shares the thinking behind a new programme to devise and test an integrated model for NHS pharmacy and medicines use in an STP/ICS:

We often refer to pharmacy by sector – community, hospital, general practice, mental health, the list goes on – but our shared purpose is patients and their medicines.

NHS pharmacy services often feel fragmented and disconnected from each other and from other parts of the system. This issue is not unique to pharmacy, it is a feature of the health system.

In 2015 NHS England established Sustainability and Transformation Partnerships (STPs) to run services in a more coordinated way, to agree system-wide priorities, and to plan collectively how to improve the health of the local population. All STPs and Integrated Care Systems (ICS) now have in place plans to address national and local priorities.

Medicines represent the second largest spend in the NHS – £17.4 billion a year – with £1 in every £7 currently spent on medicines.

We know that medicines are the most common intervention given to patients. We also know that quality, safety and increasing costs continue to be challenges across the country:

  • Around 5-8% of hospital admissions are medicines related, many preventable.
  • Up to 50% of patients don’t take their medicines as intended, meaning their health is affected.
  • Use of multiple medicines is increasing – over 1 million people now take 8 or more medicines a day.

Research published in February 2018 estimated 237 million medication errors occur in the NHS in England every year and 28% of these cause moderate or serious harm.

For these reasons, STPs and ICSs would benefit from considering medicines optimisation and pharmacy activities in every aspect of their work rather than as a standalone item or as ‘medicines management’.

It is much harder to address medicines optimisation and pharmacy as a cross-cutting theme, acknowledging that they feature in all care settings and every specialty, and taking part in the negotiations that this approach inevitably entails, but this is what we must do.  Decisions for treatment should consider the best evidence, applied to the individual patient, and there needs to be less attention on which pot of money pays.  We must work to overcome the barriers that prevent this from happening.

To do this well, we will need strategic coordination in every STP/ICS, the ‘bird’s eye view’, which encompasses local knowledge of the population, processes and relationships and, critically, a willingness to work beyond the natural walls of individual organisations.

I’m reminded of a line by Ken Jarrold in his recent book Other People’s Shoes: “Leadership is showing the way and management is the responsibility for the use of resources”. What is crucial is that leaders and managers, who are accountable, work together on a system approach to improving patient care and medicines use.

Medicines optimisation is not only a matter for pharmacists but for STP/ICS leaders too and, to achieve this, senior NHS pharmacists, from across NHS settings, will need to set the direction for the local system to ensure there is collaboration among and support for healthcare professionals to deliver. Their expertise will be vitally important in supporting STP and ICS boards and programme work streams on the use of the pharmacy workforce and medicines optimisation to deliver best outcomes for patients when developing and implementing plans.

With precision medicine underpinned by genomics becoming more of a reality, alongside new digital tools that help individual patients get the best from their medicines, this pharmaceutical expertise and leadership will be particularly important.

NHS England and NHS Improvement are launching a programme, supported by the Pharmacy Integration Fund, to test how we can integrate NHS pharmacy and medicines optimisation/safety into STPs and ICSs.  We believe there are some fundamental principles such as establishing a pharmacy and medicines leadership function and determining governance and accountability arrangements.

We will shortly be publishing a programme briefing on our web page and will be working with seven pilot areas to test different models:

  • Black Country STP (Midlands)
  • Cumbria and North East STP (North East)
  • Dorset ICS (South West)
  • Hertfordshire & West Essex STP (Central & East)
  • Lancashire & South Cumbria ICS (North West)
  • South East London STP (London)
  • Surrey Heartlands ICS (South East).

To hear more, we invite you to join our session at the Health and Innovation Expo 2018 being staged at Manchester Central on 5 September 2018 at 16.45-17.45 in Theatre 2: ‘Developing system leadership in medicines optimisation’. Register for Expo 2018.


Danielle Stacey

Danielle Stacey is the current Chief Pharmaceutical Officer’s Clinical Fellow at NHS England where she has led on the Integrating NHS Pharmacy and Medicines Optimisation into STPs/ICSs project.

Prior to this Danielle worked as a hospital pharmacist in the West Midlands and she is an independent prescriber specialising in infections.

She has recently been appointed Deputy Chief Pharmacist for Medicines Optimisation at Dudley Group NHS Foundation Trust.