Darren Archer
I’m Darren Archer, I’m senior sustainability manager within the North East and Yorkshire region and part of our function is to support the wider implementation of environmentally sustainability programmes within trusts and ICBs. So it’s great that we can actually have this focused conversation, I’m really pleased to have been asked to chair this panel because it’s an important part of the greener work that we’ve been doing. In this episode, we’re going to discuss how reducing medicine wastage can save the NHS money, as well as helping minimise negative environmental impacts of over ordering and incorrect disposal.
And I think from our perspective as well, we’ve also found that actually working on this area has also led to better health outcomes for patients, which I think we can perhaps talk about. What work is taking place in our region and go to the experts in the room who I’ll introduce in a minute and see what outcomes we’ve actually been able to have at different places.
Also, we’ll talk about how we’re asking patients to check what medicines they already have before reordering and how is ordering only the medicines that you need an easy way to look after your health. Because I’m sure we’re all familiar with elderly relatives that come out of hospital with suitcases full of medicines that they’ve already got when they’re at home. So anything that we can do to help do that.
So joining me today is Megan Seymour, Medicines Optimisation Lead, Pharmacy Technician, Pathways and Population Health, South Yorkshire Integrated Care Board. Kate Edwards, Principal Pharmacy Technician, West Yorkshire Integrated Care Board. Juliet Fletcher, Head of Pharmacy and Medicines, North East and North Cumbria ICB.
and our out of region guest, which we’re always pleased to see – people being able to describe what’s working well for them. Tracy Lyons, principal pharmacist, medicine optimisation and medicine sustainability lead in NHS Dorset. So welcome to all of our panel. The opening question, obviously we’re going to start with something easy.
And it sounds simple, but I’m sure you’ll be able to describe it as not. What impact does medicine wastage have? Thanks Tracy, you can kick us off.
Tracy Lyons
Yes, I would love to. I think you can talk about this in so many different ways, can’t you? Like, there’s so many different facets to medicines waste, but when NHS Dorset first started looking at this, we started it from, I’ve got to be honest, from a cost point of view, even though, you know, we’re really focused on the environment, etc. And we just realised that if we really want to look after our patients, we really need to make every penny count. And we were effectively throwing a huge amount of money down the drain because it wasn’t being used and it was wasted there. And then you have the knock-on effects of it, you know, harms patients because they might be taking it incorrectly or you know, their young children could access it, or it’s occupying healthcare professional time so they can’t look after their patients as well. So it has a multitude of different effects. I think you just have to identify what’s important to you in your system and what conversation you’re having right now.
Darren Archer
Thanks, Tracy. I noticed, Megan, that you were nodding along to that. Do you want to come in and then I’ll come to you, Juliet?
Megan Seymour
I think I massively agree. It has a really big effect, I think, financially, and obviously there is the huge environmental impact of it then being disposed of incorrectly as well and the large volumes of it. But I think for us, the thing that affected it most on my side is the effect on patients, and like you said it being in patients’ homes and potentially other people getting hold of medication, but also giving quite an unclear picture sometimes of a patient and their condition because the practices sometimes believe that the patients are taking that medicine and we’re not aware and we could manage their condition slightly better. I think if we had a clearer picture of actually what patients were taking rather than them over-ordering out of habit or other reasons.
Darren Archer
Thanks, Megan. Juliet?
Juliet Fletcher
I would agree with both of what Tracy and Megan said. We worked fast firstly to look at it from a cost point of view. When we looked at the figures, what it looked like nationally, what cost nationally was waste and brought it down to our own area. That’s what we were tasked with. Whether you do more of a deep dive, it is the impact on patients. And as Megan was saying, if people are taking things that we don’t know about, it’s hard for GPs to give good patient care if patients are not, they’re not being treated according to what we all think they are doing and we don’t know the impact of what’s going on.
Darren Archer
Lovely, thanks. Kate from West Yorkshire.
Kate Edwards
Thanks. We came about it again similar way in terms of looking at the cost and what it would mean in terms of waste for our population in West Yorkshire. And we’d commissioned as an ICB a piece of insight work quite a few years ago now. I think it would have been 2024, but it could possibly have been 2023. The years kind of do start to blur. And in that piece of insight work, we’d asked people around, had they ever been given any information about how to dispose of their medicines properly? And granted it was a small piece of insight work, it wasn’t very many patients, I think it was about 1500 patients, but 82% of those patients had never been told how to dispose of their medicines. So we’ve also got the things around GP practice and community pharmacy and ordering medicines and patients having things at home. We’ve also got the fact that people aren’t quite sure what to do with them when they don’t need them anymore or when they don’t use them. So we kind of found that just that in itself was a massive piece of interesting information that we hadn’t really thought of –
that people just don’t know what to do with their medicines when they don’t need them anymore.
Darren Archer
Megan.
Megan Seymour
Thank you. I think we definitely found similar findings. We ran some patient groups and found that a lot of people didn’t know how to dispose of the medicines and the patient groups we looked at, I spoke to, they tended to be quite complex patients themselves or were carers. So you would think that they might have more of an understanding, but they weren’t sure. And naturally, afterwards, some of the health care professionals that we’d involved in that conversation, they weren’t aware of how to dispose of medication. So I think it really showed that gap in knowledge that really sort of needed addressing. And some patients weren’t aware of the risks as well of taking out of date medicines because they didn’t want to throw it away. but then they didn’t know what else to do with it either. So I think it really highlighted quite a safety issue.
Darren Archer
Yes, I’m sure. Tracy, did you want to come in?
Tracy Lyons
I was just going to add, you know, I think we’ve all got little pockets of knowledge – be great if we could pool all of this. We coordinated a piece of work, talking to patients at 9 different trusts around the country about how they would dispose of medication they no longer needed. And we just found consistent themes across every location, it was 13 different sites. And when patients have medication that they no longer need, we asked them about how the formulation would impact the disposal. And I think it was it was injections, solid oral dosage forms like tablets and capsules, etc tended to go back to a community pharmacy where they should be if they were no longer needed. But even then, I think for injections, only 66% of patients said they’d return it to a community pharmacy. So there’s just this huge gulf of knowledge of what to do with medications patients no longer need or want to take. And so I guess that’s another element of the waste, isn’t it? So there’s a potential harm of, you know, improper disposal to people and to the wider environment. So I think you could probably talk about the medicines waste and what it means to the system and to the patients. You know, you could have days and days of this, but I think we’re all seeing similar themes, aren’t we? So that’s why it’s so important we pick up on this topic.
Darren Archer
Perhaps just a slight diversion in what you’re saying, because the flip side, did you come across patients who ‘just in case’ – they wanted to kind of keep that little bit extra just in case the supply didn’t work and things, so did you have issues to get past that?
Tracy Lyons
The piece of work we did was specifically about how people dispose of their medication, but when we ran the Only Order What You Need campaign in Dorset, a lot of the conversation was with patients before we ran the campaign to gain insight again about why people were stockpiling or why people carried on ordering their medication if they had a couple at home. And yeah, one of the main concerns was what if there’s a shortage? Like, will I run out? One of the big breakthroughs was explaining to people that if you stockpile, it creates a shortage problem. This is the rare example where a COVID experience can be beneficial, but we explained it to people in terms of the toilet paper situation during the COVID pandemic, you know, if you’ve got loads in your cupboard, the shops run out, you know, it was that kind of thing.
Darren Archer
Yeah, I did wonder how long we’d get before COVID came up and toilet paper. Juliet.
Juliet Fletcher
Yeah. So when we did our insight work before we started the campaign, it was a very similar theme from the patients is with the huge number of shortages of medicines that we currently have, they are very fearful of running out. So although they perhaps do know that they’ve got products in their cupboard, they just want to make sure they’ve got extra and will order well in advance to make sure they’ve got one or two months where, as you said, Tracy, it’s trying to make sure that, saying to them that actually if everybody over orders, we’re leading to shortages. But it’s very hard, isn’t it, to some people who find it difficult to get out and if they’ve previously run out it’s trying to allay their fears on this one.
Darren Archer
Kate – similar for you?
Kate Edwards
Yeah, it was, and we actually had some people that were quite open about the fact that they had shared medicine as well during a couple of our focus groups, which is interesting because they didn’t want to waste it. So they’d finished taking antibiotics, for example, and knew that someone else was on them. So shared them because they also didn’t want to put them in the bin. So I do wonder if there’s an element of that people do recognise that they want to conserve NHS resources. But obviously, you know, we’d always say a medicine is prescribed for a person and you shouldn’t be sharing. But I think that comes from a place of understanding that it’s a finite resource as well. And, you know, it’s really great that we got that feedback from people and we managed to, you know, make people feel confident enough to be able to say those things. Obviously, those things contribute to antimicrobial resistance, don’t they?
Darren Archer
Mmm and I think we often kind of just assume we know what’s best for the public. So actually finding out from people how they use medicines is really important. Megan?
Megan Seymour
I think the other thing we found, we definitely found the same themes as everyone else mentioned about doing it as quite a cautious trying to order in advance thing. But we found that people thought GPs would be cross if they didn’t order, if they didn’t think they were taking them. So even if they weren’t taking them and they knew that themselves, we found that there was a bit of apprehension around the GP or the practice finding out or that things then would be removed from their repeats. So we had to really tackle that as an issue and ensure that patients felt reassured that their repeats wouldn’t be removed automatically after their first month. It was trying to manage their fear that they had created around that situation.
Darren Archer
Yes and that must be quite tricky. Juliet?
Juliet Fletcher
Yes, in the insights of the patients, they were concerned that if they didn’t order it one month, then it would be taken off them and they couldn’t order it again. So trying to do that, you know, only order what you need, but you know there is that fear that they’re not going to have access to it in two months’ time because the GP is going to look and say they didn’t need it this month, so we’ll take it off them and try to reassure them that that’s not the case and things will be done as a review. And trying to, as Megan was saying, not telling GPs they’re not taking them and trying to have those honest conversations with GPs when they’re asking for a medication review and tell them how they’re feeling about the medicines and what works. It probably goes hand in hand about why are your medicines working for you as well and having those honest conversations about it. So I think probably what we’re saying is there’s a whole complex, complex situation that leads to overordering and medicines waste.
Darren Archer
Yeah, and I guess if you’ve got someone who’s influential in their community as well, the ripple effects in families and things must be tricky to break into. Move on a little bit then to look at successes – how can we reduce the waste and what are the benefits of only ordering what we need. There’s obviously the financial environmental rewards, but obviously there’s some healthcare benefits as well.
Tracy Lyons
So I’ll jump in here.
Darren Archer
Thanks, Tracy.
Tracy Lyons
This is where it gives me a chance to talk about the nicest project I’ve ever worked on in my NHS career. So we ran a county-wide only order what you need campaign in Dorset. And it was just brilliant because we’ve got everybody involved, all of the healthcare professionals, GPs, community pharmacy, the ICB, hospitals, etc.
And picking up on all of the messages that we, you know, we’ve spoken about here, we gave patients curated insight, like easy to understand logic for conversations about how to safely say they didn’t need it. So reassure them that they wouldn’t lose access to their medication, you know, highlighted the issues about the shortages. One really important thing that we discovered was that people worried about stockpiles at home in terms of hazard, in terms of access to medication, but for their pets as well as for their small children. So we brought that into conversations, you know. Yeah, and what we realised actually was this -the medicines hoarding was an aggravator, a real source of frustration for healthcare professionals and patients. And once we got everybody on board, there was this like sense of relief that people could say no to things. And it’s the only project I’ve worked on in the NHS where patients have written in and said thank you, because they were dealing with this problem over time. And one particular lady, you know, she said, ‘oh, you know, I’ve been trying not to have these inhalers every month for the last two years and I keep getting given them and this has given me the opportunity to stop it.’ So, as a knock on of that, we had this campaign, it saves an eye-watering amount of money, which was, you know, obviously brilliant for finance and durability of services in the NHS. But it also, we calculated, we sort of said conservatively, if it’s one minute of time saved per prescription avoided, we estimated it would save the equivalent of thousands of GP appointment slots. You know, obviously, and that would be within community pharmacy and the GP, but, that’s just a lot of time that patients can use to get better. So all from reducing, you know, unwanted medicines.
Darren Archer
And it shows the benefit of doing a proper stakeholder mapping at the start so that you don’t just make assumptions about people
Tracy Lyons
Yeah, absolutely.
Darren Archer
How did it work in North East North Cumbria, Juliet?
Juliet Fletcher
So I think we had seen Tracy’s work and looked at that. We worked in the North East and North Cumbria with a creative communications agency and they do a lot of behavioural change campaigns. So we worked with them to do the insight work. So probably similar to Tracy, but they did it for us. They do sort of stakeholder insights. So spoke to patients about it, what are their thoughts, and spoke to GPs and community pharmacies as well. But what we also did, we did it hand in hand with, because at the same time we were doing that, the NHS oversupply dashboard came out. And that was useful to be able to demonstrate to GPs that while they thought they had really good processes, when you looked at that dashboard, they probably didn’t and they needed to review their own internal processes. So the campaign went hand in hand with that piece of work as well. So then I think it helped GPs, while they reviewed their processes as well – they were more streamlined and reduced their workload by doing that. And that supported the campaign and we were supporting the sort of conversations with the campaign with the patients while they were doing that piece of work as well. And the demonstrations we got from the oversupply dashboard, we had very, very significant savings over that. But I think it isn’t just the savings, is it? It’s great because finance keeps happy, and we’re using resources, NHS resources in a far better fashion, but it is all the other methods that we’ve described.
Darren Archer
Yeah, we found a similar thing in food wastage as well in hospitals that actually once you start counting things, people have made assumptions that they don’t waste much. And then when they start measuring it, they realise actually they did – the unseen wastage and things. So it’s really a helpful tool before you even get into a direction of travel. How about in West Yorkshire? Is there anything that is different or specific that you’ve come up with?
Kate Edwards
Ours was a digital campaign, so very much run on digital social media. And we found that some of our social media posts were possibly generating slightly negative comments, as they sometimes do. So we kind of changed our emphasis really away from the money saving aspect of the posts originally, towards more environmental ones, but also more action-based ones. So we have things like suggesting people check their cupboards before they order their prescription. It might sound really simple, but actually finding out that you’ve got 10 boxes of aspirin and so you probably don’t need any, we were kind of hoping that that kind of drove some change because we tried to have it quite action focused for people so that they knew what to do.
Darren Archer
Lovely, thanks. Juliet, do you want to come back in?
Juliet Fletcher
When we did the insight work, we were quite surprised that quite a lot of the patients mentioned the savings of the money. So, so that’s what we used. I think probably we had one or two comments like you, Kate, but sometimes any publicity is good publicity, gets people talking. Ours was a two-phase approach. So we did first the scene setting and the info sharing. Do you know about medicines overordering? This is the cost or this is the other impact. And then the second phase was the call to action. So asking people to only order what they need, look in the cupboards, only tick the boxes of the medicines they need and doing that reassurance. And then we went looking at the NHS dashboard, we were able to demonstrate the areas of high oversupply. So we did more sort of leaflet dropping in those focused areas, because most of the rest of it was digital, but being able to identify those higher areas, we were able to pinpoint and do leaflet drops.
Tracy Lyons
See – you had a SMART-targeted campaign, which just makes sense all over again, doesn’t it? So yeah, the resources are going to make most impact.
Juliet Fletcher
Yeah, we did, yeah.
Darren Archer
And how about in South Yorkshire, Megan?
Megan Seymour
So we wanted to obviously all patients to know the messages because there was a gap and we had looked at prescribing numbers and things to see whether there were certain age of groups that was more affected than others and actually it was quite still widespread. But we did focus some of our efforts on patients with lots of comorbidities and where they would see this information. So we did digital and what could be shared on social media and shared on the GP practice website and things. But we also partnered with a lot of extra sectors. We partnered with the dentists, the opticians, so they all shared our resources. We did it with the community hubs and smoking cessation hubs as well and they were sharing the key messages across because we thought patients who might be attending there might also obviously have other medications. And then we had that all created into a toolkit which could be shared. But we also worked with the council who already produce a lot of materials that are shared across South Yorkshire. So you get like a quarterly newsletter put through every household. So they added our message into their newsletters and they changed their website and things like that. So we weren’t creating any more paper or ways to do it – we were using systems that already existed. But I really wanted to focus on patients that sort of maybe were housebound as well. So we worked with Age UK and with carers who provide medication support in patient homes to be able to deliver their messages in their homes because they might be the only contacts that person has. And so that way they can identify people that they can see might have the problem and just pass on their messages to start having conversations. And then sort of help to make more of an agreement between the carers and community pharmacy in terms of returns and just helping them with any sort of frictions where they might struggle when just trying to support a patient.So we just wanted to try to access as many people as we could, but really sort of focused in on our high areas of traffic. So we did do a radio campaign and billboards as well, but the billboards are only seen by people who are necessarily out and in busy areas, so we really tried to find ways of accessing other patients.
Darren Archer
Lovely. Tracy?
Tracy Lyons
I just wanted to say how much I loved Megan’s approach or the South Yorkshire approach. So we ran what we called a multimodal campaign as well to try and sort of saturate the environment the patient was in. But you’ve picked up on avenues that we didn’t even think of, which is just brilliant. But because I’ve looked into this afterwards, you know there’s a process behind communication campaigns, isn’t there? And there’s this – we were introduced to this idea of a concept of three, in that patients have to see a message at least three times to really sort of take in the validity of the message and believe what they’re seeing. So the more you can expose a patient to a message, the more success that campaigns likely to have. So using all of the voluntary and the community networks is just brilliant – so something I think I might steal for my next campaign(!)
Megan Seymour
And also it has no financial implication.
Darren Archer
It’s always useful in the benefits of being able to kind of put people together so they can kind of share information – the purpose of the podcast, obviously. Kate?
Kate Edwards
Yeah, it’s just really interesting to hear that people adopted different approaches because our campaign was solely digital, partly because we had a quite a small budget in the grand scheme of things for it. And one of the things we realised around this people needing to see things three times. We ended up actually kind of bidding against ourselves because we targeted all of West Yorkshire via social media. And in the end, we had to adapt that and just target hotspots, so to speak, around GP practices using the oversupply dashboard to show where prescribing possibly was slightly higher than what we’d expected and that seemed to have really good impact. So we had to be quite quick on changing our tactics of who we targeted. And we did end up having a more of a localised target to different areas across West Yorkshire, compared to what we set out to do.
Darren Archer
And that form of action research is really quite important because it’s a new and novel approach, being able to modify because of different groups or because of different geography or because of a whole range of different items is really quite important.
One last round, while we kind of think about this question, Megan, and then Juliet.
Megan Seymour
I was just going to say the other thing we did is we provided support to the practices. So we provided reception training, it was just to give the reception staff that confidence in how to have the conversations and when to flag things just to help sort of break that system up because we were just trying to identify all the barriers along the way and that seemed to be one that people kept coming against. So, we thought, rather than asking the practices to increase their workload and have to do something else for themselves, we did it for them.
Darren Archer
And I guess the more people who can repeat the message, the more likely it is to bed in. Juliet?
Juliet Fletcher
I think one of the areas we found helpful was we use local radio and they’re very obliging if you ask for them to pay for so much and have so many slots, if they don’t get any other people paying, they’ll just keep using your campaign. So it’s just a bit of a handy hint for anybody if there is some funding available to use local radio, please use them because you get more than your money’s worth.
Darren Archer
That’s always good advice. Anything that can make your money go further. Tracy.
Tracy Lyons
Two things, if that’s okay. Just one is with the radio as well, we discovered that if you have a SMART radio campaign, you can actually target the postcodes that an advert goes to. So again, it starts with like your base finding, you know which postcodes your patients with polypharmacy are likely to live in.etc. So it’s working smarter rather than harder. You can get targeted interventions. But I guess the thing that I took out of this whole campaign, and I’m sure everybody else has found here, is it goes back to, you know, one of the principles of sustainable health care is empower your patients, yes? So this whole campaign, all of our campaigns, were about empowering patients. And when you give people the knowledge, they use fewer resources. And effectively, we were turning our patient populations into, you know, agents of sustainability because we’ve given them the knowledge. It’s just so brilliant to see this key principle replicated across different parts of England.
Darren Archer
That’s really good advice. Doing with rather than doing to is going to be something that gives it a bit of longevity. Just quickly before we move on to the next question, obviously some of the patients you’ve said were interested and responsive to the waste and waste of resource. Did any of them feel that their over-use of or over-storage of medication had an environmental impact or was it just financial?
Tracy Lyons
Different messages are going to resonate with different groups of the population, but we definitely have groups of patients who are desperately concerned about the environment because, you know, you can turn on the news these days and hear about water pollution, etc. You can read about antimicrobial resistance. And there are quite a number of patients we found who were really concerned and wanted to make sure they weren’t part of the problem. So they wanted to make sure their medication went back to the right disposal method, etc. And they went out of their way to look after their unwanted medication, not to put it in the bin, etc. So they were really grateful to have an avenue to return it to the pharmacy or the GP drop off, etc. So that, you know, they were looking after the environment.
Darren Archer
I think that’s really interesting, particularly at the minute around rivers, that kind of if your river becomes a polypharmacy, it’s kind of quite an interesting kind of aside that people would pick up on. It’s been really interesting listening to the specific work that you’ve done within the areas. I’ve got some questions really about what are the success measures, because part of what I think you need to do in describing good projects is then explain it to other people who don’t understand what you’ve done, why you’ve done it and things. So if we quickly go around and kind of think about what were the success measures and what are the things that you’re telling your director of finance, your director of nursing, your board around why and how this has been a successful campaign. Tracy, would you like to go first?
Tracy Lyons
Oh, I’d love to. It’s my favourite topic. So yeah, I’ll just talk a little bit about the campaign that we run in Dorset on Only Order What You Need, which is just one of the most positive experiences of my professional life. We had this campaign where we empowered patients. We gave them the messages to say no to medication they didn’t need.you know, picking up on what other people have said, we made sure they were confident they’d get medication in future if they step back this month, you know, we explained to them the reasons why we were doing it, whether it was for the environment or for safety concerns, etc. And it just had a phenomenal impact
So over the course of about a month, we saw 65,000 fewer repeat prescriptions being ordered. which is just incredible. And obviously that saved a phenomenal amount of money, which made the system more durable, more sustainable, but also it liberated over 1000 hours of time, if we estimate, you know, one minute per prescription item saved, which is the equivalent of about 6 1/2 thousand GP appointments. And so you can see just this knock on effects of reducing medicines waste meant that patients had better access to healthcare professionals, whether that was in the GP surgery or in the community pharmacy.
And particularly if you think about community pharmacists, they’re being asked to spend more and more time on clinical services being the heart of our community. And it’s a complete waste of healthcare professionals’ training and time if they’re dispensing unwanted medication when they could be taking somebody’s blood pressure or helping them with a new medication review, etc. So, you know, this gives us the opportunity to really look after our patients if we can free up all of this time. We freed up an enormous amount of carbon so that the environment’s better so the environment’s not generating sickness again for us to look after.
And the other thing which we couldn’t quantify, but we had multiple stories about was this improved healthcare professional relationships, both between different groups and with patients. Healthcare professionals were able to better look after their patients, they got a better service, maybe more time chatting to people and the patients actually reported they felt listened to. So they had this opportunity to get the most out of the NHS. So it’s really hard to pin that down, but I think we need to recognise it. And I think everyone will have the, you know, the same outcome. When you talk about waste, people think, it’s not glamorous, it’s not cutting edge, etc, but it just gives systems the time and headspace to do brilliant stuff. So that’s why this is such an important topic.
Darren Archer
Very much so, because it impacts upon that interaction. You’ve said the patients take more control and things, which is great. Megan, how about measures of success in South Yorkshire?
Megan Seymour
So we also found, very similar to Tracy, the cost per item, we are below the national average for the whole area. But what we were able to do is we worked with the waste management contractor for South Yorkshire and we were able to see the volume of waste returned to pharmacies as well. And that was really interesting to see to sort of complement the data we were getting for new prescribing as well. So we have seen that that is now lower, the amount that is being returned. So that reassures us that hopefully then people aren’t ordering medicines that they don’t need, that they’re then trying to dispose of. So we found that really helpful to see.
Darren Archer
Lovely. Thanks, Kate.
Kate Edwards
I think for West Yorkshire, some of the legacy from the campaign is kind of still floating around, because obviously the social media campaign is still in the ether. And we did circulate it kind of widely amongst our stakeholders across West Yorkshire, you know, voluntary organisations, charities and council. It was adapted slightly for our ICB mandated community pharmacy campaigns. So it was again, re-shared through our community pharmacy colleagues, You know, hopefully we’ll have kind of given them an opportunity to support patients to only order what they actually need and kind of bring some of that patients feeling back in control of their medicines a little bit. So for us that was a positive.
Darren Archer
Lovely, and North East and North Cumbria Juliet?
Juliet Fletcher
We were able to demonstrate some significant savings, but I like Megan’s idea of looking at the volume of returns. So I’d like to pick your brains about that afterwards, Megan, because I think that’s a really good demonstration and something to take forward.
Darren Archer
I think this is a really good way because this time last year, or June last year, we had a series of webinars where we asked people to kind of demonstrate their sustainability projects within different parts of healthcare. And what we were finding was that different ideas sparked different people off to kind of think about how it would work in their situation.
So most of the projects focus very much on environmental sustainability, but also had a knock-on effect for costs and also improvements in patient health care. And I think all of you have been able to kind of talk about the improvements for patients, not just about improvements for your director of finance, which is amazing. Are there any other comments about measures of success that people would like to just mention that you haven’t already?
No. So if we’re going to advise or kind of offer advice to other areas that aren’t already doing this, what advice would you offer to say areas that haven’t yet started? Megan?
Megan Seymour
Something that I found really helpful and in building that is the leaning on the local and the regional networks that exist. Everyone is so enthusiastic and I found everyone so passionate in the sustainability area and that is such a good resource to people. So I really leaned on that. And I think using that network to then find other projects who’ve done it and you’d be able to sort of replicate or use resources. Really looking at your local connections you’ve got as well and the relationships you’ve got and how you can use them – I think that’s something that massively benefited us.
Darren Archer
Fabulous, Tracy?
Tracy Lyons
I’m going to do a plug for the NHS Dorset website. So if anybody wants to get behind this, yeah, definitely chat to colleagues, learn what they know etc. But if you want some ready-made resources, they’re all on the NHS Dorset Medicines Waste section of the website. We’ve got a campaign section and you can download all of the resources for only order what you need for use in your local area. And we’d be absolutely delighted if people wanted to do this to sort of, you know, give your campaign lift off and save some time.
Darren Archer
Fabulous. And I know a member of my team, is a big fan of the work that you’ve done. So that’s a good plug. Happy to have that. Juliet?
Juliet Fletcher
I’d agree with everything everybody said is make sure that you use everybody, all your stakeholders. They will have to be involved in it – patients, GP practices, community pharmacy. And I would say is don’t be frightened at doing it. As Megan said, people are very enthusiastic about this. And I think people, certainly GPs, were always worried about, ‘oh, we can’t say this to patients’, but actually our patients are concerned about this. As Tracy said, they’re very concerned about the environment. They’re very actually concerned about funding the NHS. So using all those sort of key points actually gets them engaged. So don’t be frightened and go for it. And again, like Tracy says, we’ve also got the resources to reach out. I’m very happy to share them as well.
Darren Archer
Fabulous. It does sound like this is a win for everybody. Kate?
Kate Edwards
Yeah, same. I think ask people in your network what their thoughts are and reach out to other places that have done something because between, you know, kind of the four of us, there’s so many nuggets, isn’t there, for people to take forward doing their own campaign, whether that’s in a GP practice, whether that’s kind of an ICB-led one or a community pharmacy-led one, you know, reach out and ask people because a lot of people from my experience, a lot of people that are involved in medicine sustainability do it as a bit of a passion project. They really genuinely want to make things better for people and they have a passion about medicines and sustainability in the environment that they’re quite happy to talk about it for hours. You know, use that! I would advise people to use that and reach out to those people because chances are they’re more than happy to share what they’ve learned.
Darren Archer
I think this is really reassuring because we’re finding that the political overtones to net zero kind of askew some of the national conversations that happen within our national team and also within our regional work with the fact that you know both your NHS colleagues, but also the patients are quite happy to have this as a thing that they can see the benefits all around is really useful. Are there any challenges in establishing this if people were thinking about beginning it, whether it be the changes to neighbourhoods, changes to pharmacy contracts, things that might deter people from getting started. Tracy?
Tracy Lyons
I’d say at the moment, if you’re going to involve an ICB, there’s a huge amount of restructure, isn’t there? So people have got to have time to find out who’s in their team and what resource they have. I’d say barriers that we had to overcome when we started this is you do need a certain amount of investment. So even though it saved a huge amount of money, you do need to go to your authorising team and find some capacity to fund this, particularly because we found one of the elements of the campaign that had most impact for patients was a message from their GP team, which was centrally funded through the ICB. So maybe that’s something to look at. But otherwise, I would say it’s the need to coordinate, as everyone says. So you need to make sure you’ve got effective communication channels in place so you can deliver this and do it really effectively. But I think once you’ve got that, I would just reiterate what, you know, Kate was saying before is there’s huge amounts of enthusiasm for this. So if you can get organised and get the resources in place, to use across your network, all the elements are there to do this really well.
Darren Archer
That’s fabulous. And again, thank you for the comments that have been made so far, because I knew this was going to be a good conversation, but there doesn’t seem to be a downside. There seems to be lots of wins all around. Is there anything from South Yorkshire or West Yorkshire that you think might be a challenge to getting started for people who are thinking about doing this. Megan?
Megan Seymour
I think the only initial thing that maybe slowed us down – it was trying to make each sector realise the benefit they could have because under all the pressure they’re under to deliver all the different services, it just sometimes felt like another piece of work. So it was really trying to show them, even though they knew it was a worthwhile cause, it was trying to show them what impact and benefit it could have to them and how we could support it, because I think a lot of it was that they just didn’t want to be left alone to do it and for it to be led by them. So it was trying to provide that support. But I think once they felt quite confident that they would receive that and that it would benefit them, then we did find they engaged really well.
Darren Archer
Fabulous, Kate, you’re nodding along?
Kate Edwards
Yeah, it was just to kind of echo that really sometimes we needed to understand other people’s drivers and how they were perceiving what we were doing to get people on board. But that’s often the case, isn’t it? And once you make it understandable and accessible, I really think this kind of sells itself.
Darren Archer
Juliet?.
Juliet Fletcher
As Tracy said, the funding and where ICBs are at presently will be a challenge. But also what we found is some of our areas are very rural and it’s how do we get to get to patients and especially older patients in rural areas that don’t have access to digital resources. And that was about finding those people on the ground that would help us with that. But I think that’s really interesting Megan what you said about when you went to voluntary sectors. So I think that’s something for us to take back. Don’t forget the voluntary sector.
Darren Archer
No, and I think that goes back to an earlier part of the conversation about the stakeholders, so that we’re able to not only identify who needs to be involved, but also people who we might not necessarily engage with easily because they’re not – they’re not there right in front of us. The time has raced past and thank you for your comments. I’m going to go around quickly and see if there’s anything else that people would like to talk about that we’ve not covered so far.We’ll start in South Yorkshire. Megan, is there anything from your perspective?
Megan Seymour
I think it’s just as Tracy said about the change in how ICBs are. It would be interesting and maybe because going forward how it’s going to lay out in what we would be able to do with it becoming neighbourhoods. And I think what impact we could have and how we could try to do this work in a new world going forward. Because obviously all our experience is currently how it was done – it’s seeing how that looks going forward in the new structures.
Darren Archer
Yeah, I think that’s true. And it’s making sure that the good stuff floats to the top and it’s visible to the new boards and then the new people in different teams. Tracy, anything that we haven’t touched on?
Tracy Lyons
No, I think we’ve covered everything. I think we’ve said this is a fundamental that clears space in your system for the benefit of patients, healthcare professionals and the environment as well as the finance team. There’s a really enthusiastic network of people out there to help you get going and there are resources. And I think we just need to look at the future structure of the NHS and work out how we can fit it in there. I do think this is a common-sense approach to durable, sustainable health care. So yeah, I think this is a win-win for every system.
Darren Archer
Lovely. Thank you, Kate?
Kate Edwards
It’s all our responsibility, isn’t it – really? Whether we’re in a GP practice or an ICB, medicines waste and sustainability’s down to us.
Darren Archer
Thank you, Juliet?
Juliet Fletcher
I think with the new contract, there will be benefits eventually with having prescribers within the community pharmacy. So they will be able to action the changes because the issues we have at the moment is they can identify that changes need to be made and then we have to go back to the GP for the GP to action. So yes, in long term, I think that would be a really good thing. It’s probably not quite there yet.
Darren Archer
Kate.
Kate Edwards
Yeah, I think we’ve got a scheme in a couple of parts of West Yorkshire where that feedback loop is closed. So practices are supported and community pharmacies paid essentially for making that connection back to the GP practice. But it’s also about using the skill mix, isn’t it, within your GP practices and the skill mix within the community pharmacy. So it isn’t just the GP that can alter patients records that, you know, I know plenty of pharmacy technicians in PCN and practice that would be quite happy to take an emollient off a prescription or put a pause on people’s lancets if that was what they needed. So it’s making sure that we’ve got the right skill mix, isn’t it, within the different sectors to do these things. It doesn’t have to be a GP that’s doing that action. It can be somebody who has a background in medicines, but is able to make that change within protocol if needed or within a process if needed. So it isn’t just GPs essentially having to make that change. That’s the tricky thing, isn’t it? Getting that right, because there’s limited control in that area.
Darren Archer
Lovely. Thanks – I knew this was going to be a good session and it’s proved to be. And we’ll just kind of do a roundup of what I’ve heard and hopefully other listeners will have heard the same, the fact that this is a project that’s really important and there don’t seem to be any downsides. It’s spin-offs for your chief executive, your directors of finance, your directors of nursing, your directors of pharmacy, all the people who might be important in your life at work. But more importantly, this is really important to patients.
And I think some of the things that have come through about involving the patients so they can take control, I think is really heartening because often we forget about that within the NHS that the patient also has a contributing role, which is really great. There are lots of successes and as people listen through this podcast, they’ll be able to kind of hear the successes and how best to put them into place. But I think the important part is really getting started, just wherever you are within your working environments, getting started is really quite important, not only for patient health, environmental sustainability, but also the big savings around finance and other resources that are there. And the important part is just keeping this conversation going really, and its really helpful these podcasts allow this information to be able to flow out. So with that in mind, just kind of thank the panel for their contribution. So Megan Seymour from South Yorkshire Integrated Care Board, Kate Edwards from West Yorkshire ICB, Juliet Fletcher from North East, North Cumbria, and in particular, Tracy – It’s been great to hear the success that you’ve had in Dorset as well. So thanks very much for your time.
Ends