Medicine Optimisation background

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

To date, pharmacists, working with health care professionals have delivered much to be proud about around evidence-based medicine, cost effective drug choices, and services in the community and recently around the QIPP agenda.

An informed choice of medicine used appropriately within an agreed pathway can have a positive and life changing benefit for patients and represents good value for the NHS.

We now find ourselves facing unprecedented change in terms of the patient demographic, NHS in frastructure, NHS funding and the wider financial situation.

Against this background, we know that that there are areas where current use of medicines could be improved. For example:

  • up to 50% of medicines are not taken as intended by the prescriber.
  • between 5 to 8% of all unplanned hospital admissions are due to medication issues (this figure rises to 17% in the over 65s): Polypharmacy and medicines optimisation, Making it safe and sound
  • medicines waste is a significant issue (reported as £300 million in primary care alone, about half of which is avoidable) not to mention the estimated opportunity cost of the health gains foregone because of incorrect or inadequate medicines taking in just five therapeutic contexts that is in excess of £500 million per annum
  • medication safety data indicates that we could do much better at reporting and preventing avoidable harm from medicine.
  • resistance to antimicrobial treatments presents a very real and significant threat to modern healthcare.
  • multi-morbidity and polypharmacy increase clinical workload, so doctors, nurses and pharmacists need to work coherently as a team with a balanced clinical skill.

In May 2013, the Royal Pharmaceutical Society, working with NHS England, patient groups, other Royal Colleges and the Association of British Pharmaceutical Industry published “Medicines Optimisation: Helping patients to make the most of medicines. Good practice guidance for healthcare professionals in England”.

This work highlighted that “Medicines optimisation is about ensuring that the right patients get the right choice of medicine, at the right time. By focusing on patients and their experiences, the goal is to help patients to: improve their outcomes; take their medicines correctly; avoid taking unnecessary medicines; reduce wastage of medicines; and improve medicines safety. Ultimately medicines optimisation can help encourage patients to take ownership of their treatment.” (See www.rpharms.com/medicines-safety/medicines-optimisation.asp).

NHS England via the National Medical Director, Chief Nursing Officer and Chief Pharmaceutical Officer publicly
committed to the medicines optimisation agenda (www.rpharms.com/promoting-pharmacy-pdfs/helping-patients-make-the-most-of-their-medicines.pdf).

It is now a priority for NHS England to implement these agreed principles within the NHS through its work on
Medicines Optimisation.

Medicines Optimisation offers the opportunity to make a step change in how we improve the issues highlighted above.

NHS England recognises that we will need to engage with patients and the public in a way that few of us have to date. We will need to work more closely with patients to better understand their issues around medicines use and to co-develop solutions that be tter support them with their medicines-taking.

We will be challenged to work much more collaboratively across health and social care boundaries to ensure that there is adequate support right across the medicines pathway to secure the desired outcomes for the patients as well as delivering value for money for the NHS.

NHS England’s patient/carer engagement work has started the process of better understanding medicines and medicine-taking from patient/ carer perspectives. It is the first step on the journey to deliver a programme to optimise the use of medicines, made even more important in that we have done it with patients and the public.

As this is the beginning of this work, we welcome any feedback. Your comments and suggestions for future iterations can be sent to england.modashboard@nhs.net.

The evaluation of the contribution of this dashboard, combined with our understanding of medicines optimisation from the patients’ perspective gained via our patient engagement work will inform the direction and development of the NHS England Medicines Optimisation work.