I mentioned this earlier and thought it warranted a whole blog. If only the Chief Pharmacist had said this we might all understand a little more.
The currency for medicines optimisation is commissioning GBP – or to put more simply referrals, un-planned admissions and episodes of care. I would dearly like to factor in UK PLC (although I hate that term with a passion) but it does bring in employment, social care and the economic growth, but that is too far.
Pharmacists commissioned/employed to optimise medicines should believe that they are top-sliced from the commissioning budget and this should be their driver. They should think how the selection, use and experience with medicines can be improved to deliver better outcomes for patients, resulting in fewer referrals, fewer A&E attendances and shorter or less costly episodes of care.
So what might be important within this new currency. Obviously I am interested in reconciliation in primary care and secondary care linked to the New Medicines Service through community pharmacy. I am interested in safety. I am interested in the quality of medication review in primary care and nursing homes and linked to MUR. I am interested in the patient experience of medicines linked to compliance and wastage. I am interested in commissioning disease management schemes in primary care linking self-care to charities to community pharmacy. I am interested in patient outcomes and how they can be improved by the better use of medicines. I am going to change pathways through education and the better use of medicines in primary care. I will help GPs get the right information and help so they can improve outcomes for their patients.
I am going to be positive and tell GPs and hospital Consultants what they can do and not what they can’t. When I review a medicine at a formulary, i will ask ‘ what can this medicine do for us’ rather than what does it cost. When I see a medicines approved by NICE, I will ask – how can we get this medicine offered to all appropriate patients quickly. I will drop into the shoes of a patient and ask – how do they feel about this. I will listen to then and try to understand their views. will tear up those silly health economic examples – you know if drug A cost £10 and was successful in 60% and drug B cost £5 and was successful in 40 % which one would I choose – and do what is best for the patient.
And could I live without a chart showing cost comparisons – absolutely. And when I see a Boston Matrix of prescribing cost vs clinical outcome, I will focus on the two boxes with poor outcomes and ignore the cost.
Can I hit the ground running to this agenda – you bet your life I can. And can I achieve? Well if I can save £8 for every £1 invested in the old currency why can’t I do it in the new.
Oh and I would probably commission someone to give advice in the cost effective use of medicines to GPs as managing the budget is their job now.