An interview in the Christmas future (20th december 2013)
Tell me Alison how long have you been Head of Medicines Optimisation at the PCT?
Nearly 9 months and it has been both challenging and exciting.
What was the challenging parts of the job?
Well firstly getting my head around the changed agenda. The easiest way of explaining this is by saying that my salary is top-sliced from the commissioning budget. I know that everything is together in the allocation, but it helps to understand that the outcomes are measured in terms of referrals, admissions and episodes of care.
So you have no direct role in the management of the prescribing budget?
Of course I do, everyone does, it is a single allocation. But a lot of the direction comes from the medicines management QIPP lead at the CSU and is delivered through contracts placed by the practices.
So what are you focussed on?
Well I have two large projects that I am working on at the moment. Supporting medicines reconciliation and driving medication review.
Isn’t reconciliation something that the hospital does?
They have been active in the game for some time and we can support that through our contracts, but the bigger issue is reconciliation in primary care and linking this with the New Medicine Services in community pharmacy. When patients pass across interfaces we open ourselves up to considerable risk and we must do better. You only have to read the CQC report to understand how bad we are at it.
And medication review – is this something for community pharmacy?
They are part of the solution, but we have to put our camp in order first. In some of our practices 100% of medication reviews are not done face to face. I know – you can’t believe it, so we are making this better through better organisation of general practice, targeting care homes and the elderly and including it as part of the practice based contracts. I am working on MUR projects with community pharmacy, but I have tried to give this a different focus.
What do you mean a different focus – aren’t the community pharmacists upset about this?
No, not at all. We are driving groups of patients through MUR and directed MUR in a big way. The underlying principle here is that we are trying to promote self care and stop these patients from getting stuck in the system. Yes we do the usual things around asthma, COPD, diabetes and CVD, but this is discretely different.
What do you mean?
Well we have two program’s running, IBS and GORD. There are lots of patients with both of these conditions and they can get stuck in the merry go round system. So we have improved community pharmacy, introduced PGDs and are working with two charities to deliver this work. So far we have reduced referrals to hospital, reduced endoscopes and other investigations and the patient satisfaction has increased hugely – oh and we have reduced the use of long term PPIs.
This must have taken a huge effort in the education front. Yes but I have focussed on positive education and I have some support through a small contract with the MMP for that. One feedback from the GPs has been ‘stop telling me what not to do – tell me what I can do’. I have taken that comment to heart and we have worked with the pharmaceutical industry to drive our educational effort.
Thank you for your comments, we must take a break now, but I want to come back to the practice contracts for support.