Interesting that this document was born from the issue of medicines waste – estimated at £300 million in 2009 – with about half being ‘economically recoverable’ which I assume means preventable.
The report comes up with a range of solutions, but what should we actually do?
Well some of this is actually clear, but not so clearly expresses in the document.
My starting point is to look at the interaction between repeat prescribing and medication review. A better policy, targeted training of practice staff and a drive towards better medication review within the practice – a situation recently described by the CQC – pretty disgraceful when a non-face to face review was the norm in many practices. Link this with MUR in community pharmacy.
Capture issues when medicines are changed across the interface. Medicines reconciliation policies in hospital and primary care linked to better communication and NMS in community pharmacy.
You can support both of these with public information campaigns. I am not convinced that giving prices is the way to go. The value is in the outcome, not the price that we pay.
I am less sure about repeat dispensing – it may be more convenient, but there are important issues to solve before it reduces waste. And throwing money at ‘not dispensed’ program’s sound like good money after bad.
Absolutely agree with directed MURs targeting specific groups of patients where better outcomes can be achieved.
Patient’s Own Drugs in hospital has always been a quality issue for me. It is so inappropriate to confiscate patient’s medicines and take over all control until discharge. Safety and patient empowerment are essential and the use of PODs support medicines reconciliation, patient education and assessment of medicine taking. Watching a patient take their own medicines often opens up a whole can of worms. Poor sight, poor dexterity, poor understanding and poor memory all become obvious and supportable. Waste may be a welcome secondary advantage.
Agree with multi-disciplinary approach to care homes – already proves that it can save admissions big time and some money from the prescribing budget.
Communication and engaging people in decisions about medicines is also interesting. This section is particularly naive and simplistic in many ways. Joint decision making is just one – and usually the first stage of a medicine experience that leads to patient control. Decisions are made all through the stages of patient medication experience and we need to share these also. It is fantastic to say that the patient needs to be part of the decision that the NHS leads, but the NHS needs to be part of the decisions that the patient usually makes on their own. This needs to be better thought through and a wider range of interventions suggested.
And the concept of self-care and self-management plans. The key word is ‘self’. I have often thought that this was a joint role between charities, patient advocacy groups and the NHS. A clear role for community pharmacy as the signpost and oversight of such programs.
And at the end a valiant attempt to include medicines optimisation. Just for your clarity all of the above leads to medicines optimisation – not just the ability to change behaviours. And motivational interviewing is just one useful technique.
As to the examples of good practice. Some to be very proud of – definitely good money spent and some plastering over faults perhaps good money after bad.
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