News | Prospect Health

Medicines optimisation is a term with which many readers will be familiar. For the past couple of years it has been a well publicised concept used to describe how pharmacists, and other professionals, can improve patient outcomes by helping patients get the most out of their medicines.

Although medicines optimisation is not just an agenda for pharmacy, the profession is ideally placed to lead it and last month the Royal Pharmaceutical Society published guiding principles on medicines optimisation for healthcare professionals (see Box).

Revolutionising patient care

“For once, the pharmacy profession is ahead of the game,” said Keith Ridge, chief pharmaceutical officer for England, at last month’s Guild of Healthcare Pharmacists and United Kingdom Clinical Pharmacy Association annual joint conference (Harrogate, 17–19 May). He was referring to the four RPS medicines optimisation principles, describing them as “simple but robust” with the potential to “revolutionise” medicines use in the NHS. He encouraged pharmacists to adopt the RPS principles and work alongside other professions to ensure patients get the most from the medicines they are prescribed.

“There is an overwhelming desire for quality in healthcare . . . which puts patients’ needs and experience right at its heart,” remarked Dr Ridge. He later added: “With a new health and social care system built on quality, and one which is patient-focused, clinically led and outcome-driven, medicines optimisation has appeared just at the right time.”

So, how is the recently reformed NHS in England now approaching the medicines optimisation agenda, and what support is there to help organisations ensure patients do get real benefits from their medicines and the care they receive?

In the new NHS England commissioning system a dedicated medicines optimisation clinical reference group, led by deputy chief pharmaceutical officer for England Clare Howard, will provide medicines optimisation skills and expertise to specialised medicines commissioning.

The NHS Trust Development Authority is another new NHS organisation that became fully operational in April 2013. It has been charged with overseeing the process of ensuring all NHS trusts reach foundation trust (FT) status — a target set by the Health and Social Care Act 2012 — and has made medicines optimisation one of its key priorities.

Assuring quality

There are around 100 NHS trusts across England — representing a variety of healthcare services including community, mental health and ambulance services, as well as acute care — that are currently pursuing FT status. The NHS TDA will provide support and oversight to these organisations at every stage in the process of becoming an FT, from strategic planning and systems development through to approval for assessment by Monitor, the regulator responsible for granting FT licences.

“The scale of the challenge is quite significant,” said Richard Seal, chief pharmacist at the NHS TDA, speaking at a later session. “We aspire to have sustainable, high-quality services in every part of the NHS.”

Mr Seal likened discharging patients from hospital without considering what happens with their medicines to pushing a patient out the door of an aeroplane without a parachute.

He explained that, in contrast to FT approval processes in the past, quality is sitting alongside finance in the NHS TDA as something that is “extraordinarily important” to obtaining FT status, and this includes quality in the delivery of medicines optimisation and pharmaceutical services.

Embedding the concepts

Although Mr Seal acknowledges that many NHS trusts already have strong policies and approaches to medicines optimisation, he believes the concepts are not yet embedded in their everyday business — which is something he will be encouraging in his work as clinical lead for medicines optimisation at the NHS TDA.

“Medicines are still the most common therapeutic intervention but, from my perspective, we do not support patients enough to take the medicines they are intended to take,” commented Mr Seal.

With the support of other healthcare bodies, the NHS TDA is in the process of developing a medicines optimisation and pharmaceutical services framework. Expected to be published in the coming months, the framework will be consistent with the RPS principles for medicines optimisation and be used specifically by NHS trusts seeking FT status.

Mr Seal explained that, by using the framework, NHS trusts will be able to establish a baseline of current performance to allow benchmarking of success. It will help identify areas of good practice as well as areas for development, and will provide the NHS TDA with assurance that, when the NHS trusts they have been supporting go forward for assessment by Monitor, they will have robust and effective medicines optimisation systems in place.

Unsuccessful "no cheaper stock obtainable" (NCSO) claims are mostly due to administrative errors made by contractors, a new Pharmaceutical Services Negotiating Committee survey has discovered. A further 27 per cent are due to errors made by the NHS Business Services Authority (see Panel).

The PSNC said that the current NCSO system urgently needs to be reviewed, adding that it is currently in talks with the Department of Health on the matter.

PSNC head of pricing Harpreet Chana told PJ Online that the PSNC hopes its study and analysis will help contractors to review their endorsement processes and to minimise disallowed claims. "The study also identifies other issues the PSNC is working to resolve with the Department of Health and the NHSBSA. These are the identified errors in claims processing, and the problem with enabling a simple way of making NCSO claims for electronic prescription service prescriptions. We hope to resolve these soon," he said.

Only 40 per cent of eligible items claimed for

The survey examined the impact of the NCSO arrangements using the PSNC’s new electronic auditing system, PRISM. Prescriptions for 14 different products that were granted NCSO concessions and submitted between November 2011 and November 2012 were analysed. In total, the survey encompassed 3,233 items, all of which were eligible for the concessions, from 333 different pharmacies. It found that only 1,284 NCSO claims were made, 39.7 per cent of the claims that could have been submitted.

Of the claims that were submitted, 75.9 per cent were successful, up from 16.3 per cent in a similar survey conducted in 2011. Of the successful claims, 66.5 per cent were paid as endorsed, 16.9 per cent were underpaid and 16.5 per cent were overpaid.

The PSNC suggested that contractors may not be claiming for NCSO items because they have purchased products in short supply at or below the Drug Tariff price or because the prescription was filed away before the NCSO concession was granted. It pointed out that the electronic prescription service is compounding the problem because the electronic claim message cannot be recalled once submitted.

"At present we would advise contractors dispensing electronic prescriptions to either delay submission of the electronic claim message until after the NCSO concessions are announced or make a claim in advance of an announcement being made," said Mrs Chana, who also advised visiting the PSNC website for information on NCSO lines and reading the top tips on endorsement and submission in the May Community Pharmacy News. 　

The survey was prompted by the rise in the number of supply issues affecting generic products and the subsequent increase in the number of times pharmacies are claiming for NCSO concessions. In addition, the PSNC said there has been a substantial increase in shortages since November 2012.

See also: Reports suggest wholesalers are deliberately inflating prices