Nhs Bournemouth and Poole Medicines Management Briefing

Agenda Item 4 NHS BOURNEMOUTH AND POOLE Medicines management briefing July 2011

1. BACKGROUND

1.1 Medicines are the most frequent healthcare intervention, with NHS national expenditure over £11 billion per year. The volume of items prescribed continues to grow, national growth is around 5.3%; local growth in volume for quarter 3 2010/11 was 3.74%. Expenditure on medicines in primary care (GP prescribing) in Bournemouth and Poole is around £46million and on secondary care drugs around £14million (excludes the cost of drugs captured within the Payment by Results Tariff (PbR)).

1.2 Around 60% of medicines expenditure in secondary care is on high cost drugs excluded from the PbR tariff. New technologies, the evidence base for existing technologies and increasing demand has resulted in an increase in growth on expenditure on PbR excluded drugs year on year.

1.3 The financial cost of prescribed medicines does not just stem from the actual cost of drugs provided but also stems from the way in which they are used. In 2008/09, 542,000 bed days in England and Wales were attributed to adverse events caused by medicines (cost to the NHS in excess of £235 million). In addition if patients do not take their medicines their symptoms can get much worse leading to added, avoidable extra treatment costs.

1.4 National estimates are that 50% of patients do not take their medication as intended by the prescriber and that 6% of emergency admissions are a direct result of problems with medicines.

2. MEDICINES MANAGEMENT

2.1 Medicines management is defined as ‘enabling people to make the best possible use of their medicines’. It encompasses; supporting prescribers in decision making including the review of medicines on the basis of clinical and cost effectiveness for inclusion in formularies, supporting patients in taking their medicines through medicines review and the provision of information, reducing waste and supporting improvements in public health.

2.2 The medicines management team within Bournemouth and Poole works directly with GP practices, community pharmacies, hospitals and social care staff working within care homes and domiciliary care agencies, to improve medicines management. The team supports the work of the public health team, for example with pandemic flu and public health campaigns and provides pharmaceutical advice to the commissioning teams and the individual funding request panel.

2.3 The National Institute for Health and Clinical Excellence (NICE) has published guidance for the NHS on medicines reconciliation and medicines adherence, to improve communication across health care settings and with patients on medicines use.

3. WASTE

3.1 It is estimated that £300million is wasted every year on unused or partially used medicines (includes an estimated £110million returned to community pharmacies, £90million retained in patient’s homes and £50million disposed of unused by care homes).

3.2 In addition to the potential health risks to the patient as a result of not taking their medicines, waste medicines/unused medicines represent a safety risk to other individuals, in particular children, if stockpiled at home

3.3 In Bournemouth and Poole the medicines management team is working collaboratively with the pharmaceutical industry, (waste medicines collaborative group) to identify ways to minimise waste. A number of initiatives are being explored via this group including a public campaign encouraging patients to speak to their GP or community pharmacist if they are not taking their medicines and specific work to improve the way in which patients with asthma and COPD use their inhalers.

3.4 The NHS has to pay to have the waste medicines returned to community pharmacies collected and disposed of safely by a registered contractor.

3.5 Waste medicines cannot be re-used under current guidance. This is a safety issue as it is impossible to guarantee that medicines returned from a patient’s home have, been stored appropriately, not been tampered with, are not counterfeit and are still viable. Checking returned medicines to ascertain whether they are fit for purpose would require trained staff and be an added cost. Shipping to other countries can actually cause more harm than good, as many returned medicines in the UK would not be of use and the receiving country then has to pay for the cost of disposal.

3.6 All healthcare professionals have a role to play in helping to improve the way in which medicines are used. The community pharmacy based medicines use review service and the new medicines service have both been designed to improve medicines management.

3.7 Public engagement and responsibility is key. There are key messages which the public need to hear. These include: don’t order what you don’t need; if you are not taking any of your medicines let your GP know; attend for a medicine review and if you are having problems with any of your medicines, do not know why you are taking it or have concerns about it, ask your GP or community pharmacist.

4. HOW CAN YOU HELP

4.1 The need to educate the public is an ongoing challenge for the NHS. We are hoping that partners will be able to consider supporting the PCT waste campaign. Additionally work with the boroughs, local businesses and the PCT waste medicines collaborative group can link with work being done around reducing carbon footprint and ‘saving the environment’ including work with schools. It would be helpful to include messages about medicines management in local authority communications to the public and resident’s homes.

Lynne Richley Chief Pharmacist July 2011