LPP strapline

Medicines Optimisation and Pharmacy Procurement Primary & Secondary Care Event 2016

The NHS London Procurement Partnership Medicines Optimisation & Pharmacy Procurement team held its 2016 conference on 11th July. The event was aimed at GP commissioning leads, primary care prescribing advisors, QIPP leads from primary and secondary care, senior pharmacists and clinicians from primary and secondary care, community pharmacists, and anyone from the local area who may have a special interest in the topics to be covered.

Peter Rowe (Deputy Chairman, East Lancashire NHS Trust) chaired the event and commenced the day with an overview of the current difficulties faced by the NHS and the additional potential challenges that may follow the UK’s vote to leave the EU. He highlighted a recently published report by the King’s Fund on the NHS deficit and emphasised the importance of pharmacy’s role in ensuring that Quality, Access and Affordability is achieved in the use of medicines across the NHS.

Jackie Eastwood (Outsourced Medicines Supply Services Coordinator, LPP) gave a very interesting talk on her current secondment with the LPP. Jackie is focusing on outsourced medicines, particularly homecare, and she explained the local and regional initiatives she is involved in to ensure Trusts and commissioners have the most appropriate information, frameworks and support to ensure quality prescribing and to reduce wastage.

Phil Aubrey (Medicines Optimisation & Pharmacy Procurement Secondary Care Lead, LPP) gave an insight into the current variation in the adoption of biosimilars across London and offered some strategies for success. The room was given food for thought when Phil pointed out that potential London-wide savings for a 90% etanercept/infliximab switch could be £20m+.

Jeanetta Nelson (Senior Category Manager, Surgical & Supply Chain, LPP) gave an overview of the challenges faced by the LPP, currently undertaking a nutrition supply services tender. Progress has been made with a framework agreement for FP10 Prescription Management Arrangements but further work is needed before a contract can be awarded.

Dr Bruce Warner (Deputy Chief Pharmaceutical Officer) gave an inspiring talk on Medicines Optimisation and how to define optimal variation. He discussed the principles of RightCare and what needs to be considered to maximise value for both the individual and the population. Ultimately he reminded us that medicine is an art and not a science and gave some great examples of medicines optimisation in action.

The principles and aims of Medicines Optimisation align with the Five Year Forward View, which is very much in the implementation phase. Bruce also highlighted NHS England’s recent publication on General Practice ‘Forward View’ and the need for a sustainable clinical pharmacy workforce.

Ultimately, delegates were informed that medicines optimisation will be mainstreamed through the Right Care approach and via implementation of Lord Carter’s report.

Ann Jacklin (Professional Lead, Hospital Pharmacy Transformation Programme, DH Productivity & Efficiency Division/NHS Improvement Operational Productivity Division) gave an invigorating summary of the Hospital Pharmacy Transformation Programme (HPTP), which was formed as a result of the Carter Report. For every £1 spent on hospital pharmacy, £10 is spent on medicines and the report emphasises the need to review local infrastructure services, in a bid to ensure that 80% of trusts’ pharmacist resource can be utilised on direct medicines optimisation activities, medicines governance and safety remits.

One recommendation in the Carter Report is that the HPTP should include a review of Outpatient Pharmacy Dispensing (OPD) where not already outsourced. Currently 45% of Trusts have outsourced their OPD. Marc Osborne (Project Manager, Medicines Optimisation and Pharmacy Procurement, LPP) gave an overview of the work currently underway at the LPP to create a framework agreement and toolkit that, subject to LPP approval, member trusts and NHS organisations across the UK can use as a simplified, standardised and fast-track procurement solution and review tool.

Sotiris Antoniou (Consultant Pharmacist, Cardiovascular Medicine, Barts Health NHS Trust) reminded us that CVD is still the most common cause of premature mortality and accounts for >43,000 deaths per annum in the UK. He gave a very interesting talk on current cardiovascular workstreams, including the Pan-London AF Improvement Programme, which has produced toolkits to help address variation in observed prevalence and anticoagulation rates with dedicated ‘Detect’, ‘Protect (& Correct)’ and ‘Perfect’ sections. The need for this work is clear, with an estimated 67,000 people being undiagnosed and 20% of all strokes being attributed to known AF (but most of these patients are not anticoagulated).

He also discussed lipid modification and advances in this area, alongside some suggestions as to why our implementation of medicines optimisation and new evidence is relatively slow. Overall, the integration of pharmacy across sectors and new models of care may help drive improved medicines optimisation in the future.

Dr Azhar Saleem (GP and Respiratory Lead, Lambeth) expanded on the work undertaken by the LPP Respiratory Group to date, including the dashboard, audit tool and best practice guidance. He also gave an exciting insight into the RightBreathe interactive tool, which is currently under development and is a product of collaboration between LPP and the UK Medicines Information Team.

Tim Root (Specialist Pharmacist, NHS Specialist Pharmacy Service and Strategic Pharmaceutical Lead, LPP) informed attendees that the current Primary Care workplan was on the LPP website. Recommendations and suggestions for these are welcome, as well as any interested, new members. Future primary care workstreams will be
communicated in short project proposal documents to ensure all members are aware of the current Medicines Optimisation workstreams.

Tim also introduced the Best Practice Case Studies that were submitted from across London for the conference. Attendees were given summaries of these in their packs and congratulations were given to the winners and runner-ups (along with some well deserved John Lewis vouchers) Diedre Evans from South West London and St George’s Mental Health Trust came first with her case study on the innovative app that they have developed to help with the safe prescribing, administering and monitoring of lithium. In second place was Tara Patel from NHS Southwark Clinical Commissioning Group with her case study on implementing good practice in antibiotic prescribing. In third place was Patricia McCormick from Whittington Health with her case study on the development of a permanent post for a domicillary care pharmacist.

Tim commented on the quality of all the case studies submitted and thanked all candidates for their submissions. All of the case studies submitted are available on the LPP website.

Carl Marsh (Delivery Partner, NHS Right Care) gave a fascinating overview of the RightCare strategy, success stories and the plan for the year ahead. The need to reduce variation in outcomes between demographically similar CCGs across the country is well recognised and the packs that RightCare offer can assist CCGs to address this in their localities.

Rishi Rampersad (Business Intelligence Manager, LPP) gave an update on the primary and secondary care dashboards and the exciting developments coming this year. KPIs will now be finalised in Q2 – rather than Q3 – to allow for initial scoping for the next financial year and further KPIs will be added as a product of more clinical task and finish groups. An additional primary care dashboard will show practice level data and the secondary care dashboard will link primary and secondary care usage to allow more pragmatic reviews of integrated care and the patient pathway.

All slides from the event can be downloaded by members - view the Supporting Information panel on the right.

If you have any questions or comments, please contact Jas Khambh.