LPP strapline

Medicines optimisation: a moral and professional duty

In a presentation on March 4th 2016, Sir Bruce Keogh urged us all to “accept the moral and professional duty you have to address the suboptimal use of medicines, unacceptable level of medication error, inappropriate polypharmacy, preventable medication-related admissions to hospitals, antimicrobial resistance, poor adherence, huge and rising cost of medicines”.

Medicines optimisation: a moral and professional duty

The Medicines Optimisation and Pharmacy Procurement workstream supports medicines optimisation across the whole London health economy by agreeing best value prices for medicines and related products used by providers, and by supporting the work of local pharmacy teams in provider trusts, CCGs and CSUs.


Medicines prevent, treat or manage many illnesses or conditions and are the most common intervention in healthcare. Getting the most from medicines for both patients and the NHS is becoming increasingly important.

More people are being prescribed more medicines, in many cases for lifelong treatment, but it has been estimated that between 30 per cent and 50 per cent of medicines prescribed for long term conditions are not taken as intended (World Health Organization 2003).


Medicines optimisation is defined as ‘a person-centred approach to safe and effective medicines use, to ensure people obtain the best possible outcomes from their medicines’. Medicines optimisation is a key component of Right Care.

The NHS Right Care programme was developed to build on the foundations of the Quality, Improvement, Prevention and Productivity (QIPP) programme initiated by the Department of Health in 2009. The primary objective of Right Care is to maximise value:


• the value that the patient derivesfrom their own care and treatment
• the value that the whole populationderives from the investment in their healthcare.


In 2014/15, medicines cost the NHS £2.6 billion in London alone (HSCIC data), split between acute and mental health trusts (£1.5 billion) and Clinical Commissioning Groups (1.1 billion). Compared to 2013/14, hospital expenditure rose by over 15 per cent, due mainly to the continuing introduction of innovative new high cost medicines. GP prescribing costs rose by approx. 2.5 per cent over the same period.

We have two distinct but closely
related workstreams in primary care and in acute and mental health care.
We work closely with a wide range of stakeholders to support NHS commissioners and providers in London, and their pharmacy teams by:


• helping them to achieve best value- for-money on a range of medicines, pharmacy- and medicines-relatedproducts;
• providing pan-London pricing so allhospitals pay the same price or similarprices for the same products;
• ensuring compliance with EUprocurement regulations;
• helping them to keep up-to-date onnew medicines, medicines coming offpatent and changes to the market;
• working with them to “develop onceand share” best practice and guidelines for pharmacy services and for
the choice and use of medicines;
• supporting local management ofoutsourced services for the supply ofmedicines to hospital outpatients andpatients at home; and
• providing monthly benchmarking,savings and cost avoidance data.

In 2016/17, a key focus will be to
support development and local implementation of the principles of the
Five Year Forward View and Lord Carter’s recommended Hospital Pharmacy Transformation Programme.

 Chart

22-04-16    Pharmacy

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