Managing Medicines Use by PBC Groups in West Hertfordshire

1. Managing Medicines UsebyPBC Groups in West Hertfordshire Dr Alison Davies

2. Presentation to Cover……… • Why is this important • What are the key aims • How are these addressed • What achievements to date • Going forward….

3. Why is this important • Medicines are a central component of health care (Audit Commission (AC) 2001) • but their use is not always optimised ……………………….. • Adverse events cost the NHS about £500m a year (AC 2001) • Only half of the people with chronic diseases take their medicines as recommended… (AC 2001) • Unused and wasted medicines cost the NHS at least £100m a year (NAO, 2007). In West Herts it is estimated to exceed £3m/year • In 2006-07, the NHS drugs bill was 14% of the overall NHS spend with primary care spend alone being 11%. • primary care prescribing spend for West Herts PBCs was also 11% of total • Medicines are chemicals – whilst they have benefits, they also can cause harm.Linking medicines management to clinical governance is imperative to manage such risks

4. What are the key aims • To work in collaboration with secondary care and other primary care prescribers • To ensure effective and cost-effective use of medicines and integrate these in care-pathways and service re-design specifications • For patients with LTC – to prevent admissions and complications with appropriate medicine use • To promote patient safety and public health of patients by appropriate use medicines and audits • To ensure implementation of good practice in use of medicines

5. How are these addressed • Joint committees between 10 / 20 care – WHJPG & HMMC • Consider whole evidence-base and practical application in recommendations • Communication & education to change behaviour • Inclusion of drug treatment guidelines in service re-design specifications • Systems and processes to monitor, remind and review use of medicines

6. Achievements to date • Good working relationship with secondary care on evidence-based guidelines and drug choices – COPD, Diabetes etc. • West Herts spend per capita is lowest in EoE and in the lowest quartile nationally • Achieved EoE statin and PPI target well before other areas • Patients safety issues addressed by audit and education at practice level • Patient engagement with Waste Campaign in 2007.

7. Going forward……. • Need a robust process for integrated education • Engagement of patients at individual level and public at other levels around decisions on medicine use • Sound governance processes to manage: • Influence of pharmaceutical industry • Commissioning and provision role • Development of a pharmacy strategy to maximise the contribution community pharmacists can make to optimise patient care • Strategic and operational clinical pharmacy input at all levels: • Service re-design and care-pathway development • Commissioning & contracting • Education and performance review • Practice and patient support

8. In Conclusion • West Herts PBC Groups have been very successful in managing cost-effective prescribing • Involves support of clinical pharmacists • Further areas of development necessary to ensure • Integration of community pharmacy • Educate all professionals – same messages • Empower patients in decisions and engage with public