Sixteen medicine optimisation opportunities have been identified by NHS England’s Medicines Optimisation Executive Group (MOEG), with ICBs recommended to choose at least five to sit alongside local medicines optimisation priorities.
The national opportunities identified are divided into two categories. The first of these – appropriate use, access and uptake – focuses on six areas related to systematic and procedural problems. These include issues caused by polypharmacy (the concurrent use of multiple medications by one individual), such as overprescribing or inappropriate prescribing, improving uptake of the best and most cost-effective medicines, and standardising formulations for certain compounded medications.
The second category – specific clinical areas – focuses on 10 opportunities relating to recommendations for certain types of medicine. These include addressing inappropriate antidepressant prescription, reducing opioid use for certain pain and moving from intravenous antibiotics to oral varieties.
In guidance, NHS England said ICBs would have responsibility and accountability for demonstrating progress against their chosen opportunities, using metrics and other data sources. In line with recommendations from the Hewitt review of integrated care systems, it would also identify potential improvements and gather best practices to share across the system.
The NHS Confederation recently said that a strategic approach to medicines optimisation could unlock significant opportunities to deliver against integrated care systems’ four core purposes including improving productivity and value for money. Its June report – Taking stock: the experience of medicines optimisation in ICSs – said that medication errors cost NHS England around £98m and were responsible for about 1,700 deaths each year. It also reported that 54% of errors are made at the administration level, with 21% made during prescribing.
The Confederation said there were opportunities for improvement in digitising medicines, building systems to monitor how medicines are prescribed and used and their impact on outcomes, and through refining governance arrangements. While progress had been made, it said there was much more to do. Progress could be accelerated mainstreaming medicines optimisation in pathway redesign and developing pharmacy workforce plans.
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