1. Managing Medicines Use by PBC Groups in West Hertfordshire Dr Alison Davies

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

3. Why is this important Medicines are a central component of health care (Audit Commission (AC) 2001) 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) 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) 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 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%. 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 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 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 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 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 promote patient safety and public health of patients by appropriate use medicines and audits To ensure implementation of good practice in use of medicines To ensure implementation of good practice in use of medicines

5. How are these addressed Joint committees between 1 0 / 2 0 care – WHJPG & HMMC Joint committees between 1 0 / 2 0 care – WHJPG & HMMC Consider whole evidence-base and practical application in recommendations Consider whole evidence-base and practical application in recommendations Communication & education to change behaviour Communication & education to change behaviour Inclusion of drug treatment guidelines in service re-design specifications Inclusion of drug treatment guidelines in service re-design specifications Systems and processes to monitor, remind and review use of medicines 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. 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 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 Achieved EoE statin and PPI target well before other areas Patients safety issues addressed by audit and education at practice level Patients safety issues addressed by audit and education at practice level Patient engagement with Waste Campaign in 2007. Patient engagement with Waste Campaign in 2007.

7. Going forward……. Need a robust process for integrated education Need a robust process for integrated education Engagement of patients at individual level and public at other levels around decisions on medicine use Engagement of patients at individual level and public at other levels around decisions on medicine use Sound governance processes to manage: 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 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: 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 West Herts PBC Groups have been very successful in managing cost-effective prescribing Involves support of clinical pharmacists Involves support of clinical pharmacists Further areas of development necessary to ensure Further areas of development necessary to ensure – Integration of community pharmacy – Educate all professionals – same messages – Empower patients in decisions and engage with public