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Medicines Management
At the last meeting
of the Patient Council, it was agreed that this meeting would focus on
medicines management and prescribing. Judith Green, Prescribing Advisor
aligned to NHS Wirral, attended the meeting and gave a presentation on
several areas relating to this. This presentation has been circulated
to members. Key points relating to each area were as follows:
Remit of Medicines
Management Team
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create
a formulary with the hospital – this is a list of all drugs recommended
for use to ensure that the hospital and GP practices use standardised
treatments
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review
new drugs on the market, taking into account available evidence, to
advise if these are appropriate to prescribe for Wirral patients.
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Manage
a reporting system that allows GPs to raise any issues regarding
hospital prescribing, which are then addressed with the hospital
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Help
GPs to comply with guidelines, such as NICE and NPSA alerts to ensure
patient safety
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Advise
GPs of generic drugs (ie drugs without a brand name) with the same
patient benefits but are more cost-effective
All this is done in
consultation with the GP practices.
Prescribing budgets
are set by the PCT, based on practice demographics (this is according to
a national formula). As well as being measured against expenditure, the
practices are also measured against the quality of their prescribing,
and WGPCC practices perform very highly in both areas. The WGPCC
practices have the challenge of managing the rising increase in drug
prices and the availability of new, expensive drugs, with managing a
prescribing budget.
A long discussion
around switching patients between drugs for cost-efficiency purposes
took place. It was clarified that, whilst the medicines management team
make recommendations on who the practice may wish to switch between
drugs, each decision is made on an individual basis taking into account
any potential risks or circumstances for each particular patient.
Audits take place on a quarterly basis to ascertain the effects of
switching drugs.
Action: it was
requested that patients are made aware of the results of this audit in
order to put minds at ease regarding the effects of switching.
Furthermore, patients should be advised the potential money to be saved
by switching drugs; Judith agreed to look into this.
It was confirmed
that there are EU regulations regarding the purchase of drugs, and on
the quality standards. This is dealt with at a wholesale level, and not
on an individual pharmacy level (eg Boots the company rather than Boots
the individual Chemist store).
Hospital Prescribing
Judith explained
that practices should receive green bags to put their medication into
when they are admitted to hospital, and ambulance crews should be asking
patients for their medication when they arrive at a patient’s house.
There have been public and staff campaigns to encourage this. There
have been issues regarding lost medication within the hospital, eg if it
remains in a locked bedside cabinet when a patient changes wards.
Pharmacy staff now have a tracking system to ensure that medicines
follow the patient, rather than re-ordering the drugs.
Unfortunately, the
information systems between primary and secondary care do not enable the
hospital to see at a glance which medications the patient is on, which
is why patients need to bring this medication with them.
On discharge,
patients are given 2 weeks’ supply of prescribed drugs unless it can be
demonstrated that the patient has ample supply at home.
Several patients
raised the point that waiting for drugs to be brought up often delays
discharge, and questioned why drugs cannot be collected from the
pharmacy instead. It was explained that there are insufficient
resources to enable this within the hospital, but that nurses can now
track the ordering of drugs within the hospital so that patients will
know how long it will take.
There is a scheme
whereby patients have a sticker or a notice within their home which
advises of the location of their medication, should they require
hospital admission.
Action: Judith to
look at promoting this scheme further to WGPCC patients.
A discussion took
place around whether or not patients should receive two weeks’
medication, or if they should be able to get this from a pharmacy of
their choice. It was explained that hospital prescriptions will not be
accepted outside the pharmacy. Currently a hospital stay includes the
cost of the drugs upon discharge, which is why the hospital are
contracted to provide these. Also, if the discharge letter is not
available until several days after the hospital stay, there is the
danger that the patient will run out of medication and the practice will
not know to issue a new prescription.
Action: Judith to
take this issue back to the next meeting with the hospital.
Medicines Wastage
At least £300m is
wasted on prescribed drugs in England per year, with an estimated £2m
wasted per year on the Wirral. However, as this is only based on
counting the amount of medication returned to pharmacies, this is likely
to be a great under-estimation as many patients do not return medicines.
The medicines management team has ran many public campaigns on reducing
medicines wastage but there has been little impact. The team has been
working with patients to develop a more hard-hitting campaign, and
feedback is requested on how to launch this campaign.
One patient
suggested that a powerful message is to show a picture of medicines
found in a patient’s house – an image was circulated of a medicine
cabinet containing £900 of wasted prescribed medication.
Dr Mantgani and Dr
Oates explained that the pharmacy ordering system (where pharmacies
order repeat prescriptions for patients, bypassing the need for the
patient to go to the GP) also contributes enormously to this issue. For
instance, the drugs are ordered whether or not the patient requires them
(for instance, the patient may not want ALL the drugs on their
prescription, or may have been admitted to hospital, yet the pharmacy
still orders the drugs one month in advance). There is no consistency
between pharmacies so it has been difficult to monitor and to manage.
Patients were asked to consider carefully what they are ordering as,
once it has been taken away from pharmacy premises, in accordance with
the law it cannot be reused and must be destroyed, therefore leading to
wastage.
Patients agreed that
this also reduces the contact between the practice and the patient,
which may have a negative impact.
Action: patients to
raise at their patient groups and ask their practice what action they
are taking to manage medicines wastage, particularly in conjunction with
pharmacy ordering.
Action: Patient
Council Executive Board to work with Judith to think of other means of
getting this message to the wider patient community, particularly those
who may not regularly visit their GP practice.
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