Agenda item 7 Date 25/4/2013

Transcription

1 MEDICINES OPTIMISATION STRATEGY to 25 APRIL 2013 BMIP Decision Discussion Information Follow up from last meeting Report author: Heather Gray Report signed off by: John Constable Purpose of the paper: To present the Medicines Optimisation Strategy for East and North Herts CCG Recommendations to the Board: To approve the East and North Herts CCG Medicines Optimisation Strategy Summary Medicines Optimisation Strategy Medicines are the most frequent health care intervention in the NHS accounting for over 11billion spend nationally. 8.8 billion of this prescribing is in primary care. East and North CCG expenditure on primary care prescribing was 71 million in 2012/13 About 14% of CCG budgets will pay for medicines The number of items prescribed by GPs is growing at around 5.3% annually In secondary care about 60% of medicines expenditure is on high cost drugs excluded from PbR. This expenditure is increasing by about 15% per year. CQC investigations into failing services continue to highlight poor medicines management of a contributory factor in some cases In 2007 over 86,000 medication errors were reported to the NPSA :100 of these caused death or severe harm Around 7% of all hospital admissions have been attributed to or associated with adverse drug reactions with up to two thirds of these being preventable. Up to 50% of patients do not take their prescribed medicines as intended. Inappropriate use of antibiotics is a significant problem and implicated in C. diff and MRSA infections. E&NHCCG Medicines Optimisation Strategy prepared by Pharmacy & Medicines Optimisation Team, Hertfordshire, Bedfordshire and Luton 1

2 The CCG is committed to ensuring an effective strategic oversight on the use of medicines so that this resource is used safely, efficiently and effectively to improve health and wellbeing of the population and will do this by. Engaging the public, patients and professionals in improving the quality, outcomes and value for patients from their use of medicines Establishing a culture of quality and safety assurance with respect to the use of medicines Managing the financial risk with respect to prescribing Ensuring there is specialist professional pharmaceutical support for commissioning medicines and pharmacy services To deliver these strategic goals we will need to achieve the following objectives: Objective 1: Effective Decision making We will identify all our partner organisations and stakeholders and establish effective networks in order to ensure that there is effective joint decision making to deliver innovative, quality and safe, prescribing and use of medicines across health care services. Objective 2 :Medicines safety We will ensure that there is high quality medicines governance and that mechanisms are in place to assure safe, effective and affordable medicines usage in healthcare services, reduce variation in prescribing and reduce medicines related healthcare acquired infections (C.diff and MRSA) and limit medicines related hospital admissions. Objective 3: Primary Care Prescribing The choice of medicines prescribed or recommended by practitioners in primary care will meet patients needs, be evidence based and cost-effective and efficient use of NHS resources. Objective 4: Effective commissioning for medicines optimisation We will commission providers who can show that medicines prescribed for patients accessing their services meet patients needs, are safe, evidence based and cost-effective and efficient use of NHS resources. Patients transferring between care settings will have appropriate advice and information about their medicines to enable on-going safe and effective use. Objective 5: Community Pharmacy We will engage with community pharmacists in Hertfordshire so that they are fully integrated with the CCG to maximise the opportunities in community pharmacy to achieve QIPP and medicines optimisation priorities Pharmacy & Medicines Optimisation Team E&NHCCG Medicines Optimisation Strategy prepared by Pharmacy & Medicines Optimisation Team, Hertfordshire, Bedfordshire and Luton 2

3 The Pharmacy and Medicines Optimisation team will support the delivery of the medicines optimisation strategy across the CCG. A medicines optimisation template report has been prepared for each practice and the current deployment of the team has been reviewed. The future deployment of the team will be agreed with CCG Medicines Management Prescribing lead and locality prescribing leads in order to best realise the CCG objectives. Conclusion The use of medicines presents significant financial, safety and reputational risk for East and North Herts CCG. This strategy offers an effective strategic oversight on the use of medicines so that this resource is used safely, efficiently and effectively to improve health and wellbeing of the people in East and North Herts CCG. Recommendation It is recommended that the Medicines Optimisation Strategy is approved by the Board. April 2013 Heather Gray John Constable E&NHCCG Medicines Optimisation Strategy prepared by Pharmacy & Medicines Optimisation Team, Hertfordshire, Bedfordshire and Luton 3

4 CCG Medicines Optimisation Strategy To improve the quality, outcomes and value for patients from their use of medicines Strategic Goals The CCG aims to ensure patients receive the most benefit from their medicines within the available resources and will do this by: Engaging the public, patients and professionals in improving the quality, outcomes and value for patients from their use of medicines Establishing a culture of quality and safety assurance with respect to the use of medicines Managing the financial risk with respect to prescribing Ensuring there is specialist professional pharmaceutical support for commissioning medicines and pharmacy services. 4

5 Context Medicines are the most frequent health care intervention in the NHS which if applied wisely can make a major impact to improve the health and wellbeing of a population. Modern medicines, however, are very potent and, increasingly, are designed to work at specific target sites in the body. This means that if a medicine is not used as intended it is unlikely to effective and may be harmful. Inappropriate use of medicines may also present significant financial, and reputational risk to CCGs. Medicines account for over 11billion spend nationally. 8.8 billion of this prescribing is in primary care. East and North CCG expenditure on primary care prescribing was 71 million in 2012/13 About 14% of CCG budgets will pay for medicines The number of items prescribed by GPs is growing at around 5.3% annually In secondary care about 60% of medicines expenditure is on high cost drugs excluded from PbR. This expenditure is increasing by about 15% per year. In 2008/9 over 520,000 bed days in England and Wales were attributed to adverse events caused by medicines. Costing the NHS over 235million. CQC investigations into failing services continue to highlight poor medicines management of a contributory factor in some cases In 2007 over 86,000 medication errors were reported to the NPSA :100 of these caused death or severe harm Around 7% of all hospital admissions have been attributed to or associated with adverse drug reactions with up to two thirds of these being preventable.. Up to 50% of patients do not take their prescribed medicines as intended. Inappropriate use of antibiotics is a significant problem and implicated in C. diff and MRSA infections. Medicines optimisation features in all the five domains NHS outcomes framework: Domains 1 Preventing people from dying prematurely 2 Enhancing the quality of life for patients with long term conditions 3 Helping people to recover from episodes of illhealth or following injury 4 Ensuring that people have a positive experience of care 5 Treating and caring for people in a safe environment; and protecting them from avoidable harm 5

6 Objectives The CCG is committed to ensuring an effective strategic oversight on the use of medicines so that this resource is used safely, efficiently and effectively to improve health and wellbeing of the population. To deliver these strategic goals we will need to achieve the following objectives: Objective 1: Effective Decision making We will identify all our partner organisations and stakeholders and establish effective networks in order to ensure that there is effective joint decision making to deliver innovative, quality and safe, prescribing and use of medicines across health care services. Objective 2 :Medicines safety We will ensure that there is high quality medicines governance and that mechanisms are in place to assure safe, effective and affordable medicines usage in healthcare services, reduce variation in prescribing and reduce medicines related healthcare acquired infections (C.diff and MRSA) and limit medicines related hospital admissions. Objective 3: Primary Care Prescribing The choice of medicines prescribed or recommended by practitioners in primary care will meet patients needs, be evidence based and cost-effective and efficient use of NHS resources. Objective 4: Effective commissioning for medicines optimisation We will commission providers who can show that medicines prescribed for patients accessing their services meet patients needs, are safe, evidence based and cost-effective and efficient use of NHS resources. Patients transferring between care settings will have appropriate advice and information about their medicines to enable on-going safe and effective use. Objective 5: Community Pharmacy We will engage with community pharmacists in Hertfordshire so that they are fully integrated with the CCG to maximise the opportunities in community pharmacy to achieve QIPP and medicines optimisation priorities 6

7 Objective 1: Effective Decision making We will identify all our partner organisations and stakeholders and establish effective networks in order to ensure that there is effective joint decision making to deliver innovative, quality and safe, prescribing and use of medicines across health care services. Action Appoint board level lead for medicines optimisation Ensure we have the resources to deliver the strategy and work closely with GP prescribing and clinical leads to realise its objectives Provide specialised medicines optimisation and therapeutic advice to the CCG Board, locality groups, GP practices and prescribers Maintain and develop the health economy decision making framework (the Hertfordshire Medicines Management Committee (HMMC) and the Primary Care Medicines Management group (PCMMG)) for introduction and use of medicines, meeting national criteria for good practice. Ensure engagement with local GP, nurses and practice staff through representation of locality groups on CCG prescribing strategy and planning groups Develop and communicate prescribing and medicines optimisation guidance from CCG decision making groups Ensure medicine optimisation is integrated in CCG clinical priority workstreams and integrate medicines optimisation expertise in the redesign of health services and patient pathways Establish links and joint working with council-based public health teams Improve/establish joint working and networking with relevant health care professionals, eg, Acute service, specialist pharmacists, specialist nurses, community specialists, community pharmacists, the Local Pharmaceutical Committee and the Local Medical Committee and the Local Professional Networks develop local workforce and education and training to support delivery of this strategy Commission services to ensure access to the required expertise to ensure safe, legal and effective use of medicines and develop systems to keep abreast of new medicines related guidance and legislation Be proactive in sharing best practice both within the organisation and externally 7

8 Develop a policy for working with the industry to promote innovation in line with national good practice guidance. Objective 2 :Medicines safety We will ensure that there is high quality medicines governance and that mechanisms are in place to assure safe, effective and affordable medicines usage in healthcare services, reduce variation in prescribing and reduce medicines related healthcare acquired infections (C.diff and MRSA) and limit medicines related hospital admissions. Actions Deliver improved prescribing systems for patients in accordance with national programmes Put in place effective systems to ensure safe and improved medicines optimisation across interfaces between all care settings (acute, mental health and community hospitals, intermediate care, care home, domiciliary. etc) Identify gaps and develop medicines optimisation services for the most vulnerable patients and patients at greatest risk of medicines related problems Improve assurance of medicines optimisation and safety and ensure medicines expertise by commissioning quality Medicines Information services Improve assurance of medicines management and safety by commissioning IT systems to inform decision making on prescribing and to provide intelligence about prescribing trends for GP practice Establish assurance processes for medicines governance Deliver a systematic assessment and shared learning process for medicines related events Consult and agree medicines safety audits of GP practices and ensure sign-up by all practices 8

9 Contribute to Local Authority and Hertfordshire and South Midlands Area Team and Local Professional Network quality improvement initiatives for community pharmacy services Liaise with the AT Accountable Officer (controlled drugs) to ensure safe and secure handling of controlled drugs within our CCG Deliver National Institute of Health and Care Excellence guidance/guidelines within national timeframes Deliver and local and national medicines related performance indicators Provide medicine governance information to GP practices. Ensure medicines safety through targeting medicines optimisation to high risk patients, including those on high risk medicines, polypharmacy or cared for in care homes or intermediate care Establish systems to confirm the communication of and implementation of HMMC and PCMMG decisions within the CCG Deliver improved patient safety, reduce medicines risk and avoidable hospital admissions by effective commissioning of services. Improve medicines optimisation and safety in care homes 9

10 Objective 3: Primary Care Prescribing The choice of medicines prescribed or recommended by practitioners in primary care will meet patients needs, be evidence based and cost-effective and efficient use of NHS resources. Actions Undertake annual horizon scanning for new drug developments Develop and disseminate evidence based prescribing guidelines to primary care practitioners Provide pharmaceutical and medicines optimisation support and expertise to all primary care prescribers and GP practices 10

11 Ensure the availability of up-to date and accurate prescribing data to provide intelligence to plan workstreams and to keep GP practices/primary care prescribers informed Use of effective software and computer assisted decision making technology Regular monitoring and feedback to practices on prescribing KPIs and costs Medicines optimisation arrangements to be addressed in all care pathway and pathway redesign including development of AQP services Increase the level of engagement between patients, pubic and health professionals to improve, quality outcomes and value for patients from their use of medicines. Improve the use of information for patients in relation to medicines and pharmacy services and engage the public through medicines waste reduction and self care campaigns. Identify and prioritise high risk patients with Long Term Conditions for regular clinical medication reviews Identify and prioritise high risk patients for referral to community pharmacy for New Medicines Service (NMS), or targeted Medicines Use Review (tmur) Objective 4: Effective commissioning for medicines optimisation We will commission providers who can show that medicines prescribed for patients accessing their services meet patients needs, are safe, evidence based and cost-effective and efficient use of NHS resources. Patients transferring between care settings will have appropriate advice and information about their medicines to enable on-going safe and effective use. Actions Ensure that there is joint decision making and working with neighbouring CCGs, acute and mental health trusts and community health services and other providers as appropriate to improves medicines optimisation 11

12 Contract specifications will set out our expectations for optimal use of medicines, these will include quality measures for prescribing and pharmacy services, and implementation of NICE guidance Maintain an effective, fair and transparent Individual Funding Request (IFR) process to ensure individual special circumstances can be considered objectively and fairly with respect to applications for funding medicines outwith current CCG policy Improve relationships to ensure best use of medicines across the interface between care settings (eg hospital to GP, hospital to care home) including Medicines Reconciliation on admission or transfer. Establish a protocol for referral of high risk patients to community pharmacists for New Medicines Service or targeted Medicines Use Review. Objective 5: Community Pharmacy We will engage with community pharmacists in Hertfordshire so that they are fully integrated with the CCG to maximise the opportunities in community pharmacy to achieve QIPP and medicines optimisation priorities Action Work collaboratively with community pharmacy contractors and the Hertfordshire and South Midlands Area Team in order to maximise community pharmacy engagement with the CCG and GP practices. Ensure all community pharmacy contractors are aware of CCG priorities and the potential to contribute to CCG and national QIPP and medicines optimisation priorities 12

13 Collaborate with the Hertfordshire and South Midlands Area Team and Hertfordshire Local Authority to develop community pharmacy workforce to meet national and local objectives Contribute to the Hertfordshire Pharmaceutical Need Assessment so that it reflects patients medicines management needs in each locality To collaborate with AT/Local Authority to benchmark community pharmacy services and support the Healthy Living Pharmacy accreditation scheme To use the pharmacy Local Professional Network for cross-sector pharmaceutical advice. Ref: Ensuring the delivery of prescribing, medicines management and pharmacy functions in primary and community care: an organisational competency framework and key functions checklist, October 2010 NPC The NHS Outcomes Framework 2013/14 13