Optimise this!

‘The NHS has marginalised the largest force in pharmacy – the community pharmacists. Community pharmacy know which patients struggle with which medicines’

This was the opinion of a senior hospital pharmacist, and is pretty representative of the general consensus that the NHS didn’t have much of an idea of what patients wanted out of an optimal medicines service. What did optimal mean to them? The most common assumption was that most patients want to access medicines closer to home.

But other agendas were at play. Some pharmacists mentioned patients were interested in how green their medicines were – for example, which was the most sustainable inhaler. They wondered if it might also be possible to inform their choices by better communication about costs. With inhalers, would it be helpful for patients to know what were the six different choices of inhaler, with price differences?

But this was controversial – as one said, “We need to be careful as we would not want to put patients off using services and products they need for fear of costing too much. Cheaper isn’t necessarily better and the most important thing is to have the right medicines for the right patient.” Quite right.

Where were there opportunities? Self-referral and self-management among patients would have to increase for MO to work properly, and the group sought innovations to provide to patients to enable this. Structured medication reviews are needed more, and better interaction with patients – asking the basic question, do you understand how to take this treatment?

Ultimately the right level of patient engagement needed more workforce to do the job properly – as in so many areas of the NHS. The MO community feels it has been let down by the government and Health Education England.

Attendees were keen to involve the expertise and resources of the pharma in pushing forward the medicines optimisation agenda.

The NHS seeks to partner with private organisations in the integrated care landscape: and “everyone who wants to support the NHS’ ambitions should be part of the discussions”.

Some of the elements pharma can offer include thought leadership, the “navigation of thought processes” in the words of one attendee – including case studies, intelligence and information on best practice gathered around the country.

Industry could share more education – the group affirmed it is good at this already, and appreciated its training and production of educative resources.

Data management was mentioned as another key area, as was support around outcomes, where industry has a key interest. It was also noted it could offer support in service co-design with patients. The data requirements are different depending on who they are and their locality and industry could support this.

“We need to be thinking about the outcomes we get from the products that we prescribe and how those are aligned to sort of building on the data they’ve masked through the trial setting, which we know is different”.

“But how do we get some of that post-surveillance data in informing our assessment of outcomes for the medicines that we using? I don’t think we take advantage of that, to learn about the real-life implementation of products.”

There was recognition, however, of several issues acting as an obstacle to effective partnership with the NHS.

“Pharmacy is distant from industry”, said one. There was some natural reticence to working with industry – although a broad awareness among pharmacists and organisations that they will always need some support with complex patient processes.

Not many NHS staff really understand pharma for example, what the difference is between sales and market access, what they are trying to do and how they can help. Attendees noted it would be good to have better understanding of “which conversation I have with whom”.

Equally, life sciences could be more forthcoming to pharmacists and medicines optimisation on a range of issues. Pharmacists are often the best people to have conversations with about a value proposition, rather than traditional prescribers.

On both sides it was apparent there was reticence around legality and compliance, and particularly from the NHS, what was and was not allowed. Pharmacists were unaware of ABPI current regulation around, for example, joint working.

So, medicines optimisation is “a good idea”. If industry were to grasp the nettle, there are clearly opportunities.

We’ve already mentioned data and value capture support – collection, analysis and mapping to locality. Locality case studies drawing on how systems and pharma have worked together – to support medicines optimisation or reducing health inequalities; and process mapping of potential projects were all mentioned as possible ways forward.

Just be aware in the new world that money-saving may not be enough – look at your multidimensional value proposition, your system-based approach. Know who you are going to communicate your case studies to, and ensure that your offerings ease their workload, rather than add to it. If you do this, you could establish some enduring friendships in pharmacy.