Prescribing & Medicines Management
Issue no 2, p5-6
March/April 2003

Features

Generic medicines management framework underway

An interactive guide that offers examples of best practice, links to other websites and expert contacts is being developed for pharmacists to help improve the medicines management elements of three national service frameworks.

The Department of Health's generic NSF medicines management guide is expected to be available on the internet by late summer and is aimed at pharmacists in both primary and secondary care. It will focus on the way they can help improve health outcomes in the renal NSF, which is still being developed, the NSF for diabetes which has already been released and the NSF for long-term conditions, which focuses on neurological disease — due to be published next year.

The guide is being co-ordinated by Professor Alison Blenkinsopp of the department of medicines management at Keele University, who was also responsible for the medicines management guide for the NSF for older people which was published as a written document in March 2001. However, the significant difference between the two guides is that the new one will only be available on the internet and will be a "live" document which can be regularly up-dated.

Professor Blenkinsopp explains: "We are intending that the guide should be a much more practical document which will help to get people thinking about different ways of tackling different problems. There will be a number of follow-up contacts as well as links into other web-based resources which already exist."

What the framework will cover

The guide will consider areas of medicines management that can be improved in the care of patients with diabetes, renal disease and long-term neurological conditions and will put forward existing examples of best practice for others to follow. It will also pull together evidence from published literature. She adds: "We will be looking at patient journeys across the NHS, and point out where things can be made better and reveal different ways that people are already working to help solve these problems. We will not be saying this is the only way to do it but rather here is a solution that you can think about."

Pharmacists practising in primary care, community care, those working for primary care trusts as well as hospital pharmacists are all targeted in the guide, but for it to be a success it will also have to reach beyond health professionals.

"It is important to harness all the potential people who are involved in medicines management apart from health professionals, which includes patients and their carers," says Professor Blenkinsopp.

Joanne Shaw, director of the Medicines Partnership, a government funded initiative set up two years ago to promote concordance — the idea that patients, in discussion with health professionals, should take control of their medicines management — says the framework is a significant step.

"The fact that the NSFs are recognising the importance of medicines management is extremely welcome and is a positive step. It's very significant," she says.

Ms Shaw is also a member of a multi-disciplinary steering group that includes pharmacists, nurses, doctors, patients and carers, as well as the people from the pharmaceutical industry, which first met in January to work on the guide. A second advisory group, representing a wider range of interests, has also been consulted on the guide's content.

Strong pharmacy input

Professor Blenkinsopp says she has been impressed with what the profession has had to offer so far. "In terms of the pharmacy input, what has struck me is the richness of examples of good practice which are already going on. Pharmacists have a huge role to play, particularly in improving the monitoring of the use of medicines and the review of use of medicines in partnership with patients."

Creating a web-based guide, rather than a printed version, means it will be easy to up date and will work well where the NSF is being developed in modular form such as the renal NSF.

However, Gul Root, principal pharmaceutical officer public health and community services at the DoH, emphasises the guide will only apply to the three named NSFs.

She says: "It is not necessarily going to be the core for all future NSFs although that doesn't mean we won't build on this for the future. We are keen that this guide isn't seen as a tablet of stone. We didn't want to produce guidance that people would put on their shelves and forget about, we want this to be a live document."

She hopes that the guide will identify roles that the different health professions can play in improving the health outcomes of the three NSFs. Such roles will include helping primary care trusts develop medicines management strategies and developing partnerships with patients.

She adds: "All health care professionals are important for the success of the NSFs, and pharmacists, being experts in the use of medicines, can play an instrumental role in delivering the medicines management aspects of the NSFs."

The development of a generic medicines management guide for the NSFs is welcomed by the National Pharmaceutical Association which is also involved in the initiative.

Claire Jones, assistant head of NHS services development for the NPA, says community pharmacists have a key role to play in helping improve NSF outcomes.

She adds: "If you look at the evidence base for community pharmacists in medicines management services it is good. The guide will be a sign-posting document which will be a useful resource for community pharmacists in terms of best practice." She went on to explain that as 50 per cent of patients do not take their medicines properly, community pharmacists are keen to become involved in improving this — provided they have the proper support and remuneration."

Clinical director of pharmacy at the Royal Liverpool and Broadgreen University Hospital, Alison Ewing, who was involved in the medicines management guide for older people, welcomes the second guide. The older people guide has been great and has promoted joint working with the primary care trusts. The Royal Liverpool is the regional centre for kidney transplants and if the new guide means we can get some kind of joined up working across primary care trusts and the whole health economy it will be brilliant — it will save all the leg work of trying to get people on board."

Huge professional opportunities

Ms Root says the guide provides pharmacists with huge professional opportunities and urges them to become involved: "This is a huge opportunity for pharmacists to put themselves forward and say we can deliver it for us. If they don't want to do it there are other professions who want to help," she adds.

Pharmacists with examples of best practice in medicines management for any of the three NSFs should contact Professor Blenkinsopp by email at a.blenkinsopp@virgin.net