Prescribing & Medicines Management
Issue no 3, p11-12
May/June 2003

Features

New Forest PCT: a year in the life of medicines management

The first step was to agree our local aims. We established four baseline assessment measures in June 2002 and since then there have been great improvements across the board.

Practice measures

Measure 1: Of the five pilot practices involved in the medicines management services programme, four of them had already started Read-coding at the start of the project. In these practices, 95 per cent of patients over 65 years on regular items of medication have had a clinical review within the past year. (Read-coding is now implemented in some practices outside the MMS).

Measure 2: The percentage of repeat requests that do not include all regular repeat items for a patient has decreased from 79 per cent (June 2002) to 48 per cent (February 2003).

Measure 3: The percentage of repeat prescriptions that do not have specific dosage instructions has decreased from 35 per cent (June 2002) to 6 per cent (February 2003).

Measure 4: The percentage of patients who experienced problems in ordering or receiving their last supply of medicines has decreased from 11 per cent (June 2002) to 0 per cent (February 2003). These results were achieved through successful communication between community pharmacists and GP practices/feedback from patient forums. We intend to continue monitoring this measure every three to four months.

Organisational measures

Measure 1: Implementation of medication review guidelines within care homes.

There are 87 care homes in the PCT area with 2,010 residents. The PCT already had an agreed protocol for medication reviews within care homes, but we knew less about the implementation of the guidelines.

In the year April 2001 to March 2002, 23 care homes were visited and 599 patients' medications were reviewed (these were not Read-coded).

The following year, in the care homes that were visited, 632 patients' medications were reviewed and 340 patients were Read-coded. To date we have 37 homes with 780 patients' medications left to be reviewed and Read-coded. We are confident that we can achieve this in the next 12 months.

The PCT also provides basic pharmaceutical training for carers in care homes. To date, 227 members of staff have now received training, which has been carried out by the pharmaceutical adviser.

Measure 2: To determine baseline in a agreed therapeutic area, improve it and provide value for money.

The PCT has an estimated 5,700 type 2 diabetes patients in the area who require glucose monitoring. The PCT has identified that patient education is important for improving glucose monitoring and reducing waste and over-prescribing. The PCT currently spends £250,000 annually on glucose monitoring strips for these patients. The PCT has developed a patient information leaflet, and other educational materials are in place in diabetes clinics. We are currently assessing baseline levels for glucose monitoring through practice audits.

Measure 3: Improvement of discharge medication information.

The two main hospital trusts are: Southampton General Hospital and Royal Bournemouth Hospital. We have now received protocols for discharge medication from all local hospitals and we have designed two templates to help practices in our area collate information required for this measure. Ten practices out of 19 are reporting this measure on a monthly basis. The two main hospital trusts are now ready to look at six months of data and to recommend action to remedy the concerns in primary care about discharge medication information.

Measure 4: Measuring active involvement in MMS.

The five pilot practices have adopted a multidisciplinary and skill-mixed approach to MMS. Valuable skills are being used and barriers removed to make it easier to co-ordinate and communicate. The practices have amended repeat prescriptions for warfarin, steroid inhalers, steroid eye-drops/ creams, analgesics and NSAIDs to ensure correct and clear dosage instructions. Furthermore, drugs that have not been issued, or were discontinued before January 2001 have been identified and removed from the clinical systems. This is now an on-going process through practice improvement cycles.

Synchronisation has been successfully carried out in three practices on a small number of patients, with involvement from the community pharmacist through questionnaires around drug wastage and dose optimisation.

Since April 2002 a further five practices have carried out work on "discharge information", widening the base for extending MMS in year two.

Aims for year two

Our intention is to make MMS part of the GP Prescribing Incentive Scheme for 2002/3. Part of the scheme for the coming year will be based on the successful completion of a number of medicines management projects including developing and implementing repeat prescribing protocols, patient and care home medication reviews and therapeutic audits.

The PCT has already developed repeat prescribing guidance to help practices create robust repeat prescribing protocols and a PCT-wide training programme is ready for dissemination.

We also wish to strengthen the involvement of community pharmacists in MMS. We intend to do this by creating links between general practices and community pharmacies through, for example, study days and MMS meetings. We intend to extend practice awareness of MMS across the NFPCT and to continue the momentum on MMS with all practices and other key stakeholders. We also aim to extend further benefits to patients via patient forums and with the help of expert patients, practice presentations and a stakeholder event for members of NFPCT.