How to ensure chief executives put your needs on their agenda
| Medicines management schemes are
meant to be in place in all primary care trusts in England by 2004.
Debbie Andalo describes progress in different parts of the country |
Debbie Andalo is a freelance
writer
|
Some chief executives from primary care trusts have
put medicines management high on their agenda and are beginning to
develop links across districts
to create common policies and prescribing practice. The trend to set
up committees or new structures that take medicines management beyond
the boundaries of an individual PCT comes a year before the Government
deadline. This deadline — first put forward in the NHS Plan — is
for all PCTs in England to have integrated medicines management services
in place by 2004.
Greater Manchester
Nine months ago a medicines management working group was
set up in Greater Manchester. It reports to all primary care and acute
trusts’ chief
executives within the strategic health authority. A new pharmacy team,
devoted to medicines management across Greater Manchester, is also in
the pipeline.
The chief executive of Bolton PCT, Kevin Snee, a public health doctor
has been involved in the initiative. He
explained the thinking behind the new developments: “We wanted
to underpin the efforts of the working group with some concrete medicines
management support, at Greater Manchester level. It is difficult to get
the job done if people have to do things in their spare time. It now
means we can take a much more
coherent approach to medicines management which includes the introduction
of new drugs”.
Dr Snee said that PCTs across Greater Manchester varied in their support
for medicines management services. They were restricted either by the
size of the organisation or by the views held within their PCT.
In the Bolton area, medicines management is a priority. The PCT prescribing
lead has got together with others in the west of the Greater Manchester
area, and the acute trust, to try to develop locality-wide polices for
its one million patients.
Dr Snee added: “Year on year, the PCT has constantly struggled
to manage within its prescribing budget. But now people have realised
that there are important things that can be done to manage prescribing
that haven’t been done before.” Drugs wastage, particularly
in nursing homes, and the repeat prescription system are two areas that
need to be tackled.
He said that most people on the PCT board, including the non-executive
members, have some understanding of the importance of getting medicines
use right. “If you are increasing a budget by 12 or 13 per cent
per annum you have got to take a long hard look at it,” he added Hampshire
East Hampshire PCT is also looking at medicines management
beyond its own boundaries. The PCT has just signed up to the fourth wave
medicines
management collaborative and plans to use the initiative to forge greater
links between its community pharmacists and local acute trust.
PCT chief executive Tony Horne said: “The PCT also has its own
prescribing sub-committee, that looks not only at our own medicines management
policies but also at how we link in with the local health economy.” Discussions
are also under way about developing joint medicines management initiatives
with two neighbouring PCTs and the acute trust from which all three PCTs
have historically commissioned services.
Mr Horne added: “We have always worked closely together. This is
about offering consistency in a locality but also about making the best
use of the opportunity for joint working. The impetus for this has come
from me but also our pharmaceutical advisers. There is a growing realisation
that medicines management is increasingly important — not just
from a financial point of view but also from a risk management perspective.” Peterborough
Chris Town, Chief executive of North Peterborough PCT |
The Greater Peterborough Primary Care Partnership, which
covers two PCTs, has just appointed a team of 16 community pharmacists
to promote medicines
management — reflecting the priority the PCTs give to the issue.
A similar development has taken place in south east London where Greenwich
Teaching PCT has boosted its pharmacy team to 11 to improve the use
of medicines across primary and secondary care.
North Peterborough PCT chief executive Chris Town said that it has
taken three years to reach the point where every GP practice has some
medicines
management in place. He said: “We had to work with the processes
and relationships to get GPs to understand the benefits — the historic
relationship between GPs and community pharmacists is that the pharmacist
only gets in touch if the GP has made a mistake.”
He said that the chief executive had a vital role to play in medicines
management: It is important that the chief executive takes a view on
medicines management, to give it the weight that it needs.
PCT chief executive support for medicines management has been driven
by the national medicines management collaborative, under the auspices
of the National Prescribing Centre. And, according to Joanne Shaw director
of Medicines Partnership, the government-funded initiative set up two
years ago to promote concordance, the collaborative system has encouraged
PCTs to focus on the wider issues around medicines and prescribing. Prescribing
represents such a significant slice of PCT expenditure, this has also
helped push medicines management to the fore. She suggested it was significant
that PCTs are now looking at medicines management across a locality.
She said: “I think you can trace an evolution within PCTs — beginning
with managing the prescribing budget and moving onto process efficiencies.
What we are seeing now is a new trend where PCTs manage the processes
around medicines management.
“For us in Medicines Partnership we are looking towards the next
step they can take, which is recognising the patient-centre of medicines
management
and how you can use medicines in such a way that will focus on what the
patient wants.” |
