Prescribing & Medicines Management
page PM2
June 2005

Features

What PCTs achieve with the Medicines Management Services Collaborative

Since 2001, the medicines management team, based at the National Prescribing Centre (NPC) in Liverpool, has helped primary care organisations to improve their medicines management services. Through its Medicines Management Services Colla-
borative (MMSC), now in its fourth wave, the team has worked with 146 primary care trusts in England, helping develop better medicines management services for up to 27 million people.

Collaborative working

A collaborative approach helps people from different environments to work towards a common goal. The shared MMSC goal is to optimise prescribing, and to improve the patient experience and health outcomes where medicines are involved. This is supported by four detailed aims:

· To identify and address unmet pharmaceutical need

· To help patients get the best from their medicines and so deliver real improvements in health

· To develop innovative approaches to medicines management that have patients’ needs uppermost while improving service efficiency and reducing waste

· To provide convenient access to a range of medicines management services in different environments and make better use of the skills of pharmacists

The collaborative provides PCT teams with tools to make improvements. Teams are involved in a co-ordinated programme of events and activities over two years, which include national learning workshops and a bespoke training programme for local project facilitators. Workshops focus on identifying and sharing good practice and giving project teams protected time to develop their own local objectives and agree action plans, based on what they have learnt. Between workshops, teams put their plans into action by testing rapid changes to existing ways of working. Changes are conducted on a small scale and applied more widely if successful. Every month, teams try out their ideas. They study, report and act on data they have collected to measure their improvements. All sites on the programme also develop their own local tools for measuring and assessing progress. Examples of significant improvements that teams have made as part of the collaborative programme are described below.

Specific dosage instructions If a prescription with no dosage instructions is issued, several problems can occur. The absence of clear instructions can cause unnecessary delays for the patient while the prescription is clarified. It might also mean that the patient has to journey between the surgery and pharmacy to sort out the problems, and busy surgery and pharmacy staff have to devote time to resolving problems. Moreover, lack of adequate instructions can mean that the patient does not take a medicine as intended. Through the collaborative, surgeries and pharmacies in St Helens PCT have reduced prescriptions issued with “as directed” instructions from an average of 20 to 0.2 per cent of prescriptions for repeat medicines.

Synchronisation If quantities of repeat medicines are synchronised to run out at the same time it can mean fewer trips to the surgery and pharmacy and, for the surgery, less time spent on processing repeat prescriptions. More importantly, it provides a useful way of monitoring appropriate medicine use. Amber Valley PCT in Derbyshire has introduced prescription synchronisation in its surgeries and has reduced the percentage of unsynchronised prescriptions from 60 per cent to 26 per cent.

Medicines review Polypharmacy increases the probability of drug interactions, can lead to confusion and inappropriate medicine-taking and is a contributory factor to hospital admissions. Regular medication reviews can significantly reduce the likelihood of people experiencing such problems. Blackburn with Darwen PCT has produced a medication review pack for practices. Written for GPs and their staff, nurses and pharmacy staff, it explains why everyone has a role to play in the review process. The pack has been widely promoted through learning days and the PCT’s prescribing team has also produced mouse mats with the medication review read codes and basic questions to ask patients, as an aide-memoire. Through this work, the percentage of medication reviews in the PCT’s target group rose from 18 to 79 per cent.

Care home medication reviews Patients in registered care homes are among those most likely to experience medicines-related problems so regular medication review is useful. The patient population in care homes can fluctuate widely — patients frequently move from one care home to another. Medication reviews for care home residents are promoted through the collaborative programme and local teams collect information on a regular basis to assess progress in this area. A number of PCTs have made significant improvements. For example, East Cambridgeshire and Fenland PCT piloted a multidisciplinary approach involving the GP, community geriatrician, a member of the PCT medicines management team, a care home representative and the district nursing service.In addition to reviewing medication, this team considers the overall care plan for the patient. The pilot has demonstrated improvements in patient care as well as rationalising medication and reducing both medicines-related incidents and costs. Following this success the PCT is extending the scheme to all its homes.

Improvements

As a result of a collaborative approach, improvements are spreading throughout the UK. For example, the concept of regular medication review is now firmly embedded in professional practice. The work on synchronisation of quantities and dosage instructions through the collaborative highlights the benefits of general housekeeping on GP computer systems and also of improved communication between professionals. This has, in turn, helped simplify the medication review process for surgeries — particularly appreciated since the introduction of medication review as part of the new GP contract.

The work being done by the collaborative sites is constantly developing and some sites are starting to look at ways of working with hospital trusts, social services and patient organisations. The NPC team is now also supporting a medicines management programme in hospitals and recently launched a programme to help implement the new community pharmacy contract.