Making medicines go further
Paul Gershlick explores how we can reduce the £300m worth of wasted medicines in the UK each year and questions whether community pharmacies might play a crucial role in making our medicines go further.
A lot has been said about the challenges for providing healthcare to a more demanding, diverse and ageing population in an age of austerity.
There is a growing demand from payers to achieve "more for less". Failure to make efficiencies in the UK will see a funding gap in the National Health Service of £34–48bn by 2021/2.
There are clear problems with use of medicines. Up to 50% of patients do not take their medicines as recommended. Over £300m worth of medicines a year are wasted in the UK.
In addition, some medicines are not taken safely. Up to 8% of unplanned emergency hospital admissions are due to avoidable issues from taking medicines. This costs the NHS an estimated half a billion pounds a year.
As part of the drive towards "more for less", there are surely efficiencies to be made amongst the NHS's £12bn medicines budget. This is not just a matter of encouraging more use of better value generics, but also about seeing patients take their medicines more efficiently and safely.
Over a quarter of the population are suffering from long-term conditions.
60% of the one billion medicines taken by UK patients each year are by people aged over 60. Many of those are on a cocktail of drugs. Do people turn their minds enough to how they interact and how they work?
Against this backdrop, there is a drive towards investing in more efficient use of medicines – so-called medicines optimisations.
The answer to all of this lies with community pharmacy. There are 1.6 million visits to community pharmacies in the UK every day – 440 million visits for health reasons each year. This is more than any other NHS care setting.
Pharmacists are trusted by their patients, in accessible locations and easy to see without having to book appointments. With growing pressure on doctors' time, pharmacies are increasingly being seen as an outlet to help patients to manage their long-term conditions in an efficient way.
The NHS recognised this opportunity to make more use of accessible pharmacy to achieve better health outcomes with the introduction in 2005 of Medicine Use Reviews. 2.8 million MURs were provided in 2012/2013.
The aims of an MUR are to establish a patient's actual use and experience of their medicines, to identify and resolve poor or ineffective medicinal use, to identify any side effects, to improve clinical and cost-effectiveness of the prescribed medicines and to reduce wastage.
MURs are directed at people taking higher risk medicines, people with respiratory diseases and anyone recently discharged from hospital.
There is also the New Medicines Service. This was introduced in 2011 and had 650,000 recipients in 2012/3. The NMS is for patients with long-term conditions who have been prescribed with new medicines.
The future of the NMS is in a state of flux. It had been due to expire three times in 2013, and was recently given yet another short-term stay of execution until March 2014. The Department of Health will make a final decision on the future of the NMS after an evaluation is completed, which is expected imminently.
Whether the NMS survives or not, there will undoubtedly be a greater push for pharmacy doing more to help patients manage their conditions better. There is growing momentum towards increasing the role of pharmacy. But more can be done. More needs to be done. There will increasingly be other opportunities too, including greater roles in managing medicines in care homes.
Pharmacy representative bodies such as the Independent Pharmacy Federation, National Pharmacy Association and Pharmaceutical Services Negotiation Committee have long been calling for community pharmacies taking a greater part in managing the health of the nation rather than merely dispensing medicines. They want to see further services which help to manage people's health and wellbeing in a proactive way.
The Royal Pharmaceutical Society looked to take the bull by the horns in 2013 with its "Now or Never: Shaping Pharmacy For The Future" report. But crucially in December 2013, NHS England launched its "Call To Action" for pharmacy. This is a three month consultation looking at the greater role that pharmacy can play. Although this is currently a consultation, it is clear which way things are heading.
The end game makes sense; it is just the route to getting there which poses challenges.
Whilst some see the opportunities, many in pharmacy are reluctant to change. They are busy with their existing tasks and find additional pressures on their time – whether that is dealing with supply shortages for products which are in short supply due to export or dealing with new compliance standards. Change can also be uncomfortable.
Meanwhile, perceptions are an issue. Patients do not naturally think of a pharmacist as providing additional services beyond dispensing. But pharmacy must change those perceptions, and bodies like the RPS must also do more on that front. The Government's Call To Action will also help, as will its recent promotion of pharmacy in the minds of the public as a route for health advice.
There will be opportunities for entrepreneurial-minded people to seize the initiative and help to bring about the change.
The solution is surely win-win-win. Additional service provision from pharmacy to enable better healthcare in the community will lead to opportunities for the service providers (pharmacists), the payers (the Government) and the users (patients). The quicker everyone adopts these new services, the more everyone will gain.
About the author:
Paul Gershlick is Partner and Head of the Pharmaceuticals and Life Sciences team at Matthew Arnold & Baldwin LLP; he can be contacted using the details below:-
T: +44 (0)1923 208816
F: +44 (0)1923 215004
http://www.mablaw.com/category/sectors/pharmaceuticals-and-life-sciences/
Closing thought: Do community pharmacies hold the key to encouraging patients to take their medicines more efficiently and safely?
