In the UK, evidence that pharmacists can provide better clinical outcomes and more efficient, consistent and sustainable services for patients is increasing. In this article, key themes are discussed to showcase the importance of empowering pharmacists and fostering leadership in clinical pharmacy practice.
The vision in the National Health Service (NHS) 5-Year Forward View (FYFV) is for a sustainable NHS that continues to be tax-funded, free at the point of use and that is fully equipped to meet the evolving needs of its patients, now and in the future. To deliver this vision, pharmacists are supporting efficiencies in the NHS and improving patient care by undertaking person-centered medicine reviews in a range of different care settings and as part of care pathways and multidisciplinary teams.
Within the context of an NHS struggling to cope with an ageing population, prolonged life expectancy, and large numbers of patients managing co-morbidities and polypharmacy, the National Institute for Health and Clinical Excellence (NICE) published a medicines optimisation guideline. Key recommendations include efficient medicine-related communication across different settings of care, medicines reconciliation and medication reviews. Pharmacists across the country have been leading on projects within the remit of these recommendations. This includes antimicrobial stewardship, diabetes referral tools as well as polypharmacy stop-start tools.
Medicines optimisation and cost efficiencies
Lord Carter’s efficiency review, which shed light on significant variations across NHS pharmacy services, was fundamental in paving the way for pharmacists to lead in new models of care in a financially sustainable manner. The Carter Review highlighted that unwarranted variation in the use and management of medicines costs the NHS at least £0.8 billion.
Empowering pharmacists and equipping them with the necessary training is yielding exceptional results.
Lord Carter recommended a Hospital Pharmacy Transformation Programme to ensure hospital pharmacies achieve their benchmarks such as increasing pharmacist prescribers, e-prescribing and administration, accurate cost coding of medicines and consolidating stockholding. The main objective of these activities is to ensure pharmacists and pharmacy technicians spend more time on patient facing medicines optimisation activities. The Commissioning for Quality and Innovation (CQUIN) scheme5 aids this vision by incentivising NHS organisations which achieve specific targets.
Of particular relevance to pharmacists is the medicines optimisation CQUIN scheme. The goal of this scheme is to optimise use of high cost drugs, tackle variation and reduce waste. The scheme highlights pathways to achieve this through:
- Adoption of biosimilars and generic switches
- Improved drug data quality
- Utilising most cost efficient dispensing channels
- Compliance with policies/guidelines to reduce variation and waste.
The future is envisaged through the ‘Top ten medicines’ list identifying further productivity opportunities, as recommended by Lord Carter, opening up more roles for pharmacists. The list itself was developed in collaboration with a small group of Chief Pharmacists working in NHS organisations, with the aid of a tool known as Define. Savings targets for individual NHS Trusts are based on a baseline period and represent either a simple reduction in spend or on the uptake of a less costly alternative medicine. The following example demonstrates the huge role played by pharmacists in developing and delivering cost saving efficiencies.
Learning from the Cancer Vanguard in the UK
At the core of the FYFV strategy is the development of new models of care, or the vanguards. It recognises that there are universal levels of care provision that require a degree of conformity. It has, therefore, proposed many new care models that are being explored and implemented via the vanguards.
The Cancer Vanguard, through a collaboration led by The Christie, The Royal Marsden and University College London Hospitals, has provided a platform for pharmacy to develop new models of cancer care that are replicable and transformational, which would ultimately act as blueprints for the NHS nationally. For example, a process timeline for adoption of biosimilars has been developed with accompanying guidance, resources and template documents to enhance biosimilar uptake within the NHS. The replicability of both the process and the new models developed, means that the national impact is substantial.
With the support of the pharmaceutical industry, other examples include adverse event monitoring of patients receiving immunotherapy, developing models of care for home delivery of chemotherapy, taking delivery of Denosumab out of hospital settings and the use of patient apps in metastatic colorectal pathways of care. Future opportunities are increasingly focused on prevention and early diagnosis with hospital-community pharmacy collaborations. The Cancer Vanguard has therefore provided an example of collaborative and systems leadership in terms of how quickly results are being produced as well as its replicability. Openings for further joint work with industry and involvement in early diagnosis are key learning outcomes.
This article summarises a few examples that demonstrate a central role for pharmacists in new models of healthcare in the UK. Empowering pharmacists and equipping them with the necessary training is yielding exceptional results. The future path is to foster community engagement in preventative strategies.
Except from Fostering and supporting excellence in clinical pharmacy practice, published in Open Access Government (November 2017) by Islam Elkonaissi and Zahra Laftah.
NICE guidelines NG5 (2015). Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes, London (UK): National Institute for Health and Care Excellence (NICE).