The ‘Pharmacy First’ vision is ambitious and could transform access to primary healthcare in England, following recent successes in Scotland and Wales.
According to Company Chemists’ Association (CCA) analysis, with the added capability to supply non-prescription medicines and prescribe additional prescription-only medicines, this framework could free up over 30 million GP appointments annually.
Read more: Scotland’s model for pharmacy offers lessons for England’s future
However, there are historic challenges for medicines optimisation that could limit this ambition, many of which stem from wastage, non-adherence, and ineffective prescribing.
In this article, I will explore what medicines optimisation is, the role the community pharmacy can play in boosting it and what the future of personalised prescribing could look like within the Pharmacy First model.
Unlocking greater value from medicines
According to the Royal Pharmaceutical Society (RPS), medicine use today is sub-optimal and patient outcomes are being negatively impacted. Contributing factors are patient non-adherence, prescribing errors, and medicines wastage.
The World Health Organization declared that non-adherence is an issue of global importance and a 2002 review of Cochrane agreed, stating: “Increasing the effectiveness of adherence interventions may have a far greater impact on the health of a population than any improvement in specific medical treatments”.
Every year there are over 237 million medication errors made in the UK, costing the NHS more than £98 million. Medicine wastage is also estimated to cost £300m annually.
It’s clear that sub-optimal use of medicine is costly, as well as affecting patient outcomes. That’s why medicines optimisation is key. This assesses the value that medicines deliver by ensuring they are clinically effective and cost effective.
Medicines optimisation is based on four principles, set out by the RPS, to improve patient outcomes:
- Aim to understand the patient’s experience
- Evidence-based choice of medicine
- Ensure medicines use is as safe as possible
- Make medicines optimisation part of routine practice
These four principles strive to achieve five main goals: improving outcomes, taking medicines correctly, avoiding unnecessary prescribing of medicines, reducing medicines wastage and improving medicines safety.
It is a patient-centric approach developed by the RPS in collaboration with patients and aims to ensure they get the right choice of medicines at the right time. It also supports patient engagement.
How medicines optimisations can benefit stakeholders
A recent study revealed pharmacist services are proven to enhance medicines optimisation by reducing medicine-related problems (MRP), inappropriateness of medications prescribed, and telephone consultations in general practice. All of which likely contribute to avoidable healthcare costs for the NHS.
By offering their medicines-related expertise to review patients’ medicine usage and providing ongoing monitoring and support in the correct use of medicines, pharmacists will ultimately improve public health outcomes.
For example, pharmacists in Leicester discovered 56% of their asthma patients were using their inhalers incorrectly. In training their patients, these pharmacists prevented medicine misuse, the potential bogging down of general practice and increased hospital admissions.
Read more: ‘Aiming for agreement in July’: CPE chief gives service negotiations update
Pharmacists are also key players in the pharmaceutical supply chain when it comes to reducing waste. They can adjust prescription amounts (if overprescribed), dispense opened medication packages, use dose-dispensing systems, and manage stock levels to limit medicines going out of date before dispensing them. Together, these actions can bring down the estimated cost of unused medicines.
By taking medicines in from the public for safe disposal, pharmacists also play an active role in reducing the impact of medicine waste on the environment.
The future of personalised prescribing
Another area of huge benefit and opportunity in which the community pharmacy sector could play a leading role is personalised prescribing.
Not all patients respond to drugs at the same speed, while some drugs could spark severe adverse drug reactions (ADRs) leading to hospitalisation.
But pharmacogenomics (PGx) is opening the door to personalised prescribing of medicines tailored to a patient’s genetics. Recent research has shown personalised medicines can reduce adverse reactions by 30%.
The benefits of PGx are two-fold, directly impacting both patients and the NHS. These include reduced adverse drug reactions, faster response to treatment, increased adherence, and better health outcomes due to greater accuracy and precision in treatment programmes.
Read more: Pharmacogenomics: ‘Precision prescribing could save millions’
Potential NHS benefits include the reduction of medicine waste, more efficient use of clinician time due to better patient response, and a lowered risk of readmission.
This growing clinical practice will pave a new way for the optimisation of medicines and pharmacists are well-placed to facilitate it. Evidence-based research has shown a multitude of ways in which pharmacists may be involved, including awareness and scientific understanding, close relationships with patients and their health needs, personable communication skills, the ability to perform sampling, testing and regular reviews, and make recommendations.
Pharmacists have the potential to use their unique position within communities to build infrastructure around PGx therapy, further ingraining it into public healthcare and ultimately contributing to the optimisation of medicines and improvement of patient outcomes in the UK.
But to leverage this opportunity there are many barriers to overcome. These will be discussed in my next article in this miniseries on the Pharmacy First vision.
Read the first part in this blog series: The ‘front door’ to health: The widening role of community pharmacy
Steve Brownett-Gale is the marketing lead at Origin – a company specialising in pharmaceutical packaging solutions