Medicines Optimisation Jade Tomes Medicines Management Team

Getting the most from the medicines budget Our drugs budget Getting the most from the medicines budget How much do you think primary care (GPs and practice nurses) in Brighton and Hove spend on drugs in a year? £40,000,000 This includes: Medicines Stoma and incontinence appliances Wound care Nutritional supplements (for malnutrition)

Getting the most from the medicines budget Our drugs budget Getting the most from the medicines budget We have a legal and moral responsibility to manage resources wisely to maximise the benefit to all our patients and reduce waste where possible. Any money we save in the drugs budget is put back in to buying other services for patients

Medicines Optimisation “Ensuring the right patients, get the right choice of medicine at the right time”

Medicines Optimisation Principles

Our goal is to help patients to: Improve their outcomes Have access to the right medicines for them (evidence based) Improve how and the way they take their medicines Avoid taking unnecessary medicines Reduce waste Improve medicines safety

Why? Medicines: Prevent life-threatening diseases Help change previously life-threatening diseases into long-term conditions Improve the quality of people’s lives Reduce mortality and help people live longer Medicines are still the most common intervention (treatment) AND The biggest cost to the NHS after staff

How? Brighton Area Prescribing Committee Brighton Joint Formulary Communication and Education Medicines reviews

The UK medicines market Getting the most from the medicines budget The UK medicines market is highly competitive – which we must use to the advantage of our patients There are some price controls – the Drug Tariff Patent protection applies to new medicines – 20 years usually A patented medicine will have a trademarked brand name and a generic drug name. For example Panadol® and paracetamol When generics become available, (which are usually better value for money) we encourage prescribers to use them All generic medicines have to meet the same standards of quality – otherwise they will not be allowed to be licensed

Getting the most from the medicines budget Branded Generics Getting the most from the medicines budget Sometimes a manufacturer will undercut the drug tariff price. We can only access these prices if we specify that manufacturer – the Branded Generic. Brand 90p Generic 60p Branded generic 45p Solpadol £6.74 Co-codamol £3.90 Zapain £3.03

Getting the most from the medicines budget Specials Getting the most from the medicines budget Branded medicines, generics and branded generics all need a marketing authorisation (licence). This is a guarantee of safety and quality. If a medicine does not have a marketing authorisation in the UK, it is called a special. These are most often liquid preparations of marketed medicines but may also include medicines not routinely used in UK. Specials vary widely in cost, sometimes costing hundreds of pounds more than the equivalent tablets or capsules. Amiodarone tablets costs £1.53/month Amiodarone liquid costs £247/month

Getting the most from the medicines budget What can patients do? Getting the most from the medicines budget Consider switching if your practice asks. You will never be switched to a medicine that is of lower quality or not suitable for you. As the market and prices change you may be asked to switch again. By allowing your medications to be switched you are helping the NHS to save money. (£300,000 last year in B&H!) If you are unsure your pharmacist can advise. Consider other options before asking for a liquid medicine. We reserve liquid medicines for very young children, patients who are tube fed or have swallowing difficulties Your pharmacist can advise if you have difficulty swallowing tablets. Some tablets can be halved or crushed, mixed with liquid or yogurt. (Check with your GP/pharmacist)

What can patients do? Self management / self care This doesn’t mean not seeing your doctor or not accessing other healthcare services. It means any actions you can appropriately take to recognise, treat and manage your own health. Especially short term conditions (headaches, coughs/colds, sprains). You don’t have to do this alone. It can be in partnership with the NHS e.g. visiting your pharmacy for advice.

What can patients do? http://www.wecouldbeheroes.nhs.uk/

£500,000 What can patients do? How much did Brighton and Hove spend on prescribing paracetamol and ibuprofen last year? £500,000 (And that’s just the medicine cost!) It costs the NHS over £45 for 16 paracetamol tablets to be prescribed through a GP consultation. 16 paracetamol tablets costs approximately 20p in supermarkets Buy low cost medicines from the chemist or supermarket rather than asking for a prescription - dispensed prescriptions cost more to the NHS than just the cost of the medicines. Your pharmacist can advise you which ones you can buy.

#HelpMyNHS

Reducing medicines waste What can patients do? Reducing medicines waste Only request repeat prescriptions when you need them and only ask for medicines you are taking. Tell your doctor/pharmacist if there’s a prescribed medicine that you don’t take. Check the bag before you leave the pharmacy and hand back anything you don’t need. Take your medicines with you if you go into hospital (green bag scheme).

What can patients do? Where to get advice? NHS Choices www.nhs.uk (Do NOT use google!) Community Pharmacy – medication use reviews and new medicines follow up (certain conditions only) Pharmacist at your GP - some practices have pharmacists in-house who will offer advice and review medications. Home medication review – frail, vulnerable or housebound patients may be offered a home visit (including care homes) from a pharmacist attached to the GP practice

Any questions?

For you to consider… 1. Do you take medicines? 2. Do you know what your medicines are for and what they do? 3. Did you have the side effects explained to you? 4. If you have a problem with or question about your meds, who would you ask? 5. What are the main things you go to a pharmacy for? 6. Did you know you can ask the pharmacist to review your medicines and help you manage them? 7. Did you know you can have certain checks at your pharmacy? 8. If you don’t take medicines and rely on other things to help when you feel ill, what are these?