Bruce Warner was seconded to the position of deputy chief pharmaceutical officer at NHS England in mid-September 2014, following a career in patient safety. Promoting medicines optimisation is an important aspect of this role.
Since the term ‘medicines optimisation’ was coined by NHS England in 2012, has that made a difference to what pharmacists do and patient outcomes?
It has made a big difference in terms of focusing what pharmacists do. Previously, we used the term ‘medicines management’, which had connotations that it was mainly about cost savings. Medicines optimisation is actually much broader than that so, rather than purely being about drug cost, it is about getting the best value from the use of medicines and the best outcomes for patients that we can. In some cases, this may mean not using the cheapest medicines. For instance, by working with the patients and finding out what they want from their medicines, we may be able to keep people out of hospital — that has got to be much better than simply using the cheapest medicines to keep the drug bill down but experiencing bigger costs in the wider system. We need a broader, more patient-centred approach, and so we need to stop using the term ‘medicines management’ and start using the term ‘medicines optimisation’.
What progress has been made on medicines optimisation over the past 12 months?
The Royal Pharmaceutical Society (RPS) published a report in May 2013 that set out the principles of medicines optimisation. Since then, these principles have been explored and a programme has been set up that has a high level of ministerial buy-in. The programme has been established with partners, including the Association of the British Pharmaceutical Industry (ABPI) and other professional organisations such as the RPS, and is linked to the recently agreed five-year Pharmaceutical Price Regulation Scheme [used by the Department of Health to manage the cost of branded medicines in the NHS]. It has four different workstreams that are overseen by a steering group, and the projects from within those workstreams are starting to take shape. Probably the most advanced example is the work around measurement and the development of the medicines optimisation dashboard, the prototype of which is already out there and being used. We also have a series of 15 roadshows planned jointly with the ABPI and the Academic Health Science Networks (AHSNs) to launch the programme formally in 2015. Critically, we have also held two patient panels to ensure patients remain at the heart of the programme.
A Cochrane review found that current methods to improve adherence to medicines, including support from pharmacists, are not very effective and concluded that it is uncertain how adherence to medication can be consistently improved. Do you have a view on this?
It is early days and in fact the evaluation of the new medicine service (NMS) was robust and showed clinical and cost-effectiveness but was too late to be included in the Cochrane review
. The review says that there is much more work needed to establish a sound evidence base, and part of our programme is to build on what is already there, have it evaluated and bolster the evidence base.
What are the next steps for the medicines optimisation agenda?
It is about embedding the principles of medicines optimisation into everyday practice. One of those principles is that medicines optimisation becomes the framework and the foundation for everything that we do, so the next steps for the programme is getting people used to working to those principles, communicating what they are all about, how we want people to try to use them, and getting that change in language from the old style of medicines management to the new medicines optimisation.
Does NHS England see a future for medication reviews in community pharmacies?
Undoubtedly it does. There are lots of different concepts of what a medication review is, and we need to tease that out. We have medicines use reviews (MURs), which are different to clinical medication reviews, and the NMS, for instance. Reviews done in a pharmacy may be different to the ones that are done in GP practices by pharmacists. I cannot imagine that there is not a role for pharmacists of all types here. Who is better placed to undertake those reviews than people who have trained for at least five years in medicines use?
What are your three main priorities?
As well as seeing the medicines optimisation programme established and embedded into practice [in England], I want to see pharmacy in all its guises play its full role in terms of things like the urgent and emergency care review. Key to that happening is the summary care record — I want not only to have read access to that, but it is essential that pharmacists also get write access. The five-year forward view provides an opportunity for us to do things differently and opens the door for pharmacy to start playing its full part. I want to see pharmacy providing a consistent service that allows the public and professional organisations to have confidence that it can deliver on the opportunities that it has at the moment.
 Nieuwlaat R, Wilczynski N, Navarro T et al. Interventions for enhancing medication adherence. Cochrane Library 2014 doi:10.1002/14651858.CD000011.pub4.