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Medicines optimisation teams across the UK are entrusted with managing the medicines budget for their locality. Medicines represent the second highest expenditure for the NHS after staffing, with medicines teams delivering £0.5bn savings in 2024/2025. As the NHS increasingly focuses on prevention, the role of medicines becomes even more crucial. With medicines constantly evolving, the NHS needs to keep pace for the benefit of patients.
For a long time, there has been some distance between the NHS and the pharmaceutical industry, and rightly so, since there are clear differences between the two. Increasingly, third parties have seen an opportunity to attempt to align the industry and the NHS. Industry has the funding and the staffing to be able to deliver medicines opportunities to the NHS that are simply not available within the health service. These third parties — intermediary organisations that are usually managed by pharmacy professionals — work alongside the industry and the NHS to introduce new medicines and to help problem solve. It can feel like a grey area for the NHS but that is not to say it cannot, or should not, be done.
For two years, I have had the opportunity to work alongside pharmaceutical companies and intermediary organisations to tackle some crucial issues for Leeds. Currently, the Leeds medicines optimisation team is focusing on maintenance and reliever therapy (MART), a new form of a single inhaler approach to asthma management, using a combination of an inhaled corticosteroid (ICS) and a fast-acting long-acting beta-2 agonist (LABA) — such as formoterol — for both daily maintenance and as needed for reliever use. This work is funded by a pharmaceutical company that produces one of the treatment options and is delivered to practices via an intermediary organisation.
By providing MART, we are looking to demonstrate that we can improve patients’ lives and reduce demands on primary and secondary care
We did this work because Leeds has areas where there are high numbers of people with unmanaged asthma. Poorly controlled asthma severely impacts patients’ lives and increases GP appointments and acute admissions into hospital. By providing MART, we are looking to demonstrate that, with more preventative therapies, we can improve patients’ lives and reduce demands on primary and secondary care.
The work is in its second phase, after an initial first proof of concept pilot ran in 2023/2024 with 20 practices. The current phase is well under way, with 40 practices signed up, and is months ahead of schedule for completion. It involves identifying the locations that would best benefit from this opportunity, the places with the highest numbers of patients with unmanaged asthma and liaising with practices that may want to take part.
We have also worked alongside an intermediary organisation to deliver a project on reducing problematic prescribing of oral nutritional supplements (ONS) in Leeds. This work tackled the projected growth of unmonitored ONS usage and reduced spend on ONS by £397,887 in 2024/2025, with annual savings ongoing. We have other areas of work with other organisations in the pipeline.
How did we do this and how could other areas do this? Leeds is not the only place doing this sort of work — more and more areas are doing it or contemplating it. For those that are uncertain, here are some key takeaways:
- Risk: There is always an element of risk involved — however, medicines optimisation teams should be assured that the Association of the British Pharmaceutical Industry has strict regulations regarding how the pharmaceutical and intermediary organisations can work with the NHS. Open and transparent working arrangements with comprehensive agreements and protocols are essential;
- Due diligence: Use your organisational collaborative working policy — it is there to support partnership working and expand reach and access;
- Governance: Liaise with your internal governance team regarding information governance and data protection. Data protection impact agreements are a must when considering this sort of work, alongside a quality, equality impact assessment;
- Network: Finally, when first embarking on this sort of work it can feel daunting and overwhelming. I would strongly encourage you to reach out to other areas to discuss how they did it, what they learned and would do differently. I personally had many of these discussions when we first embarked on this journey and have had many more since with other areas considering it. Reaching out to different areas will offer rich insight into potential pitfalls and benefits that may not have been considered.
The future health of the NHS and its patients can undoubtedly benefit from more collaborative approaches. We should be looking to proceed cautiously but optimistically to grasp new opportunities to the benefit of patients and prescribing budgets.
