Wes Mountain/The Pharmaceutical Journal
The medicines value team (MVT) at East Kent Hospitals University NHS Foundation Trust (EKHUFT) was formed from the legacy medicines optimisation team, with the aim of providing support for the NHS’s increasingly complex commissioning and quality agendas involving medicines. The MVT ensures the pharmacy department delivers the EKHUFT’s medicines value programme, supporting the quality and financial challenges around the effective use of medicines.
The medicines value programme was first set up by NHS England in 2018 to make the best use of the NHS medicines budget. It incorporates the challenges around patient access to medicines, clinical and cost-effectiveness, good patient outcomes, medicines safety and robust purchasing arrangements.
The MVT at EKHUFT brought together expertise in: medicines information (MI); medicines procurement; cost-effective prescribing, including formulary management; clinical informatics, including benchmarking; homecare for medicines; medicines ‘optimisation’ aspects, including the ‘Commissioning for quality and innovation’ framework, a cost improvement programme (CIP) and biosimilars. The MVT is also the point of contact for interface issues with primary care.
It was agreed that a successful MVT would be defined as one that:
- Uses evidence to ensure the most cost-effective medicines are being supplied to improve patient outcomes;
- Employs medicines usage intelligence to understand where and how medicines are being used in the EKHUFT and in our local population.
The MVT became fully established in late 2019, just before the COVID-19 pandemic. There was little time to develop and initiate any medicines value projects before all work was switched to supporting clinical teams and dealing with critical medicines shortages.
Once ‘business as usual’ started to return to the EKHUFT, the MVT’s first task was to restart the CIP. It worked closely with the specialist clinical pharmacists to identify areas of cost saving, as well as wider medicines value initiatives.
In 2022/2023 and 2023/2024, the MVT exceeded the EKHUFT’s ambitious annual target of saving £1m for medicines savings.
To achieve this target, the MVT oversaw the expansion of homecare services, ensured the introduction of biosimilars in a timely manner and supported ‘invest to save’ business cases in specialist clinical areas.
Embedding sustainability is crucial to effective medicines value practice, as it encourages a system-wide approach to changes
By working closely with the EKHUFT’s business intelligence (BI) team, a bespoke data dashboard was developed to track all cost-saving schemes, including contract savings, biosimilar switches and individual medicines saving schemes. The MVT regularly interrogates prescribing data using established national data platforms, such as ePACT and EKHUFT’s BI dashboards. It has now started to explore ways to use data from electronic prescribing and medicines administration (ePMA) systems to further evaluate medicines use, particularly related to patient outcomes.
The MVT has worked collaboratively with neighbouring acute trusts and the NHS Kent and Medway Integrated Care Board (ICB) to ensure medicines value projects are aligned and working for all patients across our ICB area. There is also ongoing work with the NHS Kent and Medway ICB to contribute to a joint formulary, align prescribing pathways, such as for rheumatoid arthritis, and ensure timely implementation of the National Institute of Health and Care Excellence’s technology appraisals, which will benefit all patients across the region.
Within the EKHUFT, the MVT works closely with our specialist pharmacists, nurses and consultants to ensure that medicines are delivered in a safe and efficient manner, biosimilar switches are effectively communicated ahead of time to both patients and teams, and financial information, such as expenditure and CIPs, are relayed to teams. By working with NHS England, the MVT has implemented shared care pathways to ensure patients have access to medicines closer to home rather than having to travel to specialist centres outside of the area.
Environmental sustainability
Acknowledging the necessity of pharmaceuticals should be considered in careful balance with understanding the downsides to their use. A significant detrimental consequence of medicines use is the associated carbon footprint, which is well documented as attributing to 25% of the total NHS carbon footprint. The selection and application of medicines, including their associated sundry items, is vitally important if the negative downsides of their carbon footprint are to be negated as much as possible.
To understand the scale of this task and embed this in decision-making practices, a new environmental sustainability role was created. This role, delivered by a senior pharmacy technician, provides the leadership and management of the MI service, as well as the sustainability agenda for the whole department. One of the first initiatives was to successfully remove all single-use plastic bags within the pharmacy department. The post-holder now regularly attends the drugs and therapeutics advisory group meetings to ensure that decision-making includes sustainability issues. Formulary applications now include a section on sustainability, so the environmental element of new medicines selection is considered.
Education on environmental sustainability is provided to ensure the sustainability agenda remains a major consideration for the entire department. Active research is encouraged within the MVT, with current projects focusing on climate change and medicines use.
The role also feeds into the NHS Kent and Medway ICB green working groups to ensure a systems approach is taken to sustainability changes — an example being the successful pilot of the largest inhaler recycling scheme in the UK.
Embedding sustainability is crucial to effective medicines value practice, as it encourages a system-wide approach to changes. While also remembering that our patients are not living in a perfectly sealed environment and detached from the impacts of climate change, the adjustments we implement should, at the very least, avoid exacerbating the situation.
The future plans for the MVT are to incorporate innovation and research into the objectives by using ePMA data to evaluate medicines use and patient outcomes, development of audits/research ideas to answer medicines value questions, and the development of a research group to improve cost-effective and safer user of medicines. There is also a need to increase work across the department on the sustainability of medicines use by leading and supporting a green pharmacy programme.
