Transforming NHS pharmacy aseptic services in England

Guidance: Transforming NHS pharmacy aseptic services in England
DHSC 29 October 2020

• Report on the service providing sterile, controlled environments for the preparation of injectable medicines into 'ready to administer' formats for patients. This report recommends investment in hubs to produce aseptic injectable medicines in England in order to create high volumes of aseptic pharmacy products which will: save time for nursing staff, enable care closer to home, produce significant savings.

Access to new medicines in the English NHS

Access to new medicines in the English NHS
Kings Fund 28 October 2020

• This briefing describes the processes that decide whether NHS services in England will pay for patients to receive new, patented drugs, from the initial development and testing of drugs, to the National Institute for Health and Care Excellence’s (NICE’s) appraisal of their effectiveness and negotiations between the NHS and pharmaceutical companies to agree prices.

Economic analysis of the prevalence and clinical and economic burden of medication error in England

Economic analysis of the prevalence and clinical and economic burden of medication error in England
BMJ Quality & Safety 11 June 2020. doi: 10.1136/bmjqs-2019-010206

• Researchers from Manchester Centre for Health Economics have estimated that 237 million medication errors occur at some point in the medication process in England annually, 38.4% occurring in primary care; 72% have little/no potential for harm and 66 million are potentially clinically significant. Prescribing in primary care accounts for 34% of all potentially clinically significant errors. Definitely avoidable adverse drug events are estimated to cost the NHS £98 462 582 per year, consuming 181 626 bed-days, and causing/contributing to 1708 deaths.

Effectiveness of Mobile Applications on Medication Adherence in Adults with Chronic Diseases

Effectiveness of Mobile Applications on Medication Adherence in Adults with Chronic Diseases: A Systematic Review and Meta-Analysis
Journal of Managed Care & Specialty Pharmacy April 2020;26(4):550-61. DOI 10.18553/jmcp.2020.26.4.550

• A systematic review of the literature identified 14 studies which measured the effect of mobile apps on medication adherence in adults with chronic diseases involving 1,785 participants. The meta-analysis showed that the use of mobile apps was associated with a significant improvement in patient adherence to medication (Cohen’s d=0.40, 95% CI=0.27-0.52; P<0 .001="" and="" but="" duration.="" evidence="" intervention="" level="" li="" low="" of="" short="" studies="" the="" were="">

Medicines and Medical Devices Bill

Medicines and Medical Devices Bill
DHSC 13 February 2020

• The Medicines and Medical Devices Bill will allow:
• NHS hospitals to use innovative, personalised medicines for unique cancers and diseases,
• increase the range of professions able to prescribe medicines in low-risk circumstances, reducing unnecessary GP appointments
• introduce new regulations on medical devices, such as pacemakers, breast implants and ultrasound imagers, to ensure patient safety
• Read the House of Commons Library briefing.

Exiting the EU: supplying the health and social care sectors and NAO EU exit hub

Exiting the EU: supplying the health and social care sectors
NAO 27 September 2019

• The NAO has reviewed the Department for Health & Social Care’s (DHSC’s) preparations to make sure the UK has a steady flow of supplies for the health and social care sector when it leaves the EU. Of the Government’s own “reasonable worst case” assumption is that the flow of goods across the Channel could be reduced to 40-60 per cent of current levels on day one. 12,300 medicines used in the UK, DHSC estimates that around 7,000 come from or via the EU.
• The NAO EU exit hub draws together work on departments’ performance on EU exit to date. https://www.nao.org.uk/exiting-the-eu/

Prescribed medicines review

Prescribed medicines review
PHE 10 September 2019

• An analysis of the scale and distribution of benzodiazepines, Z-drugs, gabapentinoids, opioid pain medications and antidepressants found that 1 in 4 adults had been prescribed at least one of these classes of medicines in the year ending March 2018. The report examines prescribing trends and links to deprivation. 
• PHE has also published a detailed geographical breakdown of prescribing rates by CCG.
• Read the PHE commentary

Medicines in health and social care

Medicines in health and adult social care
CQC 5 June 2019

• Based on analysis of inspection reports, notifications of incidents and enforcement notices CQC have identified six common areas of risk with medicines across regulated health and adult social care services. 
• These are Prescribing, monitoring and reviewing; Administration; Transfer of care; Reporting and learning from incidents; Supply, storage and disposal; Staff competence and workforce capacity (including antimicrobial stewardship and Stopping over-medication of people with a learning disability, autism or both (STOMP)). CQC suggest areas for improvement.
• (Excludes providers of online consultations over the internet or by other remote means.)

NICE Resources for local partnerships

 Resources for local partnerships

• NICE has produced a set of resources for local partnerships designed to help systems work together to provide consistent, high-quality care, based on the best evidence. Each topic includes resources from PHE, NICE, Right Care, NHS England and others.
• Current resources are: CVD prevention (kidney management, risk assessment, NHS Health checks, hypertension, atrial fibrillation, diabetes); Frailty, Transfer of care, Making Every Contact Count, Medicines Optimisation and Urgent & emergency care.
• The Urgent and emergency care care resource includes detailed tables linking to appropriate guidelines, NICE Pathways, quality standards and quick guides relevant to each strand of work.

What is a Biosimilar Medicine?

What is a Biosimilar Medicine?
NHS England 30 May 2019

• An update for key clinical and non-clinical stakeholders about the role of biosimilar medicines in the NHS in England and to support the safe, effective and consistent use of all biological medicines, including biosimilar medicines, to the benefit of patients.
• See NHS England Biosimilar medicines

Polypharmacy: Getting our medicines right

Polypharmacy: Getting our medicines right
Royal Pharmaceutical Society 1 February 2019

• This guide provides a summary of the scale and complexity of the issue of polypharmacy. It outlines how healthcare professionals, patients and carers can find solutions when polypharmacy causes problems for patients and points to useful resources that can help. 
• The guidance recommends that all healthcare organisations have systems in place to ensure people taking 10 or more medicines can be identified and highlighted as requiring a comprehensive medication review with a pharmacist.

Brexit Medicine supply update – letter

Medicine supply update – letter from Dr Keith Ridge
NHS England 18 January 2019

• As part of the ‘no deal’ EU Exit preparations a significant amount of work has been carried out by NHS England, DHSC and partners. This letter from Keith Ridge, Chief Pharmaceutical Officer, outlines the steps taken thus far to protect the continuity of supply for medicines.

Medicines management for people receiving social care in the community

Medicines management for people receiving social care in the community
NICE Quality standard [QS171] July 2018

• This quality standard covers assessing if people need help with their medicines and deciding what medicines support is needed to enable people to manage their medicines. It also includes communication between health and social care staff, to ensure people have the medicines support they need.

Open Prescribing website

OpenPrescribing.net
EBM DataLab, University of Oxford, 2017

• Anonymised data on drug prescribing by general practices for "for GPs, managers and everyone to explore"
• Data on prescribing by CCG, individual General Practice, and national trends by drug.

Investigation into NHS spending on generic medicines in primary care

Investigation into NHS spending on generic medicines in primary care
National Audit Office 8 June 2018

• This investigation focuses on primary care, where most spending on generic medicines is incurred, and it sets out the facts in relation to NHS spending on generic medicines, and the 2017-18 increase in spending on certain generic medicines. It also describes possible causes of the price increases in the market for generic medicines and how the Department of Health and Social Care and its arm’s-length bodies responded to the price increases. (Kings Fund summary)

Medicine safety: indicators for safer prescribing

Medicine safety: indicators for safer prescribing
DHSC 10 May 2018

• The Medicines Safety Programme is developing a series of prescribing indicators which link prescribing data with hospital admission. The purpose is to identify prescribing that could potentially increase the risk of harm and that may be associated with hospital admission. 
• The indicators will be available on an open access Medicines Safety Dashboard.

The rising cost of medicines to the NHS

The rising cost of medicines to the NHS: what’s the story?
Kings Fund 26 April 2018

• An examination of the health service spend on medicines, both generics and branded medicines found that the volume of prescription items provided to patients in primary care increased by almost half in the decade to 2016 (to 1.1 billion items), this was offset by a reduction of nearly a quarter in the average cost per prescription item (to £8.34).

Commissioning framework for biological medicines

Commissioning framework for biological medicines (including biosimilar medicines)
NHS England, NHS Improvement 12 September 2017

• Biological medicines are currently the largest cost and cost growth areas in the NHS medicines budget. Many biological medicines are coming off patent and “biosimilars” are becoming available. Using a new commissioning framework, NHS England aims to drive a step change in the uptake of biosimilar medicines by CCGs and providers.
• The report outlines the opportunities for use of biosimilars for a number of currently used biologicals and a link to the Medicines Optimisation Dashboard which gives details of use of Infliximab and Etanercept by provider and CCG.
• Background and developments on the NHS England Biosimilar Medicine webpage.

How can we all best use scientific evidence?

How can we all best use scientific evidence?
Academy of Medical Sciences June 2017

• A survey of British adults which indicated that only 37% of the public said they trusted evidence from medical research, compared to 65% who trusted the experiences of their friends and family. 
• The Academy of Medical Science has drawn up an action plan on how to make sure medical research is robust, relevant, trusted and that the evidence generated is useful and accessible to doctors and patients.

Accelerated Access Review

Accelerated Access Review
Department of Health June 2015 updated October 2016

• The Accelerated Access Review aims to set out new pathways for the development of medicines and medical technology, ultimately to give NHS patients quicker access. 
• To add international insight, the Review asked RAND Europe to conduct a study with the aim of identifying and gaining insight into international examples of best practice where the use of new drugs, devices and diagnostics were already being accelerated.
• An interim report (October 2015) identifies the drivers/enablers of innovation and barriers or systemic tensions perceived to be slowing access. Discussion with stakeholders identified five propositions to speed up access to transformative health technology that can change the lives of NHS patients. These are:
• Putting the patient centre stage 
• Getting ahead of the curve 
• Supporting all innovators 
• Galvanising the NHS 
• Delivering change
• Final Report (24 October 2016)  Accelerated Access Review: Review of innovative medicines and medical technologies 
• The final report, supported by the Wellcome Trust, describes the pathway to market for both strategically-important innovations and products with more incremental benefits and makes recommendations for each. The report makes recommendations on how each of the six steps in the production pathway could be streamlined and accelerated so that patients get access to the most innovative products more quickly and more cheaply.