UK Government publish overprescribing report

UK Ministers have announced action to prevent medicines from being prescribed unnecessarily, following a new review led by the Chief Pharmaceutical Officer for England.

The government will take action to prevent medicines from being prescribed unnecessarily in England, as a new review highlights the impact of overprescribing.

Led by Chief Pharmaceutical Officer for England Dr Keith Ridge CBE, the government-commissioned review into overprescribing found 10% of the volume of prescription items dispensed through primary care in England are inappropriate for that patients’ circumstances and wishes or could be better served with alternative treatments.

Around 1 in 5 hospital admissions in over-65s and around 6.5% of total hospital admissions are caused by the adverse effects of medicines. The more medicines a person takes, the higher chance there is that one or more of these medicines will have an unwanted or harmful effect. Some medicines, such as those to reduce blood pressure, can also increase the risk of falls amongst the frail and elderly.

The review sets out a series of practical and cultural changes to make sure patients get the most appropriate treatment for their needs while also ensuring clinicians’ time is well spent and taxpayer money is used wisely. This includes shared decision making with patients about starting or stopping a medicine, better use of technology, ways to review prescriptions more effectively, and considering alternative medicines which would be more effective.

Ministers have accepted all recommendations and work will now begin to implement them, with reforms to pharmacist training already underway.

The key recommendations from the review are:

  • the introduction of a new National Clinical Director for Prescribing to lead a 3-year programme including research and training to help enable effective prescribing
  • system-wide changes to improve patient records, improve handovers between primary and secondary care, develop a national toolkit and deliver training to help general practices improve the consistency of repeat prescribing processes
  • improving the evidence base for safely withdrawing inappropriate medication (deprescribing), and updated clinical guidance to support more patient-centred care. This would include ensuring GPs have the data and medical records they need, and are empowered to challenge and change prescribing made in hospitals
  • cultural changes to reduce a reliance on medicines and support shared decision-making between clinicians and patients, including increasing the use of social prescribing, which involves helping patients to improve their health and wellbeing by connecting them to community services which might be run by the council or a local charity
  • providing clear information on the NHS website for patients about their medication and the creation of a platform for patients to be able to provide information about the effectiveness and the adverse effects of their medicines; and
  • the development of interventions to reduce waste and help deliver NHS’s net zero carbon emissions

The review also calls for more research to investigate the reasons why overprescribing is more likely to affect older people, people from ethnic minority communities and people with disabilities.

Health and Social Care Secretary Sajid Javid said:

“This is an incredibly important review which will have a lasting impact on people’s lives and improve the way medicines are prescribed.

“With 15% of people taking 5 or more medicines a day, in some cases to deal with the side effects of another medicine, more needs to be done to listen to patients and help clinical teams tackle overprescribing.

“I look forward to working with Dr Keith Ridge and our dedicated NHS teams to deliver on these recommendations.

Dr Keith Ridge CBE, Chief Pharmaceutical Officer for England, said:

“Medicines do people a lot of good and the practical measures set out in this report will help clinicians ensure people are getting the right type and amount of medication, which is better for patients and also benefits taxpayers, by preventing unnecessary spending on prescriptions.

“This report recognises the strong track record of the NHS in the evidence-based use of medicines, thanks to the clinical expertise of GPs and pharmacists and their teams, and our achievements to date in addressing overprescribing, which is a global issue.

“Continuing to tackle overprescribing requires a whole system approach involving clinicians and patients, so we can continue to build the change we all wish to see in how medicines are used for the benefit of patients, and with medicines production and use a major driver of greenhouse gas emissions – contributing to the NHS’s net-zero ambition.”

Duncan Rudkin, Chief Executive of the General Pharmaceutical Council, said:

“This important report sets out changes which will help improve how medicines are prescribed for patients.

We look forward to working with the Chief Pharmaceutical Officer for England and his team, as well as the new National Clinical Director for Prescribing and other relevant regulators, to take forward its recommendations.

“Pharmacists, pharmacy technicians and the wider pharmacy team in all settings are already working closely with prescribers and with their patients to help make sure that people get the right medicines, at the right time, in the right doses.

“The report recognises that pharmacists and pharmacy technicians across England will also have a vital part to play in taking forward the actions outlined to improve patient care.  We know there is also work underway in Scotland, as outlined in the Achieving excellence in pharmaceutical care strategy and in Wales as part of delivering A healthier Wales long term plan, to help make sure that patients only get the medicines they need.

“As this report highlights, pharmacists are increasingly taking on greater responsibilities for helping to make sure that patients get the most appropriate treatment for their needs, including through working as independent prescribers.

“We are working with stakeholders to introduce major changes to the initial education and training of pharmacists so that in the future all pharmacists joining our register will be independent prescribers from the point of registration.  We will also shortly begin a consultation that proposes changes to enable more pharmacists already on our register to begin training as an independent prescriber at an earlier stage.

“The report also highlights that there will be further demand for pharmacy technicians with the skills and knowledge to help deliver the report’s recommendations. We will work with key stakeholders to consider how the education and training of pharmacy technicians needs to develop to meet this demand and the future needs of patients and the public.

“This review proposes system-wide changes to improve the use of patient records, which we fully support. It is essential that pharmacists working in all settings, including community pharmacy, can both access and update patient records, to make sure everyone involved in the patient’s care knows what medicines they are taking. We are considering what further work we can do to support improvements in the quality of record-keeping in pharmacies.

“We also fully support the focus in this review on shared decision-making with patients and the public on starting or stopping a medicine, as well as making sure that patients have all of the information they need about their medicines.  We emphasise the importance of this happening in our standards and guidance for pharmacy professionals, to support person-centred care.”

Nick Kaye, Vice Chair at the National Pharmacy Association said:

“This is a highly significant report. Medicines are the single most widespread healthcare intervention, so it’s vital that their use is optimised, to help patients and to ensure value for money for the NHS.

“Community pharmacists could play an increasingly important role in ensuring effective prescribing, for example through Structured Medication Reviews and as independent prescribers. That will improve patients’ access to advice and deploy the expertise of pharmacists to good effect. The clinical skills of all pharmacists, not just those working in GP practices, need to be brought to bear further on this important agenda.

“On the flip side of overprescribing is the matter of helping patients get the most from their medicines once dispensed, which is the bread and butter of community pharmacy.  New services like the Discharge Medicines Service and the extended New Medicine Service build on this role significantly.

“In implementing the report’s recommendations, the principle of shared decision-making will be very important, so that the focus is always on getting the best from medicines and never on denying access to medicines, which serves to exacerbate health inequalities.”

Chair of the RPS in England Thorrun Govind said:

“We welcome this review which outlines what needs to happen to stop overprescribing across healthcare and ensure more effective use of medicines. Many of us take more medicines than we need and this can have a hugely negative impact on our health. 

“As science advances and people live with complex and multiple conditions, they are prescribed an increasing number of medicines. For too long the healthcare system has focused on the positive effects of adding medicines to a prescription, rather than acknowledging that this can also increase the risk of side effects and interactions between medicines, leading to poor health and costly unnecessary admissions to hospital.

“We need to focus on putting shared decision making between the prescriber and patient at the heart of prescribing, and look at the individual needs and circumstances of each person.

“This report explores many of the issues that pharmacists have been highlighting for a long time and gives a range of solutions. Pharmacists across the country will be eager to play an active role, working alongside the patients and communities they serve, to reduce the harm that medicines can cause when over prescribed.”

RPS representative on the report’s working group, Lelly Oboh FRPharmS, said:

“Using medicines is an important aspect of health care that helps people to live better lives. It’s vital that we take a holistic approach that considers a person’s social, physical and mental health needs so they are only prescribed medicines that enable them to achieve the outcomes that are most important to them. 

“As people get older, the more long-term conditions they have, the more medicines they are prescribed to manage them. Our current culture and the way our systems are set up favour the use of medicines as a ‘one size fits all’ to manage these conditions. They continue to be prescribed long after they are wanted or needed, resulting in harmful effects, a reduced quality of life, unnecessary admissions to hospital and medicines wastage.

“This report will change how we start, stop, monitor and review people’s medicines, with a greater emphasis on having person-centred conversations, which include listening to people’s’ perspectives and sharing decisions about their priorities, preferences, risks and benefits of taking medicines.

“I welcome the report and look forward to the changes that it will bring for the benefit of our patients and the NHS. “Our role as pharmacists is essential to ensuring that medicines are safe and effective for people who take them and there are ample opportunities in the report for pharmacy ‘together’ to collaborate with other partners to implement the recommendations.

“We will make every conversation count by keeping people at the centre of their care when we undertake structured medication reviews, prescribe or dispense medicines, provide medicines information and advice, so that they get the medicines they need and are willing to take.”

NI public urged to use their local community pharmacy

Community Pharmacy Northern Ireland is highlighting the role community pharmacies are playing in alleviating pressure on other parts of the health service as we enter what is expected to be an extremely challenging winter period.

The theme of this year’s World Pharmacists Day is “Pharmacy: Always trusted for your health” and the representative body is urging the public to reflect on how pharmacies have been supporting their local communities. 

Last week, it was announced that community pharmacy is to have an expanded role in this year’s Winter Flu Vaccination Programme, taking responsibility for administering the jab to frontline health and social care workers as well as those aged over 50.

A newly expanded ‘Pharmacy First’ service will soon be introduced in Northern Ireland to provide consultations, advice, and treatments for minor health conditions and, if necessary, recommend an appropriate referral. Through the service, patients are encouraged to visit a participating community pharmacy rather than their GP for a defined list of common conditions. 

To date, community pharmacies have also seen their role in the Covid-19 vaccination programme increase to provide a permanent vaccination setting in the months ahead. Currently, in Northern Ireland, there are 350 community pharmacies still offering the Astra Zeneca vaccine, whilst 54 are currently administering the Moderna vaccine – with plans for this to be scaled up. The sector is also hopeful of inclusion in the Covid-19 booster programme.

Chief Executive of Community Pharmacy NI, Gerard Greene said:

“This World Pharmacists Day is an opportunity to showcase the range of services our community pharmacies can offer and the role they will play as a crucial, accessible part of the health service. It is also a time to pay tribute to our pharmacy teams across the network and their dedicated work to all in the community who they work tirelessly for all year round.

“Remaining agile throughout the course of the pandemic we introduced new services to meet the changing needs of the public, with the safe supply of medicines a major priority. Our community pharmacy network remains committed to supporting our communities and the wider health service by playing an increased role in primary healthcare ahead of what is expected to be a difficult winter period.

“We are all too aware of the pressures the health service is currently under. Community pharmacy is a vital community health asset, ready to provide practical solutions. I would encourage the public to think ‘Pharmacy First’ this autumn and winter.”

Community Pharmacist, Peter Rice said:

“Throughout the course of the pandemic, community pharmacies have shown that they can make a real difference in our communities as we fight against Covid-19. We are ready to do the same again as we enter what looks to be a challenging winter.

“Many are not fully aware of the impact community pharmacy teams have within their communities, for example, just recently a Northern Ireland community pharmacy pandemic delivery service identified patients who required ambulance call-outs, urgent referrals to ED, and prevented harm to many vulnerable and isolated people within our communities.”

I look forward to celebrating our network on this World Pharmacists Day as we continue to provide accessible healthcare at a convenient location to our patients with a clinician they know and trust.”

Pharmacy in Practice announces new Clinical Director

Stephen-Andrew Whyte

Pharmacy in Practice has announced the recruitment of its first-ever Clinical Director. Stephen-Andrew Whyte will take on the role of providing innovative leadership to further bolster the training offers provided by Pharmacy in Practice.

Stephen is a registered pharmacist and advanced clinical practitioner with experience in critical care, emergency care and general paediatrics. He has a background in paediatric and neonatal pharmacy and healthcare education.

Stephen was the first pharmacist in the UK to be recognised as an advanced clinical practitioner, and the first pharmacist to undertake a HEE Clinical Fellowship in Urgent and Acute Care. He also led an innovative pilot training pharmacists as advanced clinical practitioners in urgent and emergency care.

Stephen has just ended a two-and-a-half-year period as the course director for the MSc Advanced Clinical Practice (Child) course at London South Bank University and will shortly take up the position of Professional Lead for Advanced Clinical Practice at Great Ormond Street Hospital, London.

Stephen is a member of the General Pharmaceutical Council, a Fellow of the Royal Pharmaceutical Society, an Affiliate member of the Royal College of Paediatrics and Child Health and an associate member of the Royal College of Emergency Medicine.

His current research interests include advanced practice curriculum design and implementation and technological mental health interventions for children and young people. 

Clinical Director of Pharmacy in Practice Stephen-Andrew Whyte commented:

“I am delighted to have this opportunity to put my varied experiences to good use in this new position of Clinical Director at Pharmacy in Practice. I look forward to shaping the future of pharmacy education and training.” 

Director of Pharmacy in Practice Johnathan Laird said:

“I am delighted to welcome Stephen onto the Pharmacy in Practice team as our first-ever Clinical Director. Stephen has an exemplary career to date and has shown considerable leadership within the education scene particularly around competence based training and advanced practice.

“Whilst there are many reasons to be excited to work with Stephen I particularly admire and appreciate how he has sought to influence education beyond his own profession. Whilst we are both passionate about creating a well-respected pharmacist-led training provider we also need to look beyond our own profession to show leadership. Pharmacists have so much to offer but we must first understand and carve out our own professional identity.

“We have plans to deploy a large library of online learning on PIP. Stephen will guide this work and ensure quality is built in from the outset. Stephen’s experience will bring an innovative student-centred approach.

“The world has changed and the playing field has levelled giving organisations like Pharmacy in Practice the opportunity to lead within their niche. I feel that the new environment has meant that we should question everything in terms of how we connect and build our networks. Remote working is now the norm and remote learning is no different.

“Pharmacy, and in particular community pharmacy, requires significant investment. Pharmacists and their teams deserve the infrastructure, time and expertise to truly realise their potential. We will drive this investment into the sector over the coming months and years.

“In the new year, we will take 60 independent pharmacist prescribers through a novel micro-credential programme. In my view, this will set a significant precedent and change the way community pharmacists in particular seek to develop their professional competence portfolio.

“Independent prescribing and autonomous practice by pharmacists is certainly here to stay and we will be ready to support.”

PDA respond to calls to temporarily halt GP primary care pharmacy recruitment

The Pharmacist Defence Association have responded to calls from Community Pharmacy Scotland (CPS) to temporarily halt the recruitment of pharmacists and pharmacy technicians to GP primary care roles in Scotland.

The PDA has objected to these proposals indicating that their opinion would be that it is inappropriate to ‘block’ pharmacists from exploring opportunities in other sectors.

PDA Director Paul Day commented:

“This would be a mechanism used to prevent those individuals from leaving their roles in community pharmacy. The PDA are disappointed with what appears to be another high-profile example of the representatives of community pharmacy employers seeking to avoid their members’ responsibility for improving the terms and working conditions they offer to pharmacists.

“This latest development in Scotland follows a joint report in June from the three major UK community pharmacy employer bodies, AIMp, CCA and NPA which noted “reasons cited for colleagues leaving the profession are complex and multifaceted. They include concerns about pay, excessive workload and pressure, inflexible working hours, and a lack of opportunities for career progression”, but failed to commit to, or even to recommend, any actions by employers to improve these conditions.

“Employed pharmacists are increasingly aware of the reduction in the value of the pay being offered by community pharmacy employers. They understand that unless pay increases keep up with inflation the buying power of their salary reduces in real terms. Many pharmacy employers promote the belief that there is a significant shortage of pharmacists, yet then continue with an approach to pay that will further reduce the real-term value of the pay they offer. This defies the basic laws of economics that if demand outstrips supply, then “prices”, or in this case “pay” rates, should increase.

“However, levels of pay are not the only concern and it is widely known that some pharmacists have left community pharmacy for roles practicing elsewhere in the health system. Although some of these roles are lower paid they are more attractive overall due to the mix of job content, environment and working patterns when compared to roles in community pharmacy.

“The PDAs Safer Pharmacies Charter and annual Safer Pharmacies Survey highlight other areas of significant concern to pharmacists, but to date no major community pharmacy employer has agreed to ensure their pharmacies meet the basic safety standards detailed in the charter. The PDA believe that multiple chains should not ignore that some locums publicly state that they will not work in certain branches, or for entire companies, because they believe the conditions in those pharmacies are unacceptable.

“The PDA believe responsible employers faced with this reality would reflect hard on what that means, identify the causes of such concerns, and improve the situation. Instead, the representatives of community pharmacy employers seem to consider everything else except addressing those root causes that are within their control. Many promote the ideology of being an employer of choice, however, the reality appears to be quite the opposite. Therefore, It is not a surprise that some may struggle to find pharmacists prepared to be employed for the rates they want to pay and in the conditions in which they expect pharmacists to practice.

“Attempting to restrict pharmacists’ career options, so that individuals don’t have alternative opportunities is not the right way to recruit and retain more employed pharmacists in the community pharmacy workforce.

“Community pharmacy employers should focus on improving the attractiveness of the jobs they offer instead.

“Improving the balance between the focus on patient care and safety vs. profit; levels of remuneration and workplace pressure; and the level of respect for the pharmacist as a clinical health professional are all examples of factors that are well within the control of employers.”

It is worth noting that the RPS disagreed with the calls from CPS to temporarily halt GP primary care pharmacy recruitment.

MHRA approves Pfizer and AstraZeneca Covid-19 vaccines for booster doses

The Medicine Healthcare Regulatory Authority (MHRA) has provided an update on booster vaccines for Covid-19 and in doing so have approved the use of both the Pfizer and Astra Zeneca Covid-19 vaccines for booster doses.

The MHRA has said it will be for the JVCI to advise on whether booster jabs will be given and if so, which vaccines should be used.

The current supply of the Covid-19 vaccines made by Pfizer and AstraZeneca has been authorised on an emergency use basis by the MHRA under Regulation 174 of the Human Medicine Regulations 2012 and the changes today have been made to the Regulation 174 Product Information only. Both vaccines are also authorised under Conditional Marketing Authorisations (CMAs) but changes to these would follow a different procedure. Vaccines covered by CMAs can also be used as part of a deployment programme via “off-label” use under a prescriber’s direction.

This regulatory decision follows a careful review of available data on safety and effectiveness of booster or supplementary vaccine doses by the MHRA and the independent Commission on Human Medicines (CHM), which advises the government.

Dr June Raine, MHRA Chief Executive said:

“We are committed to getting safe and effective Covid-19 vaccines to the UK public. This means ensuring that existing Covid-19 vaccines can continue to be used in the most effective way possible.

“We know that a person’s immunity may decline over time after their first vaccine course. I am pleased to confirm that the Covid-19 vaccines made by Pfizer and AstraZeneca can be used as safe and effective booster doses. This is an important regulatory change as it gives further options for the vaccination programme, which has saved thousands of lives so far. It will now be for the JVCI to advise on whether booster jabs will be given and if so, which vaccines should be used.

“We have in place a comprehensive safety surveillance strategy for monitoring the safety of all UK-approved Covid-19 vaccines and this surveillance will include booster jabs.”

Elements of this story have been shared under the Open Government license.

‘Pharmacy Collect’ service launches for rapid Covid-19 tests in NI

The Health Minister in Northern Ireland has launched a new ‘Pharmacy Collect’ service which enables people to collect rapid Covid-19 tests from selected community pharmacies.

To date, 420 pharmacies in Northern Ireland have signed up for the scheme.

Rapid tests are available for anyone who requires them in Northern Ireland. All results should be reported. Where someone receives a positive test, they should immediately self-isolate and book a confirmatory PCR test.

The Health Minister Robin Swann commented:

“Alongside vaccination and contact tracing, testing is one of the main pillars of protection against the virus.” 

“1 in 3 people who have COVID-19 have no symptoms or are pre-symptomatic. The introduction of the Pharmacy Collect service will significantly increase the range of locations that people who require rapid tests can access them.

The service supplements the existing workforce testing schemes and other community collect sites, which can all be found using the Sitefinder website.

“By engaging in rapid COVID testing, we can help keep each other safe and play our part in helping society return to normality.”

Cathy Harrison, Chief Pharmaceutical Officer said:

“The contribution of community pharmacy teams to the Covid-19 pandemic response has been invaluable and the introduction of the new Pharmacy Collect service will improve access to testing for the general public.

“This is another step forward to people getting their normal lives back. Many people with Covid-19 have mild or no symptoms, but they can continue to spread the virus. Rapid tests, in conjunction with the wearing of masks, regular hand washing and social distancing, can help to prevent onward transmission of the virus.”

Vice-Chair of Community Pharmacy NI, Peter Rice said:

“The introduction of the Lateral Flow Device (LFD) distribution service to community pharmacy will greatly increase the public’s access to testing at a crucial time. As we enter what is expected to be an even more difficult period for our health service, tests will now be available for collection from over 400 community pharmacies throughout Northern Ireland. By increasing access to testing at a local level we can help to prevent the transmission of the virus within our communities.

“This further demonstrates the desire of our community pharmacy network to deliver new services throughout the course of the pandemic. Having this service in our pharmacies is another significant step forward and supplements our role in the vaccination effort to date.”