National Prescribing Centre < Influencers contents | Print this page National Prescribing Centre The National Prescribing Centre (NPC), based in Liverpool, is a key centre for NHS influencers to be aware of. The NPC is funded by the Department of Health (DH) as a major support centre for pharmacists and prescribing/pharmaceutical advisers. It coordinates the training of these important industry customers. It also produces the MeReC Bulletins, which review prescribing issues for GPs, including newly licensed medicines. The NPC is also the central coordinating point for the UK Medicines Information Pharmacist Group (UKMIPG), which coordinates the evaluation of new chemical entities, on behalf of the DH, before they are launched. In this connection, the NPC also works closely with the National Horizon Scanning Centre at the University of Birmingham, which alerts the DH on new technologies on their way. New Drugs in Clinical Development New Drugs in Clinical Development bulletins are produced about six times a year by the NPC and are sent to NHS decision-makers. The centre also produces a range of useful publications, including the MeReC bulletins. These can be accessed from www.npc.co.uk. The NPC also provides support for nurse prescribers, and a particularly important publication for NHS influencers is a competency framework for independent nurse prescribers. National Medicines Management Services Collaborative Programme A significant number of all PCTs are now pilot sites for the National Medicines Management Services (MMS) Collaborative Programme. This programme is much about meeting the commitments within the document Pharmacy in the future. The sites have recruited local facilitators to work closely with GPs, pharmacists and primary healthcare teams. See the National Prescribing Centre’s (NPC) medicines management section for further guidance on the MMS programme. The first NPC report on the MMS first wave pilots is now available. The report clearly shows that those practices involved reduced the average number of prescription items given to older people — this a requirement of older people NSF. These continued developments in medicines management are likely to impact on a wide range of a pharma company’s commercial strategies. These initiatives also go to the heart of the extended role of pharmacists and nurses as new prescribing customers. This is an important area for local NHS influencers to track and should be part of their local account management strategies. Modernising medicines management The National Prescribing Centre, in collaboration with the National Primary Care Research and Development Centre, has produced a useful practical guide aimed at supporting the NHS locally in the development of effective medicines management services. Modernising medicines management: a guide to achieving benefits for patients, professionals and the NHS consists of two books and is aimed at professionals and managers in PCTs, GP practices and also hospitals. The first book gives a concise overview of the 'why, what and how' of medicines management, and is aimed primarily at senior NHS managers and professionals. Book two is a more detailed reference source and will be of most value ‘to those individuals who have direct responsibilities for developing and delivering effective medicines management services for patients in practice.’ See either www.npc.co.uk or www.npcrdc.man.ac.uk for more details. This should therefore be an essential industry read for NHS influencers — in order to understand in more detail the threats and opportunities inherent in medicines management, as well as becoming more aware of the many relevant local initiatives. Medicines management and the NSFs An important document in this area has been published by the DH — Management of medicines: a resource to support implementation of the wider aspects of medicines management for the national service frameworks for diabetes, renal services and long-term conditions. Ostensibly to support better prescribing for the newer NSFs and those coming on line, this is also a much more general approach to medicines management — essentially than the management of medicines. Not only are concordance, safety and the expert patient programme described but also chronic disease management, NICE guidance, managed entry, health outcomes and the role that chief executives should have in the management of medicines. The ‘statement of values’ (p.3) includes ‘encouraging partnership working between patients, professionals, managers and the industry to improve the use of medicines’, NatPaCT's self-assessment tool for (organisational) medicines management in hospitals and a similar PCT competency framework (both on p.62). The definition of medicines management in the document is also now much broader — ‘medicines management includes the clinical, cost effective and safe use of medicines to ensure that patients get the maximum benefit from the medicines they need’ — and one of the key messages of the new resource is that improving medicines management should be everybody’s business. NHS influencers should expect the medicines management roles in PCTs to become more strategic. Luton Teaching PCT (tPCT) advertising for a medicines management coordinator, was looking for someone to deal with the implementation of NSFs and NICE guidance and the new primary care contracts: ‘You will also contribute to the strategic planning within the clinical quality directorate to inform annual priorities and delivery plans via matrix working with other senior managers within the tPCT’. NHS influencers should also be aware that related and more specific documents have also been produced to support the older people’s NSF and the first part of the renal services NSF, which deals with dialysis and transplantation. Room for review: a guide to medication review Room for review: a guide to medication review has been jointly produced by the medicines partnership task force and the MMS Programme. See www.medicines-partnership.org/medication-review/welcome. It might be worth NHS influencers checking this site regularly. The Medicines Partnership is a DH-funded initiative set up to tackle patient non-compliance. In a recent study it found that in 11 disease areas — including national priority areas like CHD and diabetes, and also depression and osteoporosis — patient compliance was still problematical. For instance, a third of patients who were prescribed statins for the secondary prevention of heart disease were taking their medication incorrectly. The Medicines Partnership has also published A systematic review of two-way communication between patients and health professionals about medicines. The review, led by Kate Cox (Guy's King's and St Thomas' School of Medicine), is aimed at identifying and summarising research in this area in order to update the model of concordance. The particular aims of the study are to:
Patient compliance or concordance continues to become more of an issue with regard to medicines management, particularly as to how it relates to chronic disease management. The DH coordinated another ‘Ask about medicines’ week in November 2004. (See Wellard’s NHS news, October) In 2003 BMJ ran a useful theme issue on the area. In an editorial on the subject there was the comment, ‘Attention and resources devoted by pharmaceutical companies to discovering, developing, and promoting new drugs utterly dwarf their efforts to see that medicines are taken by patients.’ As the BMJ editorial says, concordance presents new challenges for patients, doctors, nurses, pharmacists, policy makers and pharmaceutical companies. In the special issue, there was much editorial comment that concordance was fine in theory but that mostly it was not being practised. Then editor Richard Smith suggested that ‘it doesn’t seem to be very useful for drugs to be invented, researched, marketed, prescribed and then not taken’. One writer wondered whether concordance was not just a gift-wrapped version of compliance with doctors still in control. The issue strongly suggested that significant changes in practice were now required with the emphasis being more on patient needs and wants and how they influenced the way they took their medicines. Also more evidence was required on the specific elements of the prescribing process and how they interact. There are a couple of British Medical Journal articles worth looking at. ‘Doing prescribing: how doctors can be more effective’ looks at the prescribing process and suggests ways that concordance can be implemented. And a useful critique of the whole area by a GP who discusses the DoH’s medicines partnership programme and challenges that concordance is simply ‘window dressing’ for the doctor-centred world. The GP suggests that the Medicines Partnership website shows this quite clearly since there is a presumption that high levels of medicines intake were just fine and that in fact excessive consumption of medicines was more to the point. See ‘A wolf in sheep's clothing: a critical look at the ethics of drug taking’. A report in Quality and Safety in Health Care (2004;13:172-175) suggests that a significant number of patients initiated on drug therapy for a newly diagnosed chronic condition stop taking the medicine soon after and often intentionally. The study involved 258 patients, 239 of whom were interviewed at 10 days and 197 at four weeks after starting a new prescription medication. At 10 days, 67 of 226 patients (30 per cent) were not taking their new medications as prescribed, almost half of these deliberately so and at four weeks, 43 of 171 (25 per cent) were non-adherent. Patients frequently encountered problems with the new medication and many had substantial unmet needs for information and support. Researchers at the London School of Pharmacy suggested that doctors were guilty of focusing on the condition rather than the person when prescribing medication. Also see BMJ (2004;13:172-175). The authors conclude that there is a clear need for supporting patients in this difficult period, and they are now evaluating a service in which a pharmacist rings up the patient to offer any help, advice or information on their medicines — called pharmaceutical care. Medicines management is supposed to be about delivering quality prescribing — but this is a difficult term to define. One approach has been to use prescribing indicators (PIs) but some commentators have questioned the validity of those PIs in common use in general practice and have suggested that many are more about cost minimisation rather than improving the quality of GPs’ prescribing. The rate of generic prescribing is still a key target but is this quality or cost? The ratio of inhaled corticosteroids to inhaled bronchodilators is still banded about but with some question over its validity. And the level of prescribing for drugs of ‘limited clinical value’ (eg, peripheral vasodilators) is frequently used. Of course some PIs now tie directly into NICE decisions like those on proton pump inhibitors, non-steroidal anti-inflammatory drugs and the newer antipsychotic atypical/typical ratio. NHS influencers might look at this area again as PIs are sure to have a more central role in the clinical governance activities of PCTs. For instance, are you comfortable with acronyms like STAR-PUs, DDDs and NICs? These indicators were also used for 2004’s PCT star ratings. See Wellard’s Library’s abbreviations and acronyms. |