Medicines optimisation

The case for medicines optimisation

Getting the most from medicines for both patients and the NHS is becoming increasingly important as the aging population mean more people have complex multimorbidities. We spend approx. £20 billion a year on medicines but up to half of medicines prescribed for long-term conditions are not taken as intended, and around 5 to 8% of hospital admissions are medicines-related. Many of these are preventable. 

Medicines optimisation is about ensuring the right patients get the right choice of medicine, at the right time. It is a person-centred approach that improves safety, adherence to treatment and reduces waste. Medicines optimisation is part of the NHS Long Term Plan.

For the system, medicines optimisation ensures that prescribing is high quality, safe and good value. It needs greater patient engagement and collaboration by practitioners across health and social care settings.

Our guidance and quality standards on medicines optimisation can support several strands of work to improve people’s health and wellbeing.

Shared decision-making

We're committed to helping patients and clinicians have more meaningful conversations about their treatment options – see our information on shared decision-making. Our guideline on medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence has recommendations to help clinicians have more meaningful conversations with people about their treatment options. And we also produce decision aids which support discussions between health professionals and patients about complex decisions.

To identify ways to improve quality of care around shared decision-making on medicines, you could use our quality standard on patient experience in adult NHS services. This covers the need for patients to:

• have opportunities to discuss their health beliefs, concerns and preferences (statement 4)
• be supported by healthcare professionals to understand the benefits, risks and potential consequences of their treatment options (statement 5)
• be actively involved in shared decision-making and supported by healthcare professionals to make fully informed choices that reflect what is important to them (statement 6).

Multimorbidity

Our guideline on multimorbidity: clinical assessment and management has recommendations relevant to medicines optimisation for people with multiple conditions.

You can use the baseline assessment tool to check whether practice in your area is in line with the recommendations in the guideline, and plan activity to meet the recommendations.

You could use our quality standard on multimorbidity when considering priorities for improvement. It includes quality statements:

• identifying adults with multimorbidity (statement 1)
• giving people with an individualised management plan a chance to discuss their values, priorities and goals (statement 2)
• making sure they know who is responsible for coordinating their care (statement 3).

We have guidance and quality standards covering medicines management for people in care homes or their own homes, and when moving between settings.

For recommendations covering medicines optimisation during transfer of care, see our guideline on transition between inpatient hospital settings and community or care home settings for adults with social care needs. It includes recommendations on supporting high-risk patients, information sharing and training and development.

In particular, the guideline recommends that all relevant staff are trained in the hospital discharge process as soon as possible after they start work, and with regular updates (recommendation 1.7.1).

Shared learning case studies are examples of how organisations have put our guidance and quality standards into practice to improve local services. The following examples involve new care models:

• NHS Wigan Borough CCG employed a team of pharmacists to work with GP practices and care homes on medication reviews, in line with our guidance. This led to a reduction in the number of pills people take, and in inappropriate polypharmacy.
• Western Health and Social Care Trust focused on older people in intermediate care, using a case management model led by a consultant pharmacist. 
• In Leeds, the NHS trust and university re-engineered the post-MI care pathway based on the principles set out in NICE guidelines on medicines optimisation and medicines adherence. The new service resulted in improvements to patient experience, medicines adherence and optimisation, outpatient clinic waiting times and readmission rates.
• Croydon Integrated Community Network Medicines Optimisation Service is part of a whole system approach to support patients with long term conditions to use their medicines appropriately and to manage independently for as long as possible.

To help you focus on areas for quality improvement, the quality standard on medicines optimisation has 2 quality statements on medicines reconciliation when people move between settings. Statement 4 covers admission to hospital, and statement 5 covers GP records after a discharge from a care setting.

Our guideline on medicines optimisation has recommendations on medicines management relevant to integrated care, covering medicines related communications systems when patients move between settings (section 1.2), and models for organisational and cross-sector working (section 1.8).

For new models of care to support people in their own homes, the following sections of the guideline on managing medicines for adults receiving social care in the community are particularly relevant:

• governance for managing medicines safely and effectively (section 1.1)
• joint working between health and social care (section 1.3)
• sharing information about a person's medicines (section 1.4)
• ensuring that records are accurate and up to date (section 1.5) .

Discussing and planning medicines support is a quick and user-friendly guide to the guideline for home care managers. It covers the main points of the guideline on managing medicines for adults receiving social care in the community.

For new models of care covering care homes, our guideline on managing medicines in care homes is highly relevant. It covers policies for medicines use, supporting people to make informed decisions and look after their own medicines, sharing information, medicines-related problems, prescribing and reviewing medicines, and giving over-the-counter medicines.

A key recommendation is that health and social care practitioners should work together to make sure that everyone involved in a resident's care knows when medicines have been started, stopped or changed (recommendation 1.9.3).

The tools and resources tab for this guideline includes a 2-part e-learning resource that we've endorsed as supporting the guideline.

The quality standard on medicines management in care homes has 2 quality statements that could support quality improvement. They cover making a list of medicines on the day a person moves into a care home (statement 1), and sending a discharge summary with details of current medicines with a person who moves into or from a care home (statement 2).

To support implementation of our guidance on medicines optimisation, we produce products designed to help improve efficiency and get the best value out of medicines. The costing statement on the tools and resources tab for the guideline on medicines optimisation shows that it could save costs by reducing variation, and the baseline assessment tool will help organisations in your local partnership check their practice against the guideline recommendations, and plan activity to meet the recommendations.

Some of our key therapeutic topics help with getting best value out of medicines, including wound care products, and chemotherapy dose standardisation.

NHS England’s Innovation Scorecard shows how our technology appraisals are being taken up around England. It includes heat maps with data for individual CCGs, so you can benchmark performance in your local partnership.

Our outcome indicators can be particularly useful to local partnerships when:

• creating local performance dashboards
• benchmarking performance against national data
• developing local quality improvement schemes
• measuring progress that local health systems are making on outcomes.

Indicators that are particularly relevant to medicines optimisation include:

• NM88: The percentage of patients with coronary heart disease with a record in the preceding 12 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken.

If you're leading and managing the wider development of medicines optimisation at a system level, our NICE Pathways are an easy way to find everything we've said on these topics:

• Local formulary development covers systems and processes for developing and updating local formularies. 
• Patient group directions covers good practice for developing, authorising, using and updating patient group directions. Patient group directions can be used to supply or administer medicines in certain care settings to patients with an identified clinical condition without a prescription or an instruction from a prescriber. The competency framework on the tools and resources tab of the guideline on this topic is a useful tool to assess staff competency in this area.

NHS England’s Innovation Scorecard shows how our technology appraisals are being taken up around England. It includes heat maps with data for individual CCGs, so you can benchmark performance in your local partnership.

We have a network of NICE Medicine and Prescribing Associates who can advise you. They're involved in medicines optimisation across the UK, and share information about our guidance across their professional networks. They can help identify key medicines issues in new guidance, share examples of good practice, and use the network to problem-solve specific issues. Some of them also sit on Regional Medicines Optimisation committees, which outline priorities for medicines optimisation. Your local medicines implementation consultant can put you in touch with an associate near you. Find out more on our medicines and prescribing page.

We produce daily, weekly and monthly medicines and prescribing summaries and alerts. Choose the level of support you need.

You can also subscribe to our monthly resource planner. This summarises the potential resource impact of new guidance and will help you to plan for implementing our guidance.

Our work is closely aligned with national programmes including RightCare and Getting it Right First Time (GIRFT).