I am based in a Clinical Commissioning Group (CCG), so I'm not a traditional pharmacist and don't work as part of an integrated care team. Being part of a commissioning organisation means that I provide medicines optimisation support to commissioners and also to providers (particularly primary care clinicians). My role provides me with an overview of the services that we commission.
In my role as Head of Medicines Optimisation, I am able to access primary care prescribing data which gives me an insight into the drugs that we prescribe. It also allows me to compare prescribing practices across my organisation - this information does not tell you what is right and what is wrong, but acts as a useful starting point for discussions with clinicians.
Guidelines are developed with clinical input from both primary and secondary care clinicians and they can then be monitored through prescribing data.
Respiratory medicines feature in the national medicines optimisation agenda, particularly the use of high dose inhaled corticosteroids. Medicines Optimisation teams across the country routinely visit GP practices to discuss Key Therapeutic Topics, so respiratory medicine is high on the agenda for these practice visits.
As part of my CCG role I am involved in the development of prescribing guidelines to support evidence-based, cost-effective prescribing. These guidelines are developed with clinical input from both primary and secondary care clinicians and they can then be monitored through prescribing data.
I am a member of our local secondary care Drug and Therapeutics Committees which make decisions about the drugs that are included in secondary care formularies. As a medicines optimisation lead I am able to ensure that the voice of primary care is considered when hospital formulary decisions are made. It is essential that the impact of hospital formulary decisions on primary care are considered as we have an obligation to ensure that our finite budgets are used in a way that will provide benefit to the greatest number of people in our population as possible.
Medicines optimisation leads are ideally placed to take on the role of operational lead as medicines are involved in virtually all pathways of care
In addition to my role as Head of Medicines Optimisation, I am my organisation’s operational lead for the NHS RightCare Programme which aims to improve the health of our population by reducing unwarranted variation. All CCGs are mandated to participate in RightCare.
Medicines optimisation leads are ideally placed to take on the role of operational lead as medicines are involved in virtually all pathways of care and we routinely work with multidisciplinary teams to redesign pathways. As part of the RightCare Programme we identified that our CCG has potentially unwarranted variation across the respiratory pathways of care compared to 10 demographically similar CCGs. Respiratory medicine is therefore one of our 'RightCare Priority Programmes of Care' for the current financial year, and this is where my involvement with respiratory medicine and integrated care really stems from.
I am currently working with a multidisciplinary team of managers, clinicians and patients from right across the health system to review the opportunities identified in RightCare packs. As part of this review we will be making contact with the other demographically-similar CCGs to understand how their integrated care services differ from our own. This will allow us to understand whether we need to make any changes to our current services to address the potentially unwarranted variation. We recognise that clinician engagement is essential when reviewing any care pathway and therefore we ensure that our clinicians are at the heart of any service redesign.