The Role of a Medicines Optimisation Pharmacist

What is Medicines Optimisation?

Healthcare costs are rising worldwide, due to the combination of an aging population, increasing burden of chronic diseases, technological advances, the prevalence of medication errors, and increasing yearly spending of medicines, often attributed to polypharmacy and medical waste.  In 2019/20, the NHS spent £20.9 billion on medicines  – this was the second-highest area of spending in the NHS, after staffing costs. The increased cost of medicines has intensified the pressure on NHS organizations to identify and implement cost-control measures as a means to establish and maintain the financial sustainability of the NHS.

The bridge between Clinical Commissioning Groups (CCGs) and Medicine Optimisation (MO) is formed by the requirements for CCGs to commission the right services to improve the lives of those living within their local population. CCGs are required to ensure that services and pathways in which medicines are used to deliver cost-effective use of resources, reduce risks associated with medicines use, and improve the health, safety, and wellbeing of the population.

My day-to-day role

As a Medicines Optimisation pharmacist, working within Devon CCG, my main aim is to utilize the principles of medicine optimization – getting the right medicine to the right person at the right time – to ensure the best possible health outcomes from appropriate investment in medicines. The optimization of medicines not only produces savings for the NHS but can also be used to have greater beneficial impacts to our social and healthcare system, such as:

• Supporting the Climate Change Agenda, by reviewing our formulary to support prescribing of Dry Powder Inhalers over Pressurised Metered Dose Inhalers in asthma and COPD.
• Tackling polypharmacy and medicine waste by providing clinical support to care homes.
• Addressing health inequalities by working collaboratively with healthcare providers such as mental health, drug, and alcohol addiction services, and pain management specialists, to reduce prescribing of drugs associated with dependence and withdrawal.
• Reducing GP workload by supporting the implementation of national and local medicines management initiatives such as electronic prescribing, repeat dispensing, Pharmacy First scheme, and GP Community Pharmacist Consultation Service (CPCS).
• Working closely in a multidisciplinary team to reduce the prevalence of medicines-related safety incidents that often contribute to poorer health outcomes and patient experience, prolonged and expensive hospital admissions, and increased GP and emergency department visits.

• Reviewing variance in local and national prescribing data, to drive changes in prescribing behaviors and encourage high-quality, safe, evidence-based prescribing.

The impact of COVID-19

However, like many, the pandemic has altered my usual day-to-day role, and I have had to adapt both the ways in which I work and the work activities I now undertake. I have felt privileged to be able to play such an important role in supporting and coordinating the NHS response to the COVID-19 pandemic. Over the past 22 months, I have been involved in the following activities:

• Trained and worked as a dilutor for vaccination sites, and housebound patients
• Providing clinical support to care homes in Devon
• Delivering legal, clinical, and pharmaceutical advice to COVID vaccination service providers
• Visiting non-NHS sites to complete site assurance and reviewing virtual assurances of sites to ensure vaccine integrity is maintained
• Interpreting the latest national and local guidance and providing updates to vaccination sites and internal colleagues
• Reviewing and organizing the transfers of COVID vaccines between sites in Devon in order to increase vaccine uptake
• Liaising with Regional Vaccine Operations Centre (RVOC) and/or Immunisation Clinical Advice Response Service (iCARS) regarding vaccine-related queries, where appropriate

In summary, the MO team has a significant role in supporting the CCG to ensure that appropriate investment in medicines leads to improved health outcomes and patients’ experiences with their medicine. However, the landscape of the CCG is changing, and its functions and staff will soon become absorbed into the Integrated Care System (ICS) NHS body. There is also the possibility that some of the commissioning responsibilities of NHS England will be passed down to ICSs. This exciting change in the way NHS commissions services could mean that the MO team will have the opportunity to further stretch and challenge our current roles and responsibilities