CHI Review in primary care relating to quality issues in medicines management

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CHI Review in primary care relating to quality
issues in medicines management prescribing

• Dr Robert Queenborough
• Director of Clinical Governance
• Trafford North PCT
• UK DURG 14th Annual Scientific Meeting
• 30th January 2003

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Overview

• Remit of CHI
• Scope of review
• Medicines Management Services
• Repeat Prescribing
• resources

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Remit of CHI

• Review of Clinical Governance
• Patient Public participation
• Clinical Audit
• Risk Management
• Education, training CPPD
• Effectiveness
• Staffing Staff Management
• Use of information
• Strategic Capacity

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Scope of review

• Involves patients, service users, public
• Clinicians
• All
• incl Independent contractors
• Managers
• Board Members
• Staff

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Policy Context Effective Medicines Management

• Re-shape care around the patient
• Commission for Health Improvement (CHI)
  (Commission for Healthcare Audit and Inspection
  -CHAI) CHI/NCSC/HAC
• The Expert Patient
• NSFs
• Reduce risk
• An Organisation with a Memory National
  Patient Safety Agency (NPSA)
• Improve health
• Saving lives Our Healthier Nation (OHN)
• Make better use of skills and knowledge of staff
• local contracts such as PMS and LPS

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What are Medicines Management Services (MMS)?

• Systems for designing, implementing and
  delivering accessible, appropriate and
  cost-effective pharmaceutical care to patients
  based on need
• Can include all aspects of the therapeutic use of
  medicines from organisation to individual patient
  level

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Medicines Management Services

• Clinical
• Systems and processes
• Health of the public
• Interface
• Patients and their medicines
• Modernising Medicines Management A guide to
  achieving benefits for patients, professionals
  and the NHS - NPC/NPCRDC

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Evidence of the need for MMS

• Half of all patients with chronic conditions do
  not use their medicines as intended
• Medication problems are implicated in 5-17 of
  hospital admissions
• Medication errors have been estimated to cost the
  NHS 500 million a year in additional days spent
  in hospital
• People who could benefit from medicines are not
  receiving them

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Does Medicines Management fit with the aims of
the PCT?

• MMS needs to be linked to other local health
  programmes
• local organisational development
• local Health Improvement Modernisation
  Programme
• National Service Frameworks
• Clinical Governance
• Commissioning activity
• Introduction of New Drugs
• Medicines Management across the Interface
• NICE Guidance
• Local Development Plan

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What does all this mean for our organisation?

• Are we doing MMS already?
• Professional input is increasing
• Needs to be more strategic
• Need to reconsider how many people work
• Challenge existing mindsets
• Need to take stock
• Revise strategy to deliver improvement
• Integrate MMS in to other programmes of work

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Repeat prescribing

• Accounts for 80 of costs all primary care
  prescribing
• 10 total NHS expenditure
• 80 people over 75 take at least one prescribed
  medicine
• 40 taking four or more drugs
• Needs improving

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Am I doing it right?

• Review system
• process mapping
• Implement change
• little by little (PDSA)
• Measure performance
• Review again
• Benchmarking

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Self-assessment

• CHI tools
• not yet available for primary care
• NatPaCT
• Modernising Medicines Management
• Short
• Detailed

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NatPaCT - Medicines Management

• Senior management awareness and involvement in
  medicines management
• Information and financial issues
• Medicines policy management including the
  introduction of new drugs
• Commissioning secondary and tertiary care
  services
• The primary and secondary care interface and the
  unified budget
• Influencing prescribers
• Risk reduction and management
• Financial incentives
• Community pharmacy contracts and developments
• Pharmaceutical support for community health
  services

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So you think your organisation is ready for
medicines management? 1) What methods do you
use to improve quality? 2) How effective is your
organisation in communicating and working with
partners? 3) How confident are you that your
organisation can handle risk? 4) How effectively
does your organisation use information to deliver
and monitor medicines management services? 5)
What methods can you demonstrate that indicate
involvement of the public in the development and
operation of services by your organisation? 6)
To what extent does your organisation utilise
clinical effectiveness material (including NICE
guidance and research) to inform the services
provided? 7) What are the arrangements for
education and training throughout your
organisation? 8) How do you manage complaints?
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Modernising Medicines Management

• More information available at
• www.npc.co.uk
• www.npcrdc.man.ac.uk
• To order additional copies write or fax
• National Prescribing Centre (NPC)
• The Infirmary70 Pembroke PlaceLiverpool L69 3GF
  Fax [phone] / 8144

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Coming soon...

• Routes to better repeat prescribing from the
  NPC
• Spring 2003

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Thank you

• The end