Medicines Management, Optimisation & Information

NHS Alliance (Feb 2013)

A new guide  has been put together by the NHS Alliance in conjunction with the Primary Care Pharmacists Association (PCPA).  This guide has been produced for distribution to GPs and GP Commissioners in order to give them a greater understanding of the important work carried out by primary care pharmacists and to support discussions between emerging Commissioning Support Services (CSSs) and Clinical Commissioning Groups (CCGs) in relation to the provision of Medicines support.  It outlines the considerations that CCGs and CSSs should take in managing prescribing and medicines optimisation in the current changing NHS climate and emphasises the importance of preserving and utilising the wealth of local knowledge and intelligence currently held in your Medicines Management Teams.

Action plan for improving the use of medicines and reducing waste (Jan 2013)

A report commissioned by the Department of Health looks at how the NHS is working to improve the use of medicines and tackle avoidable medicines wastage. The action plan outlines how best practice could be shared across the NHS in the future. The plan identifies how everybody – not just pharmacists, GPs and care home staff, but also patients and the public – can stop avoidable medicines wastage.

British National Formulary publications now updated monthly online (Nov 2012)

British National Formulary (BNF) publications have issued their first online monthly update in the form of a revised version of BNF for Children 2012-13, which has gone live in tandem with BNF 64. From now on both the BNF and BNF for Children will be updated online every month; this is a step which will support healthcare professionals everywhere to provide better patient care. Print editions of BNF will continue to be published every six months, and BNF for Children annually.

BNF and BNF for Children online (Oct 2012)

Following a move to monthly updates for BNF and BNF for Children online, as well as maintaining the existing print frequency of every six-months for BNF (March, September) and annually for BNF for Children (July), it remains vital to use up-to-date information on prescribing and dispensing medicines effectively and safely. The BNF (a joint publication of the British Medical Association (BMA) and the Royal Pharmaceutical Society (RPS)) and BNF for Children (a joint publication of BMA, RPS, Royal College of Paediatrics and Child Health and Neonatal and Paediatric Pharmacists Group) are widely accessible in both digital and print formats.

From September 2012 the digital delivery of BNF and BNF for Children online will be updated monthly via bnf.org, MedicinesComplete, and NHS Evidence. In addition the NICE BNF app will be updated monthly.

Users that find the traditional print format more convenient are alerted that it expires with each new print edition. As the BNF and BNF for Children are point-of-care tools it is important that when new print editions are available the previous edition is withdrawn and replaced. Vital information that comes to light between editions will also be provided on the BNF website (bnf.org).

The BNF and BNF for Children are available online at bnf.org (content delivered by MedicinesComplete) and as a key part of NHS Evidence website (NICE’s search engine for health information). Additional digital formats include MedicinesComplete, FormularyComplete (the unique locally hosted formulary management tool), and as an App for mobile devices (Apple, Android, Blackberry) as well as being a part of many clinical systems.

Healthcare professionals wishing to be updated with the latest changes affecting clinical practice can sign up to receive joint newsletters from BNF and BNFC here. Members of the RPS may also wish to access our “How to use the BNF” Quick Reference Guide here.

Free BNF for children app launches (Sept 2012)

Tablet splitting: a review of the clinical and economic outcomes and patient acceptance. Second of a 2-part series  (June 2012)

This study describes the clinical outcomes, patient acceptance and economic effect associated with tablet splitting. The majority of trials conducted to evaluate clinical outcomes associated with tablet splitting were in patients receiving statins and antihypertensives.  Clinical outcomes associated with risperidone were also assessed.  No adverse clinical outcomes were observed with therapy.  Most studies evaluating the economic effects of tablet splitting have revealed cost savings associated with this process; however, many studies were subject to limitations.  The first part of this two-part series reviewed the weight and content uniformity in tablet splitting. The authors concluded that tablet splitting does not seem to affect clinical outcomes related to management of hypertension, cholesterol or psychiatric disorders significantly, nor influence overall patient adherence. For further information click on this Abstract link

GMC reverses plans to allow doctors to prescribe cheaper off-label or unlicensed alternatives (May 2012)

The General Medical Council (GMC) has postponed plans to allow doctors to prescribe cheaper off-label or unlicensed alternatives to licensed medicines, which were put out for consultation last year. The GMC currently limits the prescribing of off-label or unlicensed medicines to circumstances where there is no appropriately licensed alternative and, in relation to off-label prescribing, where the doctor judges that such a medicine would better serve the patient's needs than the appropriately licensed alternative.  The GMC had proposed making changes to allow off-label or unlicensed prescribing even when a licensed product is available, as long as the prescriber is satisfied, on the basis of authoritative clinical guidance, that it is as safe and effective as an appropriately licensed alternative.  According to the report, the consultation revealed "significant divergence of views".  

Although 70% of respondents supported the Council's proposed changes, the MHRA and ABPI opposed them; the GMC therefore sought legal advice on the European Union (EU) directive on medicinal products for human use. This advice confirmed that unlicensed medicines could be prescribed only where there was a "special need," and that this could not be taken to encompass unlicensed medicines for patients with rare conditions if there were a licensed alternative or circumstances in which commissioning bodies did not support the funding of a licensed alternative. As a result, the GMC agreed to revert to their existing guidance on prescribing unlicensed medicines.

The EU directive does not specifically address the issue of prescribing drugs outside the terms of their licence and the GMC is still exploring "the extent to which this should be taken to prevent prescribing medicines off-label other than in circumstances in which there is no licensed alternative.” For further information click on Link (free registration required) 

Winners and losers as many medicines come off patent in the next two years (May 2012)

Patents for some 25 medicines currently marketed in the UK are due to expire by the end of 2012, with another 21 coming off patent in 2013.  Implications for National Health Service expenditure, both in primary care and the hospital sector, are discussed.  A list of patent expiries compiled by UK Medicines Information (UKMi) is mentioned. For further information click on PJ Online website link

Key therapeutic topics – Medicines management options for local implementation – April 2012 update available (May 2012)

The latest update of the National Prescribing Centre’s “Key therapeutic topics – Medicines management options for local implementation” is now available (April 2012). This update contains revised options reflecting progress made in some of these areas, and changing circumstances and priorities. Click on Update for more information.

Public understanding of Drug Therapy (May 2012) 

Knowing some basic principles about medicines would help patients to understand drug therapy and to help and encourage them to use it well.  These principles relate to the categories and names of drugs, their different uses, how they reach the site of action (absorption, distribution, fate), how they produce their effects, both beneficial and harmful, the time courses of drug actions, how the pattern and intensity of the effects of a drug depend on dose and timing, drug interactions, how drug effects are demonstrated and investigated and sources of information and their trustworthiness. These basic principles are an essential part of health literacy and understanding them would enable individuals to comprehend better the information that they are likely to receive about medicines that they will take. 

Different populations need different types of education.  For schoolchildren, the principles could fit into biology and domestic science teaching, starting in the later years of primary school or early in secondary school.  A teaching package would also be needed for their teachers.  For adults, web-based learning seems the most practical option.  Web-based programmes could be supported by the NHS and professional bodies and through public libraries and local community health services.  Specific groups for targeting could include young mothers and carers of chronically ill people.  For retired people, one could envisage special programmes, perhaps in collaboration with the University of the Third Age.  Conversations between patients and professionals would then become more effective and help shared decision making. For further information click on this  Abstract link

NHS Prescription Services: modernisation of information systems (May 2012)

NHS Prescription Services is looking at how to improve the systems that support management and monitoring of prescribing in primary care. The information systems modernisation project will result in a single access portal for information which will allow users to identify trends and best practice. The first phase of the project is on track to be delivered in May/June 2012. This will provide a new secure portal for users to access prescribing information reports. PCC is working with NHS Prescription Services to demonstrate the new portal at upcoming regional networks.

Unbound Medicine and Datapharm launch mobile Medicines Compendium UK (May 2012) 

Unbound Medicine and Datapharm have announced the release of Medicines Compendium UK for mobile devices. Available for popular smart phones and tablets such as iPhone®, iPad®, and Android®, Medicines Compendium UK represents the first mobile application with the unabridged Summary of Product Characteristics (SPCs) with full details of the composition and clinical application of more than 5,000 unique pharmaceutical products.  Once the application is downloaded, the full database of SPCs will be available from any location without requiring internet connectivity.  Click on this Link to further information

GP prescribing – improvement possible (May 2012)

A major study of GP prescribing has found that while the vast majority of prescriptions written by family doctors are appropriate and effectively monitored, around 1 in 20 contain an error. Researchers looking at a sample of GP practices in England found that where there were errors, most were classed as mild or moderate, but around 1 in every 550 prescription items was judged to contain a serious error. The most common errors were missing information on dosage, prescribing an incorrect dosage, and failing to ensure that patients got necessary monitoring through blood tests. The research, commissioned by the General Medical Council, is the largest-scale study of its kind. It provides an important insight into how errors in prescribing come about.

NPC publishes 7th edition of Tough Decisions- local decision-making news (April 2012)

This edition of the National Prescribing Centre’s newsletter 'Tough Decisions' addresses the following topics:

• Top tips for successfully undertaking an internal fitness for purpose review of your Area Prescribing Committee (APC)
• Review from the four individual funding request (IFR) managers sharing practice learning events (September 2011 – February 2012) which covered the concept of ‘exceptionality’, patient involvement in the IFR process and handling challenging conversations.
• Process and contractual arrangements for managing applications for the funding of healthcare in EU Member States.

For further information click on this Link 

Medicines management options for local implementation (Mar 2012)

The National Prescribing Centre (NPC) has updated its guide to medicines management Key Therapeutic Topics - Medicines Management Options for Local Implementation. This provides practical guidance on the delivery of specific prescribing savings opportunities and prescribing advice. The guide covers 13 topics including antibiotic prescribing, non-steroidal anti-inflammatory drugs and wound care products.

NHS Information Centre issues Prescribing Toolkit (April 2012)

The NHS Information Centre has issued a Prescribing Toolkit which includes prescribing indicators, prescribing comparators and other sets of data likely to be routinely required by those working with prescribing issues in primary care. The aim is to reduce the workload in primary care by providing sets of accurate and comparable data. Prescribing Indicators are agreed by a range of stakeholders to be a valid method to measure or monitor an area of prescribing. They are often used within the performance management process or locally in prescribing incentive schemes. Prescribing Comparators are not indicators but are commonly used in prescribing incentive schemes where target levels of use are set locally, in showing trends and variations between organisations, and for identifying areas of growth in prescribing, and the rate at which this occurs. For further information click on this Link or on NPC Rapid Review

NPC publishes “Local decision-making competency framework” (April 2012)

The National Prescribing Centre has published a “Local decision-making competency framework” aimed at supporting local decision-makers within the NHS, on funding for medicines and treatments that have a positive technology appraisal (TA).  The framework builds upon the principles for reducing variation in local decision-making systems. For further information click on this Link

A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis (April 2012)

Medication errors are common in primary care and are associated with considerable risk of patient harm.  This study tested whether a pharmacist-led, information technology-based intervention was more effective than simple feedback in reducing the number of patients at risk of measures related to hazardous prescribing and inadequate blood-test monitoring of medicines 6 months after the intervention. 72 general practices with a combined list size of 480,942 patients were randomised.  At 6 months' follow-up, patients in the PINCER group were significantly less likely to have been prescribed a non-selective NSAID if they had a history of peptic ulcer without gastroprotection; a beta-blocker if they had asthma; or an ACE inhibitor or loop diuretic without appropriate monitoring. The results demonstrate that PINCER intervention is an effective method for reducing a range of medication errors in general practices with computerised clinical records. For further information click on Abstract link (ScienceDirect)

BNF 63 & Newsletter (Mar 2012)

BNF 63 and March e-newsletter have now been published. The BNF e-newsletter provides insight into the most significant changes made for BNF 63 including updated guidance on the management of hypertension and the management of stable angina, and new guidance on the treatment of antiepileptic hypersensitivity syndrome. The  case study reviews the management of hypertension, whilst the tip introduces you to some of the tabulated information included in BNF. Click here to view the e-newsletter.

New search experience via bnf.org (Feb 2012)

From 13 March 2012, your experience of searching trusted BNF and BNF for Children (BNFC) content online will be improving . Soon you will be able to:

• Search both BNF and BNFC together from the bnf.org homepage 
• See related links between content 
• Broaden your search by subscribing to other medicines information resources including Martindale: The Complete Drug Reference, Stockley's Drug Interactions and Injectable Drugs Guide

To provide you with these benefits, the BNF and BNFC content are moving to a different content platform, called MedicinesComplete. To learn more about the improved search experience visit the BNF website

Will optimisation help save the NHS? (Feb 2012)

Brief report on the opportunities and barriers to implementing medicines optimisation - which focuses on the use of medicines by patients - in the NHS. For further information click on PJ Online website

Medicines reconciliation video (Jan 2012)

NHS Employers has produced a video to highlight the role of hospital and community pharmacy medicines reconciliation. The video views the medicines pathway from a patient's point of view, demonstrating how hospital and community pharmacists can work together to improve patients' understanding of their medicines. The video builds on guidance from NHS Employers and the Pharmaceutical Services Negotiating Committee.

Improving access to NICE approved drugs (Jan 2012)

NICE is to produce a best practice guide to help trusts develop local formularies, as part of a move to ensure that all patients in England have access to clinically and cost-effective drugs. Local formularies provide a list of selected or preferred drugs available to local prescribers and have an important role in underpinning safe and effective use of medicines.However, there is currently no standard process or advice for putting together a local formulary which has led to variations across the country.

A recent report into innovation in healthcare by the Department of Health has highlighted that not all local formularies are including all of NICE's technology appraisals. This can lead to a postcode lottery where patients miss out on drugs approved by NICE.

MeReC Rapid Review: The idolatry of surrogates and the 10 commandments of the new therapeutics (Jan 2012)

This MeReC Rapid Review from the National Prescribing Centre discusses an article published in the British Medical Journal about surrogate outcomes, which are often used in clinical trials instead of patient-oriented outcomes.  The authors argue that over-interpretation of surrogates and ascribing them undue importance can damage patient care.  The Review calls for all those involved in medicines use to be cautious when interpreting claims for effectiveness that are based on surrogate outcomes, and to consider the suggested ‘10 commandments’ in their own practice.  For more information click on these links: Link, BMJ article, Comment (including the ‘10 commandments’)

Lancet now accessible via NHS Athens (Jan 2012)

A three year agreement has been signed nationally by NICE to provide all NHS staff with access to The Lancet via NHS Evidence.  From 03 January 2012 every member of staff who is eligible for an NHS Athens password can access the latest online editions of The Lancet, as well as back copies from the last 4 years.  The agreement will also cover healthcare students from an NHS-commissioned education programme involving practice and placement within NHS services across England. 

Value-based pricing of new drugs: where are we now? (Dec 2011)

A government statement in Jun 2011 indicates that there will still be a mandate to the NHS to support funding of drugs that have been recommended under the NICE Technology Appraisal system.  This mandate currently applies to England and Wales but was to be removed in 2014 under the NHS reforms alongside the introduction of value-based pricing.  Specific details of how drugs will be evaluated, approved and priced for the NHS after 2014 are still being worked out.  Issues discussed include the Cancer Drugs Fund, end-of-life criteria, the role of the new clinical commissioning groups, and the attitude of the pharmaceutical industry. For further information click on Full text link (PDF

BNF mobile app now available on three main smartphone platforms (Dec 2011)

BNF and BNF for Children (BNFC) are now available for download to Apple, Android or Blackberry devices.
Availability via mobile app will ensure instant and uninterrupted access to BNF and BNF for Children wherever and whenever you need it. The full content of the current edition is downloaded on to the mobile device allowing users to access without relying on an internet connection. BNF and BNFC apps provide real support for doctors, pharmacists and nurses working in the community or on the hospital wards, regardless of wi-fi availability. They encourage safe prescribing and help health professionals make the best decisions for their patients. Apps are available via App Store,iTunes , Android Market, or Blackberry App world.

Drug shortages: process for evaluating impact on patient safety (Dec 2011)

The objective of this study was to develop safety assessment checklists for use during a drug shortage, whether the same drug is available or an alternative is required. A failure modes and effects analysis (FMEA) was conducted following the Institute for Healthcare Improvement's FMEA tool. To supplement the results of the FMEA, a survey focusing on the perception of patient safety during a drug shortage was developed and sent to various e-mail lists.  The FMEA and survey results noted that unfamiliarity with an alternative agent was a high vulnerability during a shortage where an alternative is required.  The potential for incorrect doses was the greatest concern during a shortage where the same drug is available, but in a different concentration or presentation. Safety assessment checklists for use when the same drug is available and when an alternative is required during a drug shortage were developed to aid institutions. For further information click on this Abstract link

Medicines for children website launched (Dec 2011)

WellChild, the Royal College of Paediatrics and Child Health (RCPCH), and the Neonatal and Paediatric Pharmacists Group (NPPG) have launched the new Medicines for Children website, currently providing access to information leaflets on over 100 key medicines.  Please see the link below for details. For further information click on this Link to website

Homecare Medicines: Towards a vision for the future (Dec 2011)

In November 2010, the Department of Health sponsored the CEO of Southampton University Hospitals NHS Foundation Trust, to lead a rapid review of homecare medicine supply to consider the current operational arrangements and its future for the best value for patients, the NHS and the provider market. The findings of the review have been published in this report available from this Link to report

New decision framework to support NICE recommendations published (Nov 2011)

According to a report by PharmaTimes, a new decision framework to support recommendations by the National Institute for Health and Clinical Excellence (NICE) on the use of new drugs and devices in the NHS has been published by the Centre for Health Economics at the University of York. The project is funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme. For further information click on this Link

Better access to drugs for rare disease patients (Oct 2011)

The Health secretary has announced help for patients with rare diseases, whose doctors may not be able to provide them with unlicensed or off label medication. Most drugs are licensed for use in conditions where the drug manufacturers are able to recruit enough patients into clinical trials and where they will yield enough sales to justify running the trial. This presents a consistent problem for patients with rare diseases, whose access to medication is limited because not enough patients are available to run a clinical trial. Under new plans, the Department of Health will commission expert assessments of the evidence on the use of off-label medicines, including in rare conditions. These assessments will be designed to inform doctors' decision making and patients' choices, not to provide a yes or no recommendation.

New Nurse Prescribers' Formulary published (Oct 2011)

A new edition of the Nurse Prescribers' Formulary for Community Practitioners (NPF 2011–2013) has been published, containing the latest nurse prescribers’ list and providing an overview of some common conditions together with relevant medicines. A number of sections (e.g. nicotine replacement therapy; prescribing paracetamol in children) have been revised/updated, and the publication also contains details about wound management products and elasticated garments from BNF 62 (September 2011) and Yellow Cards to assist nurses in reporting suspected adverse drug reactions directly to the MHRA. The NPF is issued every two years and designed for use with the full British National Formulary (BNF).  It costs £15.99 and is available from www.pharmpress.com.

NPC publishes fifth issue of ‘tough decisions’ (Aug 2011)

The National Prescribing Centre (NPC) has published the fifth edition of its newsletter 'Tough Decisions', a quarterly publication available to all NHS personnel making decisions about the funding and commissioning of medicines at a local level. This issue, which can be viewed by clicking on link, addresses the following topics:

• Local decision-making news
• New medicines (boceprevir and telaprevir for chronic hepatitis C genotype 1 infection)
• What’s new on the NPC website
• Patient Access Schemes and the NICE Patient Access Scheme Liaison Unit
• Commissioning Support Appraisals Service
• IFR manager news
• Sharing practice
• Report from workshop on ‘Making Difficult Choices: Priority setting for GP commissioners in the new NHS’.

King’s Fund report on the quality of GP prescribing (Aug 2011)

The King’s Fund has published a report on the quality of GP prescribing, as part of its inquiry into the quality of general practice in England.  The report makes a number of recommendations and proposes quality indicators that could be used to describe high-quality prescribing.  

A PharmaTimes report  discussing the publication focuses on the recommendation that the system that causes branded generics to undercut generic prices in the Category M basket be urgently revised.  The paper comments that the current system can perversely encourage switching from generic prescribing back to brand prescribing, which is contrary to years spent encouraging generic prescribing as a principle and is additionally confusing for patients.

The authors of the inquiry paper say that there is a general agreement that GPs do consider cost when making drug choices; however they also believe that more can be done to flag up cost implications at the time of prescribing.  They recommend that systems to enable GPs to be more cost-aware in their prescribing choices be developed.  For full details of the recommendations, click on this Link to King’s Fund report 

New Steering Group set up to tackle medicines wastage in the NHS (Aug 2011)

The Government has announced the establishment of a new group to tackle medicines wastage, which is estimated to cost the NHS £300 million every year.  The new Steering Group to Improve the Use of Medicines will also look to identify how people can be better supported in taking their medicines as prescribed, helping to improve their long-term outcomes and ensure better value for the NHS. The Steering Group, which will consist of experts and patients representatives, will initially report in early 2012, and will be jointly chaired by Robert Johnstone, a Trustee of National Voices (the national charity coalition for health and social care) and Rob Darracott, Chief Executive of Pharmacy Voice.  The Department of Health has asked the Group to develop an action plan by Autumn 2011.

Common clinical language for NHS will help improve patient care and safety

The Department of Health has announced that the Information Standards Board for Health and Social Care, has approved SNOMED Clinical Terms (CT), the most comprehensive, multilingual clinical healthcare terminology for use across the NHS in UK, allowing for information to be exchanged accurately and safely across all healthcare settings, thus improving patient safety.  

SNOMED CT is available in more than fifty countries including the US, Canada, Australia, Spain, Sweden and the Netherlands. It is already widely used in the UK for the exchange of clinical information, including the Choose and Book service for hospital appointments and for patients’ Summary Care Records. For further information click in this Link

NPC publishes five guiding principles for prescribing specials

This guidance includes five guiding principles based on good prescribing practice that highlight specific issues to support prescribers in the safe and appropriate use of Specials. Appendix 2 of the document contains a quick practical checklist for prescribers to print out and use as a tool when prescribing. The five guiding principles detailed in the document are:

1. Establish a clinical need
2. Identify medicines and preparations
3. Make a shared decision with the patient (or carer)
4. Ensure effective prescribing governance
5. Monitor and review on an ongoing basis 

For further information click on Guidance

BNF on FormularyComplete available for trial (July 2011)

Since its launch BNF on FormularyComplete has received significant interest from hospital trusts, PCTs, health organisations and academic institutions. Numerous trials are now taking place. The new product from Pharmaceutical Press is a unique point-of-care tool that allows users to create, edit and manage their local formulary built upon the trusted advice of BNF and BNF for Children.

The editing tool is intuitive and flexible and reduces time spent on creating and updating local content. This is the answer to improved formulary management and better access to expert guidance. To learn more about BNF on FormularyComplete  visit the website .  Or click to start your free four week trial .

Articles that previously appeared on this page have been moved into this section's archive and can be accessed by clicking here.