In these times of austerity, almost all businesses and public sector organisations are battening down the hatches and being tasked with finding huge savings to preserve their services for the future. Although health and social care are essential public services, they do not escape this scrutiny, and each health board in Scotland has their own target for efficiencies to be made each year. In 2015/16, boards reported an impressive total of £291 million in savings, but the challenge in the current year is greater – a targeted £492 million which must be found.
It’s not all doom and gloom though – we would like to see these challenges as opportunities to be more efficient and effective in the way we deliver quality healthcare, and community pharmacies are ideally placed to do exactly that.
Helping people to use their medicines more effectively has always been part and parcel of any pharmacist’s role. Now more than ever we need to tap into this unique skill to improve medicine use across the country. First and foremost, this will lead to patients living better quality lives for longer, but it also saves the NHS money as a side-effect, using specialist resources that are already out there, near patients and without a waiting list for an appointment.
There are a number of ways in which a community pharmacy can (and does) contribute to efficiency savings through the better use of medicines. An estimated 11 per cent of non-elective hospital admissions in Scotland are as a result of medicines use, whether this be overdose, side-effects or not taking medicines as prescribed.
This represents an alarming danger to patients, as well as massive expenditure to deal with a mostly avoidable cause of illness. Most of these admissions can be attributed to just five common classes of medication, including anti-inflammatories such as Ibuprofen, and anticoagulants including warfarin.
As part of the Chronic Medication Service (CMS), which is available to anyone taking long-term medication and registered with a GP in Scotland, pharmacists identify patients on certain high-risk medications and target them as a priority for in-depth reviews. By doing this, pharmacists can pick up on and resolve any potential issues with the treatment that may arise during the consultation, thus reducing the risk of adverse events and hospital admission.
The Scottish drugs bill also attracts attention when savings have to be made – in 2015/16 this topped a record £1.1 billion, and this can be explained in part by the gradually aging population; as advances are made in the treatments for conditions such as heart disease, diabetes and cancer, people are living longer.
The flipside of this is that we are seeing an increase in diseases linked with advanced age, and the likelihood of developing several long-term conditions also rises steeply with age. The complex needs of these patients result in increased costs in terms of both medication and service use.
This is not the only reason for the increase though – the number of patients of any age who regularly take five or more medicines (often called polypharmacy) has been seen to increase year-on-year. That’s not to say that this is a bad thing, as long as each of the medicines is prescribed and taken appropriately.
However, over the course of a lifetime the need for continuing treatment may well change, and in recent years a focus has been put on ensuring that where there is polypharmacy, this is reviewed regularly to ensure that all treatments are still needed, and that any gaps in patient care or new evidence which might call for a medication to be stopped or changed are addressed. These polypharmacy reviews are a fantastic way to perform a ‘medicines MOT’, and being the experts in drugs, pharmacists are perfectly qualified and experienced to carry them out.
Unfortunately, unlike the reviews of high-risk medications, this is not a formalised part of the community pharmacy contract as yet. CPS is committed to making this a reality, as we can see the enormous difference that could be made to patients’ health and as a result NHS spending by working as part of a team to optimise medicines use. These are just a few of the ways in which community pharmacies can help make the NHS more cost-effective, and our next article will explore further exciting developments which will have a significant impact on care delivery in Scotland.
Harry McQuillan is chief executive of Community Pharmacy Scotland.