The Royal Pharmaceutical Society (RPS) has published a guide to medicines optimisation for primary care professionals.

Medicines Optimisation: helping patients make the most of medicines places emphasis on safe and evidence-based medicine use to reduce wastage and improve patient outcomes.

The guide, endorsed by the ABPI and the Royal College of General Practitioners, reflects the growing role of community pharmacists in medicines management and the care of people with long-term conditions.

Sir Bruce Keogh, Medical Director of NHS England, said the guide “could revolutionise medicines use and outcomes”. It outlines four basic principles:

• Aim to understand the patient’s experience.

• Make sure the choice of medicine is made on the best available evidence.

• Ensure that medicines use is as safe as possible.

• Make medicines optimisation part of routine practice.

“I would encourage everyone to adopt these principles whether prescribing, dispensing, administering or taking medicines,” Keogh concluded.

The RPS guide is partly a response to evidence that 30–50% of patients are not compliant with prescribed medication, and £300m worth of NHS medicines are wasted each year.

Shilpa Gohil, Chair of RPS England, commented: “As care shifts towards primary care prevention, unprecedented economic challenges combined with problems around medicines waste, adherence and safety mean that medicines optimisation is now essential to good patient care and the effective use of NHS resources.

“Medicines optimisation will require health professionals to work across boundaries to individualise care and work in partnership with each other and patients to secure better outcomes and drive improved adherence.”

NHS Hambleton, Richmondshire and Whitby CCG has started a new scheme to tackle the expected demand in healthcare services from elderly residents.

Commissioners estimate that by 2021 the number of people aged 65 and over within the local population will have increased by nearly a third (30%).

The scheme, Fit 4 the future, will focus on four main areas: staying healthy, long-term conditions, dementia and end of life care.

Dr Mark Hodgson, a governing body member, said the CCG wanted to hear from patients about “what they want from local healthcare and how we can work together to design future services.”

A series of meetings will be held by commissioners where people can attend and give their experiences of care, outline what they require from the NHS and discuss what’s important to them.

The CCG hopes it will then be better prepared for the expected increase in demand for health and social care as the elderly population increases.

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NICE will be responsible for assessing the value of medicines in the new value-based pricing (VBP) system to be implemented in 2014.

The Government’s decision to make NICE central to VBP follows recommendations by the Health Select Committee (HSC).

It also follows a report by the European Commission stating that NICE’s QALY metric, the basis of its current value appraisals, is unfit for purpose.

The new role in VBP assessment will enable NICE to broaden the scope of its appraisals of the costs and benefits of drugs.

This will simplify the current routine of NICE declaring a drug too expensive in draft guidelines and then revising its verdict when the company offers a confidential patient access scheme.

Health Minister Lord Howe said: “We are delighted to announce the central role NICE will take in assessing the value of new medicines. This will allow us to draw on NICE’s world-leading expertise as we develop the Value-Based Pricing scheme.”

From April, NICE will be led by new Chairman David Haslam (pictured). It will have responsibility for social care as well as the NHS and public health, enabling it to play a major role in the integration of care.

The Government approved three other HSC recommendations: NICE should develop healthcare quality standards for patients with long-term conditions, co-morbidities or complex needs; NICE should promote better-integrated commissioning and care; and industry should be more transparent as regards clinical trial data.

Stephen Whitehead, Chief Executive of the ABPI, commented: “What will determine whether value-based pricing works for the pharmaceutical industry, the NHS and most importantly patients is not who does the assessment, but how it is done and what goes into it.

“NICE has an important role in supporting growth, which is often overlooked. NICE needs to be an enabler of innovation by the NHS and this is lacking from the Government’s response.

“We urge the Government to keep its foot on the pedal in spreading innovation through the NHS and ensuring that NICE helps to deliver its part of the growth agenda.”

The focus of NHS investment needs to shift from large acute hospitals to community and home-based services, according to the NHS Confederation.

A new report, Transforming Local Care, argued that “significant” investment in making the community the “default setting” of healthcare is needed to meet the combined pressures of increasing demand and shrinking budgets.

Hospital inpatient services can be reserved for complex surgery and treatment of life-threatening conditions, the report said – but major and visible improvements in community-based care need to take place at the same time.

The NHS Confederation, which represents commissioner and provider organisations, called for long-term condition management to be shifted decisively out of the hospital framework.

It highlighted the proven value of strategies such as home monitoring, mobile diagnostics and medication adjustment in helping to keep people out of hospital.

While these strategies were recommended by Lord Darzi’s NHS review in 2008, the “unprecedented” economic pressures have made them urgent priorities for national adoption, the report argued.

Calling on the NHS Commissioning Board to “facilitate the necessary shift in the financing of care”, the Confederation outlined the need for payment incentives to promote prevention, early intervention and early supported discharge.

Crucially, it added, efficiency savings must be reinvested in community-based services, instead of being claimed by the Treasury (as currently happens).

“It is time we started thinking differently and making sure investment supports innovative service delivery that supports patients’ independence and recovery,” said Jo Webber (pictured), the NHS Confederation’s interim Director of Policy.

“For too long, the default setting when we think about healthcare or support is to think of a hospital. But in reality, acute hospitals are rarely the best place for someone who needs ongoing treatment.”

The Department of Health has published a ‘pledge’ to improve health outcomes for children and young people through co-ordinated activity across the NHS.

Stated aims include a reduction in the child mortality rate, improved care for children with long-term conditions, and better mental health care for the young.

A new Children and Young People’s Health Outcomes Board, led by the Chief Medical Officer, will focus on improving outcomes across paediatric care.

The DH is responding to a report from the Children and Young People’s Health Outcomes Forum, warning that child mortality rates in England are among the worst in Europe and that 26% of children’s deaths are linked to failures in direct care.

The Forum calls for attention to obesity, maintenance of long-term conditions, earlier diagnosis of mental health disorders, and better attention to the health needs of looked-after children.

GPs will be offered specialised training or support in paediatric health, and provided with new colour-coded health maps showing trends in conditions such as asthma and diabetes.

The CCGs will be asked to review their provision of services for children and investigate poor outcomes.

The DH also said it would investigate proposals by the Royal College of General Practitioners to extend GP training for a fourth year to include child health and mental health.

Health Minister Dan Poulter said: “It is a shocking fact that child mortality in Britain is the worst when compared to other similar European countries. There is unacceptable variation across the country in the quality of care for children – for example in the treatment of long-term conditions.

“Our pledge demonstrates how all parts of the system will play their part and work together to improve children’s health.”

Hilary Cass, President of the Royal College of Paediatrics and Child Health, commented: “It’s crucial that this momentum is maintained and that outcomes are regularly measured to drive improvements.

“We will be directly involved in a number of areas, which include enhancing the use of medicines in children and working with GPs to ensure paediatrics is part of their training.”

Signatories to the pledge include the DH, Healthwatch, the NHS Commissioning Board, NICE, MHRA and Public Health England.

A key principle of the pledge is that improving children’s health outcomes will not only reduce child mortality but lay the foundations for healthier adult lives.

The global market in statins, once the pharmaceutical industry’s lead blockbuster products, is predicted to decline by 40% in the next five years.

The forecast by GBI Research of a negative CAGR of 7.2% up to 2013 for the cholesterol-lowering drugs is based on prospects of generic erosion, weak pipelines and failing prescriber confidence.

The decline in the statins market shows that the shift of healthcare towards prevention and management of long-term conditions is not without pitfalls for the pharma industry.

Statins, which lower cholesterol levels by targeting an enzyme in the liver, have been hailed as ‘wonder drugs’ that could radically reduce the global incidence of cardiovascular events.

Routinely prescribed for ‘high-risk’ patients such as people with high blood pressure or diabetes, statins have also been linked to reduced risk of bowel cancer and reduced death rate from influenza.

However, their global market declined from $23.7 billion in 2004 to $20.5 billion in 2011 (a negative CAGR of 2.5%), due largely to patent expiry.

The report predicts a much steeper decline in the statins market over the next five years, for four reasons:

• Patent expiry – the generic share of the statins market is predicted to grow from 11% in 2011 to 34% in 2018.

• Austerity health budgets – spending on prevention is likely to be cut back.

• Weak product pipelines – the ‘me-too’ nature of most statins betrays a lack of potential for innovation.

• Increased use of alternative drugs.

Medical writer Ben Goldacre has argued that the marketing of statins in terms of relative risk reduction glossed over the low absolute risk reduction they offer, and left the products open to a backlash over side-effects.

Statins are associated with both symptomatic side-effects (including digestive disorders) and potential ones (including increased risk of type 2 diabetes).

As the overall statins market declines, the report says, individual products will struggle to gain or keep a place within it: “The global statins market has reached the competitive stage of its lifecycle, with many branded and generic drugs competing with each other on price.”

The Department of Health has outlined plans to make personal health budgets (PHBs) available to the 56,000 people receiving NHS continuing healthcare from April 2014.

It also anticipates that CCGs will offer PHBs to millions of people with long-term conditions.

However, it has admitted that no training or infrastructure exists to make this transformation of NHS care provision work.

A more fundamental change than the NHS reforms, the introduction of personal health budgets makes patients responsible for commissioning their own care.

Based on a three-year pilot study with 2,700 patients in 20 sites, the DH is confident that this system will reduce GP visits and hospital admissions, and so cut the cost of NHS care.

Patients will receive an agreed sum of money and will be responsible for designing a care package and choosing providers.

NHS continuing healthcare is provided outside hospital for people with ongoing healthcare needs – i.e. people with a complex medical condition that requires a lot of care, including specialised nursing support.

At a conference organised by the Westminster Health Forum, the DH’s PHB team leader Alison Austin said the new system offers “fantastic opportunities” for integrated care with better outcomes at less cost.

However, she said, healthcare providers currently lack the capacity to manage this “huge” change in the organisation of NHS care.

Other speakers at the conference discussed the challenge of taking responsibility for patient care out of the hands of clinicians.

Sarah Carr, a senior analyst at the Social Care Institute for Excellence charity, noted that patients choosing their own care package would represent “a really big challenge for clinicians schooled in evidence-based medicine”.

Jay Dobson, one of the organisers of the PHB pilot scheme, said the new approach would “revolutionise” NHS care – but at present, providers were unaware of it, and the healthcare market was not ready to provide that level of choice.

Further aspects discussed included the role of the voluntary sector (supported by CCG funding) in helping patients to manage their options; and the need for legal support to help commissioners draw up contracts.

Olympic gold medal winner Laura Trott OBE is supporting charity Asthma UK as the face of its online resource for young people.

Trott, 20, who won two gold medals in track cycling at the London 2012 Olympics, has suffered from severe asthma – her career is a testament to the successful management of this long-term condition.

Asthma UK’s award-winning Facebook page Big Up Your Chest provides health information and a forum for 16–25 year olds living with asthma.

The charity supports over five million young people living with asthma, and aims to halve their hospitalisation rate over the next five years.

As a young child, Trott developed severe asthma and took up sport to help her regulate her breathing.

“I was overjoyed when I won two gold medals for track cycling at the London 2012 Olympics – I couldn't believe how far I'd come and I was so proud to fly the flag for Britain!” she said.

“I was able to achieve these amazing victories because I manage my asthma by taking my medicines and making sure I’m looking after my condition sensibly. It still impacts me physically as I tend to get a dry cough after I’ve been training, so I have to be aware of my limits.

“I hope that I can inspire other people my age with asthma through my own accomplishments and show that with the right treatment, management and attitude to asthma, it doesn’t have to hold you back.”

David Hiles, Head of Health Promotion at Asthma UK, commented: “We are thrilled to have Laura on board. Her fantastic achievements make her a huge inspiration to young people with asthma, who can ensure they are managing their condition properly by using the Big Up Your Chest page.”

Two new competitions, with £5m of funding, have been launched to help improve standards of end of life care and care for people with mental illnesses.

Businesses can win funding by creating new products or services that drive standards for patients with long-term conditions.

Health Minister Lord Howe (pictured) said that “small businesses play a crucial role in providing creative and innovative solutions to existing problems. That’s why we are supporting them.”

One competition challenges businesses to generate creative ideas and technologies that could see mental health illnesses diagnosed earlier – resulting in better management through a tailored approach.

The other focuses on how new technologies can assist people to have a better experience of end of life care.

Sir David Nicholson, NHS Chief Executive, said the NHS can be “proud of the innovation it has introduced” but it needs to get “smarter at making it easy for others to adopt”. He added that “technologies that can give people a better end of life or improve the management of mental illness could make a real difference to many.”

The competitions are part of the Small Business Research Initiative (SBRI), and will be managed by NHS Midlands and East.

A new telehealth scheme has been launched by the DH to help an initial 100,000 patients with long-term conditions gain control over their own care.

Patients will get access to the use of electronic information and technology to help manage their health independently reducing the need to visit primary or secondary care facilities.

The scheme complements the NHS Mandate, which aims to provide telehealth access to three million people by 2017.

Health Secretary Jeremy Hunt said it was “logical” that the NHS should use technology to help patients “manage their condition at home, free up a lot of time and save the NHS money.”

The initial roll out of the project will see seven NHS ‘pathfinders’ across the country agreeing contracts with telehealth suppliers. The project is like no other witnessed in the UK before and is the largest outside the US.

The DH aims to make England the world leader in telehealth in coming years.

“In a world where technology increasingly helps us manage our social and professional lives, it seems logical that it should also help people manage their health,” said Jeremy Hunt. “With our industry partners, we will make England a world leader on telehealth.

“Getting another 100,000 people to benefit from this technology is a very important step and I congratulate all involved on their hard work. I hope it will be the first of many steps towards our overall goal of getting three million people to benefit in the years to come.”

David Nicholson, Chief Executive of the NHS Commissioning Board, said the introduction of the scheme had the potential to transform the lives of people with long-term conditions. “Telehealth not only saves lives, it transforms them, so that people with a long-term condition can feel in control of their life,” he said.

“The seven pathfinders that are offering this new technology to patients will give the NHS Commissioning Board important insight into how best to extend this option to any patient managing prolonged ill health or a chronic condition. 

“Working closely with the local commissioners involved and informed by their experience, we plan to promote vigorously the use of telehealth across England from next April.”