PrescQIPP

Medicines Optimisation in Diabetes Care: Evaluation of the impact of specialist pharmacist-led diabetes clinical reviews across Birmingham and Solihull ICB (2025)

Medicines Management and Optimisation Team Birmingham and Solihull Integrated Care Board

Project summary

In Birmingham and Solihull (BSOL), there are 181 GP practices in total. The prevalence of diabetes is very high at 9.2%; this is notably higher than the national prevalence in England of 7.7%.1 This is particularly an issue in deprived areas with significant health inequalities. A team of six specialist diabetes pharmacists working in the medicines management team at Birmingham and Solihull Integrated Care Board (ICB) led by a senior prescribing advisor were assigned to GP practices across BSOL. Through a local improvement scheme, (LIS) practices were required to engage with the diabetes pharmacist to review 1% of patients on their diabetes register, reviewing a minimum of 10 patients. The reviews aimed to look at quality, safety and cost-improvement measures. This initiative was funded through a repurposed LIS budget, managed by the ICB, without additional financial input. The primary goal was to work with GP practices to implement change and enhance patient care. The diabetes pharmacists designed and ran searches in all GP practice clinical systems. The searches covered a range of safety and quality issues and prescribing combinations not recommended e.g. mixed insulin and long-acting insulin, sulfonylurea and mixed insulin and the co-prescribing of GLP-1/GIP and DPP4 inhibitors. Safety searches included metformin prescribed in patients with eGFR less than 30ml/min), and sulfonylurea prescribing in patients with low Hba1c (less than 53mmol/mol). Another aspect of the searches was to actively identify patients who would benefit from a cardio-renal metabolic review e.g. type 2 diabetes with out of range blood pressure and cholesterol levels and type 2 diabetes patients with CKD or heart failure and not on an SGLT2i. Some practices opted to focus on a few clinical areas whereas others chose to run all of the clinical searches. As per the LIS, a minimum of 10 patients identified through these searches were selected for further review and discussion. The pharmacists clinically reviewed patients, including their medications, lipid levels, blood pressure, renal function, and national diabetes audit (NDA) targets.