The NHS South East London (SEL) ICS overprescribing project is a strategic, system response to implement the 20 cross-system recommendations in the National Overprescribing Review (NOR).
We have reduced overprescribing through delivery of systemic and cultural improvements within the ICS, through dedicated, focused pharmacy leadership. We have leveraged integrated and collaborative ways of working in the ICS to deliver system wide solutions through a combination of mini projects across system partners and engagement with our public. We are now mainstreaming our interventions into long term, sustainable change and sharing our work with other ICS systems.
Many neighbourhoods in SEL are affected by deprivation meaning that multimorbidity, frailty and polypharmacy (8 or more medicines) occurs 10-15 years earlier. Higher populations of ethnic minorities and lower levels of literacy compound the intersectionality of experiencing health inequalities from overprescribing. Our goal is to change existing culture and establish systems and resources to reduce the exposure of our population to overprescribing. Through this we will improve patient outcomes through better use of medicines and alternatives, whilst reducing harm, health inequalities, medicines waste, financial inefficiencies, and positively reduce impact of overprescribing on the environment. We are addressing the complex drivers of overprescribing using the relationships and partnerships of the ICS to adopt a whole systems social mobilisation approach to drive transformational change needed.
By putting dedicated clinical leadership into place, identifying system partners and community assets, setting a compelling vision and agreeing a clear plan we have mobilised people towards our common goal. Key innovative elements of the work have been across health and social care sectors and organisational boundaries with multidisciplinary working involving primary care network staff, community pharmacy, acute, mental health and community trusts, councils and public health as part of Local Care Partnerships.
A unique focus was engaging with community groups and patients across all sections of our diverse population to give them a voice in shaping the change required. We are working alongside the South London Health Innovation Network to implement a community of practice to support staff from all disciplines who did not feel empowered to tackle polypharmacy.Through system work and 12 mini-projects in collaboration with partners, the project tackled multiple drivers of overprescribing to implement the National Overprescribing Report recommendations.
Organisations have also committed to improving information on medicines on discharge.
Pharmacy technician interventions to reduce medicines waste in care homes led to a savings of £2.4k in one month. Savings were calculated using data from the Prescribing-Polypharmacy-SIMPATHY-Economic-Analysis-Tool to estimate direct savings per SMR, per annum of £99 per and indirect savings of £441 from avoidance of adverse drug reactions and £55 from hospital admission avoidance.
Taking 10 or more medicines is 300% more likely lead to hospital admission because of an adverse drug reaction. Training and education sessions were delivered for pharmacy teams and other practitioners to empower them to facilitate shared decision-making with patients during encounters/medication reviews to reduce overprescribing.
SEL Integrated Medicines Optimisation Committee has included a requirement to explicitly consider overprescribing when applying for new drugs or guidelines development. This has also extended to our wider clinical effectiveness and quality improvement approaches who now routinely address overprescribing in guidelines and educational events.
Extensive patient engagement in real-world settings, particularly those experiencing health inequalities, has provided crucial insights into barriers and challenges faced by SEL patients and their carers. This has been incorporated into our work, for example targeted work on chronic pain and access to SMRs.
Feedback from a waste outreach project provided some new insights over and above national data about reasons for waste, behaviours and attitudes towards medicines disposal and the environment. We are planning to deliver a public awareness campaign and a community pharmacy waste avoidance project following this work. Patient stories and visuals were also developed to illustrate the value of reducing overprescribing on people's experience of care, the cost reduction involved in medicines, hospital admissions, adverse effects and outcomes.
Collaboration between Trusts, primary care, care homes and community pharmacists has improved with pathways in place to optimise medicines post discharge and enable collaborative cross sector referrals for Structured Medicines Review.
Feedback from community pharmacists included feeling more valued as part of the team and able to better support patients. Projects on medicines waste demonstrated that clinician behaviour and patient decisions are key drivers of medicines waste. This aligns with patient engagement feedback about the need for more information and better conversations to help patients make the right choices about their medicines to get the best outcomes. These insights will feed into our future work to support patients and clinicians to reduce overprescribing.
Older people, people living in the most deprived areas, and people from Asian, black and mixed black ethnicities are more likely to be taking 8 or more medicines. To reduce health inequalities, we developed tools and resources for case finding populations and individuals with the highest needs and then sought to test/target appropriate interventions to reduce overprescribing and improve outcomes. Projects focussed on improving patient knowledge of SMRs, a public campaign, a pharmacy outreach service for underserved populations, and a care model for SMR for non-verbal people with learning difficulties and autism. More recently, we are using data to identify and target SMRs in CORE20PLUS5 population to drive improvement and reduce inequalities.
Workforce training, education and patient engagement has given us more confidence to use co-production approaches to design culturally sensitive and specific models of care and services to address what matters most to our population. Unintended workforce benefits are also emerging with feedback from community pharmacy feeling more valued and better able to support care.
This confirms the huge impact of pharmacy teams working together across organisational barriers to have longer and more joined up conversations about medicines.Through this initiative, pharmacy professionals emerge as leaders in driving system-wide change to address overprescribing and contribute to broader ICS objectives of improving population health outcomes, tackling inequalities, enhancing productivity, and supporting socioeconomic development. https://www.selondonics.org/icb/healthcare-professionals/medicines/overprescribing/
