During 2022/23 the SSOT ICB Medicines Optimisation team launched a totally new model for clinical pharmacy and medicines optimisation support to General Practice. This was in response to the pharmacy workforce challenges presented by the formation of PCNs. The new model is a collaboration between practice/PCN based clinical pharmacy teams and the ICB based MO teams transacted through a Service Level Agreement between Provider and Commissioner. The ICB MO team designed, piloted and launched the SLA after extensive engagement with stakeholders. The practice/PCN based were tasked to deliver the SLA.
During the delivery phase a range measures such as orientation and training sessions, feedback meetings and general mutual support facilitated productive working relationships between ICB MO team and the practice/PCN based clinical pharmacy teams. Furthermore MedOptimise Tool was chosen as the digital solution acting as a single platform of interaction between the teams obviating the need and eliminating costs for multiple software products.
The model was highly successful. The outcomes below have been categorised according to the different elements of the SLA:
Structured Medication Reviews (SMR):
• 16,753 structured medication reviews were delivered - covering cohorts of care home residents, patients over the age of 65 with 10 or more items and patients on inhalers.
• 22,945 interventions were recorded
• £1 million cost saving in prescribing – 74% due to drug stoppages
• Potentially 194 hospital admissions prevented
High Impact Prescribing Interventions (HIPI):
• 6207 specific drug reviews conducted
• £1,770,057 cost savings in prescribing – 72% due to switches
• 3081 patients taking a direct oral anticoagulant (other than edoxaban) for non-valvular AF were reviewed and their treatment changed to Edoxaban
• £1,797,406 cost saving achieved on DOAC prescribing
Sodium Valproate Safety Audit
• 463 Patient records audited (women of childbearing age)
• 75% of practices participated
High Dose Opioid Safety Audit
• 1650 patient records audited
• 71% of practices participated
Antibiotic Audits
• 1992 patient records audited
• 83% of practices participated
Note : All audits provided rich insight into how quality and safety of prescribing could be improved
