This page will bring together all the PrescQIPP medicines adherence and waste resources as well as showcase good practice examples of projects focusing reducing medicines waste. Each set of resources contains tools that can be adapted for local use before implementation.
B166: Medicines adherence and waste
This PrescQIPP bulletin focuses on tackling medicines adherence and waste locally. It provides guidance, advice, and examples of good practice for medicines optimisation teams to develop local initiatives and campaigns.
This PrescQIPP project planning tool allows commissioners to identify key stakeholders, consider strengths, weaknesses, opportunities, and threats of a project and consider the best way to ensure there is buy in to drive the project forward locally. This tool is available as a word document for you to adapt locally.
PrescQIPP Medicines Waste Campaign Materials Webinar - Sajida Khatri and Claire Dearden - 12 January
In this webinar, Sajida Khatri, PrescQIPP Medicines Optimisation Director and Claire Dearden PrescQIPP Pharmacy Technician showcased the Medicines Adherence and Waste Webkit including the supporting evidence and campaign materials available. Subscribers can now view this webinar below.
Public facing campaign materials
PrescQIPP have developed a suite of patient information resources to support local medicine adherence and waste campaigns. See each slider below for further information. These resources can be used in isolation or as a package and can be distributed via stakeholders identified in the project planning tool. Our resources have been developed after engagement with patient groups and are based on a pill family, which have been created to visualise the key messages around medicines adherence and waste. If you would like advice on how you can localise the resources then please contact Michelle (email@example.com).
We have produced a campaign video, which is also split up into separate scenes that you can use locally. These can be used to be played in GP/health centre waiting rooms, pharmacies, via social media etc. Subtitles are on each video so they can be played with the sound turned down.
Below you will see the separate videos, their embed codes and links to download the files:
Waste Campaign Video Full
The postcards also complement the video resources. They can also be adapted to incorporate your own messages on the back of the postcards. Again, if you or your communications team need support on how to use these resources please contact firstname.lastname@example.org
Labels for pharmacies and practices
These labels/stickers contain the key campaign messages for use in different settings. We have provided two sets of ready-made labels in Word, in size 2.5 x 6cm. We have also provided the image files if you would like to recreate for your own custom size labels.
Example patient letter
The patient letter contains all the key messages from the waste campaign. It needs to be adapted before sending to patients.
Resources for professionals
PrescQIPP have developed various resources for professionals who can also contribute to a waste campaign. These include checklists for care home/GP receptionist staff, pharmacy patient stock check form and email footers for commissioners use.
B98: Medicines Waste in Care Homes
This bulletin discusses the factors that contribute to waste in care homes and provides advice for care home staff and prescribers on how to reduce this potential wastage.
If not managed effectively, repeat prescribing can contribute to medicines waste. This resource It provides guidance and advice for prescribers, practice managers, practice staff, community pharmacists and medicines management teams etc. on developing, implementing and reviewing repeat prescribing systems.
B124: Repeat PrescribingThe repeat prescribing bulletin includes information on repeat prescribing policies, managed repeat prescriptions from community pharmacies, repeat dispensing and electronic prescribing. It also includes training for practice staff on proper management of repeat prescribing including housekeeping and review.
Polypharmacy and Deprescribing Webkit
The Polypharmacy and Deprescribing Webkit brings together all the PrescQIPP Polypharmacy and Deprescribing (P&D) resources and showcases good practice examples of projects focusing on medicines optimisation, medication review and appropriate polypharmacy gathered nationally and internationally. Some resources contain tools and templates that can be adapted for local use and implementation.
EAHSN and PrescQIPP Medicines Adherence and Waste Joint Working Campaign
EAHSN and PrescQIPP Medicines Adherence and Waste Joint Working CampaignIn 2013 PrescQIPP was commissioned by the Eastern Academic Health Science Network to deliver a framework around how the Pharmaceutical Industry could support the NHS around Adherence and Waste. Below you’ll find all of the resources delivered as part of this work:
Introducing Medicines Adherence and Waste (framework)Optimal use of medicines can be defined as ‘medicines consumed as per evidence-based guidelines to the best possible therapeutic effect’, in other words, making sure that patients get the best outcomes possible from their medicines. Factors which reduce the possibility of gaining the best outcomes possible include:
- Therapeutic loss when the patient does take their medicines but in ways which limit or negate their therapeutic benefit
- Material waste when medicines are partially consumed but with optimal therapeutic effect
- Material waste and therapeutic loss when medicines are partially consumed, with limited or no net therapeutic effect or when medicines are dispensed but packs are not opened, or opened and never consumed
Not adhering to a therapeutic regime can be intentional or unintentional, and there are specific situations where confusion or misunderstanding can arise, along with various opportunities to ensure that at various points in the patient’s journey. Evaluating how medicines are used in primary care (both repeat and acute), hospitals and care home or carer support settings and also understand from the patient’s perspective how medicines systems and information can be improved is a vital to inform this work.
Medicines adherence and waste projects also offer some of the greatest opportunity for commissioners to deliver transformational improvements around patient outcomes and also systemic costs in the NHS, with hundreds of millions spent each year on interventions resulting from poor adherence. This, however, is a complicated area with better integration of care systems and processes required to fully realise these objectives. This is very much a key ambition of the principles and objectives within Medicines Optimisation.
Background to the EAHSN Medicines Adherence and Waste (MAW) CampaignIn 2013 the Eastern Academic Health Science Network tasked PrescQIPP with the objective to deliver a framework so that a package of projects to improve medicines adherence and reduce medicines waste could then be taken forward in line with the current national themes around Medicines Optimisation. A key element of this project was to look at opportunities for the NHS and pharmaceutical industry to collaborate.
Following the Call for Collaboration (see the guide below joint working toolkit for information on these below) by PrescQIPP in November 2013, Rachel Webb was seconded from Pfizer to develop, collaboratively, a framework for and between the EAHSN and the wider Pharmaceutical Industry, to kick-start a wider joint working programme with a specific focus on delivering tangible improvements around improving medicines adherence and reducing waste. The aim was to deliver a clear, robust and concrete framework for companies to engage with, and commit to through defining the strategic objectives, joint commitment to improvement and collaborative mind-set within a framework, this sought to help companies have the confidence that specific outcomes will result from their committing resources.
One of the key objectives of this project was to then share the processes and materials used for other interested areas to adopt and adapt for their own campaigns. Consequently the projects steps have been reorganised into the form of a toolkit, but will explain what we did in parallel to a pragmatic guide. We hope that you find this useful.
Why ‘Joint Working’ and how? The PrescQIPP approachAs introduced earlier, a key remit of this EAHSN funded project was to create a clear framework (context) to enable and then facilitate pragmatic discussions between the NHS and pharmaceutical industry to support improvements within this area. In the vast majority of contemporary guidance within the NHS, including Medicines Optimisation, the pharmaceutical industry is seen as a key stakeholder who, through joint working, could help the NHS to improve patient care and outcomes - in particular in relation to medicines care.
As a result of this new direction of travel - in particular defined in Innovation Health and Wealth - we have produced a comprehensive toolkit called Preparing for joint working that offers a range of perspectives, insight, step by step guidance for the NHS to prepare for joint working, along with a walkthough of the ABPI Seven Steps that would configure any joint working agreements. A more detailed overview can be found linked below, along with some key resources, such as a poster showcased at the Pharmacy Management conference 2014.
Throughout this project we used the steps outlined within the preparing for joint working toolkit to guide us through the stages of the project. In the following segments we will often refer to elements within the toolkit - so would recommend that you are familiar with the toolkit, especially if you or your organisation or group is looking to emulate the joint working aspect of the project.
Preparation 1 - Collaboratively developing a vision for MAW (framework)
One of the main drivers of this project was to develop a framework, or needs assessment of where some of the biggest challenges and opportunities existed within the EAHSN area around medicines adherence and waste.
In November 2013, we released a call for collaboration to the pharmaceutical industry for a short term secondment in order to work with PrescQIPP, the EAHSN, patients and key stakeholders from CCGs, LPNs, LPCs, Trusts and CSUs in order to identify a set of challenges / opportunities that need to be addressed. In early 2014 Pfizer kindly agreed for Rachel Webb to deliver this assessment.
The findings presented within the above report could provide a useful context to start your own discussions, as always the resources are available for you to use elsewhere although we’d always appreciate any reference to the originating work. We’d also be delighted to hear anything you do and any innovative changes that you make as a result.
Planning - A great start maybe to arrange a meeting with your key stakeholders to look at the report, the maps and the challenges, and then to identify how this matches with your own local needs. It’s OK if your picture looks different and you may wish to remove or amend elements. If you are looking to do a smaller project then maybe you want to just use one or two challenges?
Put joint working on the table - JW is seen as a great opportunity for improved patient outcomes - but everyone needs to be happy with this in principle - you may wish to discuss this openly within your group to ensure that everyone is on board, and to check that this is the avenue that you’re looking to pursue. If members of your group are not supportive you may need to step back and consider some more general sessions around joint working.
Preparation 2 - Get the board on boardThroughout the project we communicated with the EAHSN executive group via Carol Roberts, the EAHSN and PrescQIPP Director of Strategic Prescribing. In the early stages we produced an exec paper / proposal to ensure that there was support for this project at a high level, and following conversations referred back to this paper:
If your project is CCG or CSU led we strongly recommend that you secure higher level strategic support for the project in advance of the following steps.
Preparation 3 - Developing the calls for collaborationIn the preparing for joint working toolkit we recommend the formation and distribution of calls for collaboration, to give the opportunity for you to find the right company to work with. Remember the one who you’re currently talking to may not necessarily be the most suitable partner for the project that you have in mind.
As part of our work we developed six calls for collaboration that were distributed to colleagues in the pharmaceutical industry and also via the ABPI and EMIG. As part of the project we only wanted companies that were:
- Ready to engage in joint working, and had internal support to enable commitment to these projects.
- Aware of the report, challenges and the calls (aka the NHS need) and keen to specifically engage in one or more projects relating to these areas.
- Able to have open, collaborative and constructive conversations amongst NHS, competitors etc.
In line with the challenges from the report, the areas that we released as expressions of interest were:
- Challenge 1 - Prescribing and the Patient
- Challenge 2 - Transmission/ Transcription/ Supply of Medicines
- Challenge 3 - Communication between primary and secondary care
- Challenge 4 - Effective use of patients’ medicines in hospitals
- Challenge 5 - Ensuring patients understand the cost and value of medicines
- Challenge 6 - Effective Engagement of Community Pharmacists in Pharmaceutical Review
For further detail please open the sliders below:
Challenge 1 - Prescribing and the PatientIn line with the national Medicines Optimisation agenda outlined by the Royal Pharmaceutical Society, the key aim is to enable, and work with, patients and carers to get the best from prescribed medicines, by ensuring they gain an informed understanding of both their condition and their treatment. This challenge specifically relates to improvements around patient understanding and engagement, through effectively communicated information relating to medicines. Download the call (or pack of calls) below:
Challenge 2 - Transmission/ Transcription/ Supply of MedicinesIn line with the national Medicines Optimisation agenda outlined by the Royal Pharmaceutical Society, the key aim is to enable, and work with, patients and carers to get the best from prescribed medicines, by ensuring they gain an informed understanding of both their condition and their treatment. This challenge specifically relates to improvements around the transmission, transcription or supply of medicines either in response to technological changes (e.g. e-prescribing) or vulnerable / higher-need patients (e.g. within a care or nursing home setting).Download the call (or pack of calls) below:
Challenge 3 - Communication between primary and secondary careIn line with the national Medicines Optimisation agenda outlined by the Royal Pharmaceutical Society, the key aim is to enable, and work with, patients and carers to get the best from prescribed medicines, by ensuring they gain an informed understanding of both their condition and their treatment. This challenge specifically relates to improvements around communication between the various settings of care that the patient may progress through. Download the call (or pack of calls) below:
Challenge 4 - Effective use of patients’ medicines in hospitalsIn line with the national Medicines Optimisation agenda outlined by the Royal Pharmaceutical Society, the key aim is to enable, and work with, patients and carers to get the best from prescribed medicines, by ensuring they gain an informed understanding of both their condition and their treatment. This challenge specifically relates to improving the effectiveness of patients’ medicines within the hospital setting. Download the call (or pack of calls) below:
Challenge 5 - Ensuring patients understand the cost and value of medicinesIn line with the national Medicines Optimisation agenda outlined by the Royal Pharmaceutical Society, the key aim is to enable, and work with, patients and carers to get the best from prescribed medicines, by ensuring they gain an informed understanding of both their condition and their treatment. This challenge specifically relates to pursuing opportunities to ensure that patients understand the cost and the value of their medicines and how this aligns with their care. This could possibly relate to the proactive use of public campaigns or materials to improve public awareness. Download the call (or pack of calls) below:
Challenge 6 - Effective Engagement of Community Pharmacists in Pharmaceutical ReviewIn line with the national Medicines Optimisation agenda outlined by the Royal Pharmaceutical Society, the key aim is to enable, and work with, patients and carers to get the best from prescribed medicines, by ensuring they gain an informed understanding of both their condition and their treatment. This challenge specifically relates to the effective engagement of Community Pharmacists in pharmaceutical review, by exploring how to make New Medicines or Medicines Use Reviews more effective in targeted patient groups. Download the call (or pack of calls) below:
If you’re looking to release some calls for collaboration yourself (and we recommend that you do), you will likely need to rebuild these to suit your own area, needs and identified projects (or challenges). Linked below is an implementation document from the toolkit that you can use to construct your own.
Preparation 4 - Expressions of interest and preparing for idea generationWith the MAW Idea Generation Event being one of the main outputs of this EAHSN project we had to ensure that everything was in place to make the event a success. After releasing the calls for collaboration we received a great response from companies who had identified their interest in particular project areas. In advance of the day we produced a briefing report including highlights from the EOIs we received, this is available below:
We recommend that you consider an expression of interest form, to ensure that (covered later) companies have properly prepared and are responding with the full intention to build projects.
In parallel we worked closely with the anticipated colleagues from the NHS CCGs, trusts, LPCs etc. to ensure that both NHS and industry colleagues were fully engaged before the event. The construction of the day and associated resources can be found in the next section.
ABPI Step 1 - The idea generation workshop
With most of the preparatory activities complete it was then time to progress from the PREPs to the STEPs (i.e. the ABPI recommended Seven Steps process) for the EAHSN MAW initiative. The first stage of which being idea generation. We had a great attendee list for our event on the 2nd October however with a lot to areas to cover throughout the day, and with lots of different successful, we recruited four excellent facilitators and scribes to help us with the workshops, to stakeholders wanting to contribute, we needed to ensure that the sessions were clearly facilitated and kept oriented to the six challenges in hand. To ensure that the day was facilitate and to record key points from the discussions. Available below is the facilitator briefing, the agenda for the day and introductory presentations by Carol Roberts (outlining the challenges) and Liam Cahill (outlining the format and choreography of the day)
Above, and below (in more detail) we’ll be looking at the facilitation of the event. As we were covering a large geographic area and including a number of companies from different fields to discuss a selection of different topics the composition of our day was quite complex. In your own campaigns you may find that you have one round table discussion, which will be more straightforward, and perhaps less topics. That said we’d definitely recommend a facilitator for the conversations. If you are building your own large complex initiative please contact Liam Cahill (email@example.com) who can offer more detailed information around the composition of the day.
After presentations to set the scene, the rest of the day was focused on the six facilitated workshops. The attendees were split into four groups with an equal distribution of NHS and industry where possible. Each table had a facilitator and a scribe who would extract and record highlights, but attendees were also encouraged to fill in their own ‘speed generating sheets’ which would be left and collated after the event (see next section). Attendees were encouraged to record interest areas and links that may be possible from the discussions, using the sheet below:
Each facilitated workshop session lasted 30 minutes, and the objective was to hold frank and constructive conversations, with a view to collaborate. Companies were encouraged to not bring concrete offers or proposals, but instead to bring ideas that are open to discussion, in the spirit of truly joint working. The sessions were composed as follows:
- Five minutes - An expert from the facilitator group explains the challenge in detail, with some context and thoughts that attendees may wish to consider.
- Ten minutes - The NHS attendees on the table respond outlining their perceptions of the challenge in relation to their own local priorities and needs.
- Ten minutes - The companies respond to the previous 15 minutes also expressing their thoughts and possible opportunities in relation to the challenges, their own interest areas and the NHS needs.
- Five minutes - The facilitators work with their tables to extract key points and summarise possible opportunities for joint working.
Again, the composition of your event may differ from ours, especially if the group is ready and able to start building joint working projects. However, the proposed format above is one that worked well for us, as it has the right mix of detail and brevity. Remember the objective isn’t necessarily to create all of the details for a project, but instead start to build concepts that can later be crafted into projects.
In the next section we will look at what was discussed and what came out of the day.
Outcomes from the day and next stepsIn line with the remit and role of the AHSNs the objective of this project was to:
- Work with NHS stakeholders in the EAHSN area to provide a needs assessment (or framework) around Medicines Adherence and Waste, which could be used for discussions around joint working.
- Take a whole system approach so that the audience is multidisciplinary and relating to different settings of care.
- Create a platform for constructive NHS-Pharma discussions with the hope to enable joint working projects in the EAHSN’s localities.
- Mentor and support any resulting projects.
An important element of this campaign was to energise and enable local projects rather than try build our own, as the CCGs and other NHS stakeholders are ultimately the most appropriate organisations to engage in these agreements and improve patient care. This means that the next stage will be to share links and outputs to encourage more specific constructive discussions from groups. That said we have already heard of a lot of great feedback around conversations that are happening so should be able to start to profile projects very soon.
A document outlining the links for the day (generated from the speed generating sheets) will be circulated to attendees shortly. The highlights from the facilitators and scribes will be summarised and published here shortly, along with any key outcomes.
Examples of Successful Projects
This section highlights resources from CCGs, CSUs and other NHS organisations who have implemented waste projects tackling different themes. Projects have been grouped under the sliders below.
- Wasting Away - Belfast Health and Social Care Trust
- Breathe Better Waste Less - Brighton and Hove CCG
- Solihull Waste Campaign - Solihull CCG
- Only order what you need - Southern Derbyshire CCG
- “What a Waste” - East Staffordshire CCG
- Innovative ways to reduce medicines waste - Nene CCG and Corby CCG
- Medicines Waste reduction project - Northern, Eastern and Western Devon CCG
- Waste Campaign - Open the bag - Great Yarmouth and Waveney CCG
- Waste Not, Want Not - Thurrock CCG and Basildon and Brentwood CCG
- Medicines Waste Toolkit - Mid Essex CCG
Innovation Award Winner Webinar: 'What a Waste' - East Staffordshire CCG - January 2015
Claire Dearden from East Staffs CCG presents 'What a waste' project that won the Improving medicines adherence and waste category and gold award at the PrescQIPP Innovation Awards.
Repeat Prescription Management
- Reducing medicines waste; improvements to repeat medicines management - Luton CCG
- Practice Medicines Co-ordinators (PMCs) - Nene CCG and Corby CCG
- Medication Review Template (SystmOne and Emis Web) - West Norfolk CCG
- Reviewing those with 21 or more items on repeat prescription - Ipswich and East Suffolk CCG
- Medicines Optimisation - Repeat prescription management Dudley CCG/Dudley MBC Office of Public Health
- Prescription Ordering Direct scheme - Coventry and Rugby CCG
- Medicines Management Facilitator Scheme - Leeds South & East CCG
- Repeat Prescription Project - Sandwell & West Birmingham CCG
- Repeat Prescribing Risk Assessment in General Practice across Lambeth CCG - Medical Protection Society (MPS) commissioned by Lambeth CCG
Best Practice Webinar: Prescription Ordering Direct Scheme with Coventry and Rugby CCG - May 2016
On 4th May we welcomed Altaz Dhanani and Lisa Scullion from Coventry and Rugby CCG to talk about their ‘Prescription Ordering Direct’ (POD) scheme which was recently showcased by the HSJ. The scheme aims to reduce medicines waste by allowing patients to order their repeats over the phone from the Medicines Management Team.
Innovation Award Winner Webinar - Practice Medicines Co-ordinators (PMCs) - Nene CCG and Corby CCG - April 2016
On 26th April we welcomed Sue Smith from Nene CCG and Corby CCG to further capture and share their award winning innovative work on Practice Medicines Co-ordinators (PMCs).
Innovation Award Winner Webinar - Reducing Medicines Waste; Improvements to Repeat Medicines Management - Luton CCG - April 2016
On 18th April we welcomed Tess Dawoud and Richard Jones from Luton CCG to further capture and share their award winning innovative work on Reducing Medicines Waste; Improvements to Repeat Medicines Management.
- Medicines Optimisation reviews in GP practice - South East Staffordshire & Seisdon Peninsula CCG
- To provide a medication review service to patients at the GP surgery and in a domiciliary setting (Pharmacy Technician led) - Bedfordshire CCG
- Deprescribing - North Derbyshire and Hardwick CCGs
- Polypharmacy and deprescribing - West Hampshire CCG
- Proactive care – an integrated pharmacist led service - Coastal West Sussex CCG
- Primary Care Medicines Optimisation Service - Wyre Forest CCG
- Medicines Optimisation Review Programme - Swale CCG
- Pilot of Medicines Quality Team in GP Practice Hub - East Leicestershire and Rutland CCG
- Pilot of Social/Health Integrated Pharmacists in Primary Care - East Leicestershire and Rutland CCG
- Optimising medicines with practice based pharmacists - Mid Essex CCG
Innovation Award Winner Webinar: 'Integrated Care Clinical Pharmacist (Older People)' - Guy’s and St Thomas’ NHS FT - March 2015
Sulman Qadir from Guy’s and St Thomas’ NHS Foundation Trust presents, 'Integrated care clinical pharmacist (older people)' that won the Supporting shared decision making with the patient category at the PrescQIPP Innovation Awards.
Medication Reviews in Care Homes
- Reducing avoidable waste in the care home setting - NHS North of England Commissioning Support
- Integrating Medicines Optimisation into the Care Home setting - NHS North of England Commissioning Support
- Improving Medicines Management in a care centre - Arden and GEM CSU
- Demonstrating the effectiveness of a Pharmacy Led Medication Reviews in Care Homes - Cambridgeshire & Peterborough CCG
- Pharmacist-led Medication Review of Care Home Patients - South East Staffordshire and Seisdon Peninsula CCG
- Informing the role of a Pharmacist in the Integrated Care team - East Leicestershire & Rutland CCG
- Care Home Medicines Review Team - Royal Wolverhampton NHS Trust
- Integrated Care Clinical Pharmacist – Older People - Guy’s and St Thomas’ NHS FT Community Health Services
- Improving medicines management in care homes - North of England CSU
- Medicines Optimisation in Care Homes Summer Student Project - Arden and GEM CSU
- Waste Reduction in South Tees - North of England CSU - Medicines Optimisation
Secondary Care Interface
- Reducing the risk of medicines-related hospital admissions through CCG medicines management team identification, triage and review - High Weald Lewes and Havens CCG
- 'HELP FOR HARRY’ Discharge Referral Service - Derby Teaching Hospitals NHS Foundation Trust
- Ward based pharmacy assistant on a medical admissions unit to reduce medicines waste and improve medicines transfer- Western Sussex Hospitals NHS FT
- The National Institute for Health and Care Excellence (NICE). Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes NG5. March 2015.
- The National Institute for Health and Care Excellence (NICE). Medicines optimisation: NICE Quality Standards. QS120. March 2106.
- The Royal Pharmaceutical Society. Medicines Optimisation: Helping patients to make the most of medicines. May 2013.
- World Health Organisation. The world medicines situation 2011 rational use of medicines. Kathleen Holloway Department of Essential Medicines and Pharmaceutical Policies, WHO, Geneva Liset van Dijk University of Utrecht, the Netherlands. 2011.
- Department of Health. Action plan for improving the use of medicines and reducing waste. 2012.
- NHS England. Pharmaceutical waste reduction in the NHS. 2015.
- East and South East England Specialist Pharmacy Services. Reducing medicines waste throughout the patient journey. Simple guide and support information. 2015.
- NHS Institute for Healthcare Research. Medication Passports. 2014.
- The Royal Pharmaceutical Society. Keeping patients safe when they transfer between care providers – getting the medicines right. 2012.