Getting the right medicine to the right patient at the right time has long been considered an area in which digital solutions can be a valuable aid. Traditionally, the focus has been at an organisational level. But with integrated care systems having become statutory bodies, what does effective medicines management now look like? Claire Read reports.

As a senior policy advisor at the NHS Confederation, Edward Jones has a mission which is far from straightforward – to help healthcare leaders navigate the many strategic challenges currently facing the service. Fundamentally that means uncovering ways to meet the needs of patients and citizens more efficiently. And that in turn means, he says, that medicines management is a natural area of focus for him and his colleagues.

“We know medicines are really important to healthcare,” says Jones. “They’re the most common healthcare intervention in the world, they’re the second highest cause of avoidable harm, and they are the second largest of spend in the NHS after workforce.”

In September 2021, he co-authored a report on medicines and integrated care systems (ICSs), the partnerships of health and care services in a local area which became statutory earlier this year.

Entitled “Why medicines optimisation is a priority for integrated care systems and how it can be improved”, the paper argues that proper use of medicines goes right to the very heart of ICSs’ activities.

Fundamental to ICS activity

“Medicines optimisation is about how we do healthcare interventions in a way that keeps people healthier, keeps people out of hospital, and tackles health inequalities,” says Jones, who works as part of the Confederation’s ICS Network.

“It’s not just about looking at varying patterns of prescribing and cutting down unwarranted variation,” he continues. “Actually, it’s about saying: how can we get increased diagnosis to get more medicines to the right patients, at the right time, and in the right place?”

And that, he says, makes medicines optimisation “integral to what ICSs are going to do”.

“We shouldn’t just see it as something to put in the pharmacy box. It isn’t something that’s just for pharmacists, medicines are everyone’s business.”

That ‘everyone’ undoubtedly includes chief information officers (CIOs), chief clinical information officers (CCIOs) and all other members of digital teams. It’s long been argued that the process of providing the right patient with safe, effective, evidence-based and cost-effective medicine at the right time – referred to by some as medicines management and others as medicines optimisation – is an area ripe for digital interventions.

Back in 2018, for instance, then-health and social care secretary Jeremy Hunt announced a big push to implement electronic prescribing (e-prescribing) and medicines administration (EPMA) more widely across acute trusts. For Terry Hainsworth, senior business consultant at Civica, the result is that ICSs don’t feel like an enormous change.

Full steam ahead

“What I’m seeing from the organisations we work with [the company’s Civica Prescribing EPMA software is currently used at 10 trusts] is kind of more of the same,” she says. “They are planning on maximising their use of electronic prescribing and medicines administration.”

This can be viewed as a part of the integrated care agenda embodied by ICSs, Hainsworth acknowledges. “They’re trying to enable more clinicians across more care settings to gain those benefits from using an EPMA.”

But she sees it as more about “maximising support for clinicians who have got a really demanding workload that is likely to be significantly more pressurised over this winter” rather than as a development triggered by the advent of the statutory ICS.

Patrick Wilkinson is marketing manager for BD’s Connected Medication Management products, which integrate the company’s pharmacy and ward products with other investments such as electronic prescribing.

Some way to go

He explains: “I believe some organisations think of medicines management as [only being about] a pharmacy setting, yet most medication errors actually occur at the administration stage.

“Pharmacies track inventory levels within the department, but when medicines are transported to the various wards within a hospital we feel medicines efficiency and safety improvements can be made.”

“BD wants to work with healthcare organisations, including ICSs, so all medicines can be digitally recorded and tracked throughout the medication journey.”

The engagement challenge

Engaging clinicians in such changes will undoubtedly be key, but there are worries that the enormous pressures currently falling on health and care are a barrier to engagement – making it hard to further advance digital means of supporting medicines management. And that applies at trust level and ICS level equally.

“We’re going to start seeing that as a real challenge,” argues Civica’s Hainsworth. “You cannot successfully roll out a really clinically-based system like EPMA without involving clinicians, and trying to get their time is so difficult.

“I think this is the challenge that we have across the whole sector at the moment, not just for people like us who sell software systems, but also from our deployment teams who work with [NHS organisations].”

At FDB UK – which provides solutions including drug databases and clinical decision support for medicines management – there are similar concerns.

Darren Nichols, the company’s managing director, says that “while we can all collectively see where we need to get to, particularly around improving patients’ experiences of the interface between primary and secondary care”, he thinks “the reality of day-to-day demand for healthcare is a challenging foundation on which to accelerate transformation”.

However, he says the move to ICSs has led to an evolution in focus. There has been increased demand for FDB products that help support organisational change. But, notably, Nichols says the firm has also supported what he calls “step changes” in system-wide medicines interoperability for shared care records.

He’s optimistic that the early waves of the pandemic embedded an understanding of the value of shared data in decision making across a local health and social care economy.

“The shift to data-led healthcare gives us the opportunity to demonstrate the positive impact of medicines interventions in the context of an ICS’s wider population health and clinical strategy,” he says.

Shared care records as a medicines management tool

When considering what effective medicines management might look like at an ICS level, the shared care record is considered by many to be a particularly important tool. Aaron Jackson, Medicines product director or Orion Health, says he and colleagues “are seeing growing momentum towards consolidated medication records (CMRs), supported by central bodies”.

He describes such records as “contemporaneous and accurate lists of medicines an individual is taking in the community, assembled from multiple sources”.

“We are currently working with some of our more mature shared care record customers on creating their CMRs,” he reports. “There are also some areas approaching this at an ICS level, such as the One Medication Record in Wessex.”

In the end, quite what successful medicines management looks like in the context of a statutory ICS is a matter still up for discussion and development. And, for the NHS Confederation’s Jones, it comes down less to what the legal structures are and more to a willingness to embrace new relationships and new ways of working.

“Medicines is everyone’s business, but it’s hard to break out of some of these organisational boundaries; to break out of some of the habits we’ve got into.

“Ultimately, ICSs are about culture change, and we can’t change culture through legislation,” he says. “The legislation is an enabler. Now we’ve got to get on and do the job.”