The systematisation of medicines optimisation: Why medicines optimisation is a priority for integrated care systems and how it can be improved

Key points

• Medicines optimisation aims to improve health outcomes, service quality and sustainability. It is a patient-centred approach to ensuring patients are prescribed and taking their medicines as recommended by guidance, so that they derive the intended benefits and avoid incurring harms. As the most common healthcare intervention in the world and perhaps the one carrying the greatest risk of avoidable harm, optimising medicines use is a priority to improve the quality of healthcare and quality of life.
• Medicines spending consumes a growing share as proportion of the overall NHS budget in England, making it vital to the sustainability of the health service that medicines are managed responsibly and equitably within available resources.
• As the NHS in England undergoes a period of reform, with integrated care systems (ICSs) taking over strategic resource planning responsibilities from clinical commissioning groups (CCGs) and responsibility for collaboration between and the integration of health and care services, this report considers how the systemisation of the NHS can be used to galvanise medicines optimisation, improving both health outcomes and financial sustainability.
• Given that medicines optimisation relies as much on effective governance and collaborative working arrangements across clinical pathways and care settings as they do on technical pharmacy expertise, we have framed medicines optimisation as much as a public management and clinical systems issue as it is a technical and pharmacy issue. Based on expertise of stakeholders across the healthcare system involved in medicines optimisation, from commissioners to providers in primary, community and acute care settings, the report sets out recommendations across five key areas to enable systemorientated medicines optimisation: workforce, governance, national leadership, pathways, and data and technology.
• With some specialised and community pharmacy commissioning being delegated to ICSs (planned to be fully in place by 2023), systems will have an even greater share of commissioning budgets and ownership of the whole pharmaceutical pathway’ than ever before. Given systems will also be the nucleus of integration, we believe the relationship between ICS, regional and national teams should be seen as a partnership ‘co-commissioning’ approach with clear responsibilities defined across the different tiers of governance.
• In line with the Long Term Plan, ICSs should be the nucleus for tailored medicines optimisation strategies at the system-level to advance national goals, with tactics adapted to local needs at a place-level. This approach hopes to achieve an effective balance between co-ordination and subsidiarity.
• Building collaborative ways of working takes time. New structures can be an enabler of change, but they are not the culmination of change. For many systems, sustained effort and focus on the priorities outlined in this paper can help facilitate the successful systematisation of medicines optimisation, but it may take around three to five years before systems will see real benefits for population health, clinical quality and value.