Is the latest preoccupation with medicines 'optimisation' all rather meaningless?

Optimisation is a funny word. It means making something the best it can be. I havealways found it a vague word, the kind of fudge word that politicians like to use. It’s because optimisation is a word that is hard to pin down to define exactly what it means or what it’s intended to mean. A year ago, the Royal Pharmaceutical Society called for the adoption of medicines optimisation across the NHS, publishing a landmark document called, imaginatively, Medicines Optimisation. It would, it was said, improve outcomes and reduce waste. The document was hailed by Sir Bruce Keogh, medical director of NHS England, who said he would “encourage everyone to adopt these principles whether prescribing, dispensing, administering or taking medicines.”

"Optimisation is a word that is hard to pin down
to define what it means"

“Encourage” – that’s another one of these vague words, isn’t it, Sir Bruce. It means you don’t actually have to do anything meaningful about it. If, as has often been said, 30-50 per cent of patients don’t take their medicines as prescribed, that means that between £4bn and £7bn is being wasted annually on medicines where the use is far from being optimised, and the figure is increasing every year. At a time of austerity in public finances, this is a national disgrace.

Recently there was a media storm over a £2bn shortfall in NHS funding for 2015. That is between a half and a quarter of the money that is being wasted on medicines every year. Where is the media storm on this issue? However, all is not lost. NHS England has developed a Medicines Optimisation ‘Dashboard’ (www.england.nhs.uk/ourwork/pe/mo- dash/),whatever that means. According to the blurb that accompanies the ‘dashboard’, medicines optimisation is about ensuring that the right patients get the right choice of medicine, at the right time. (When I was studying for my degree these same words were used to define the role of a pharmacist.) According to NHS England, the dashboard has been developed to encourage (that word again) clinical commissioning groups to think more about how well their patients are being supported to use medicines more effectively and safely, and less about the cost and volume of the drugs. It could result in funding for more pharmacy services. But will it? Here we see the baleful effects of the NHS ‘reforms’ introduced by the current government. The first effect is fragmentation: health and wellbeing boards and other commissioners are not working with pharmacies; it’s as though we have become invisible.

It’s not me saying this, it’s the chief executive of the NHS Alliance. A recent survey found that only one in five HWBs have had meetings with LPCs. In addition, the element of competition introduced by the reforms means that many GPs now view pharmacists as competitors with relationships between the two professions turning sour as a result. A culture shift is needed to ensure commissioners start to understand community pharmacy so that pharmacists’ skills are fully used and GPs need to surrender services that can be provided by others, but will it happen? Will the new medicines optimisation dashboard help? Unless we stop using weasel words like ‘optimise’ and ‘encourage’ and take meaningful steps at national level to bring pharmacy in from the margins of primary care, I don’t think anything will change.