Exclusion of community pharmacy from medicines optimisation is 'crazy'
By Neil Trainis
Sanjay Ganvir, a director at Green Light Pharmacy, told the chief pharmaceutical officer David Webb during a session at the Pharmacy Show that NHS England has excluded community pharmacy from its medicines optimisation programme.
Ganvir, who is also the superintendent pharmacist at Green Light Pharmacy which has 16 branches across London, used a talk on community pharmacy’s clinical future to emphasise that the community pharmacy network is “one of the biggest assets the NHS has to impact medicines optimisation” but was not being utilised by NHSE, something he insisted was “crazy.”
NHSE put forward 16 national medicines optimisation opportunities for the NHS in 2023-24 which it said would be delivered through integrated care boards. Those included addressing problematic polypharmacy and low priority prescribing, improving the uptake of the most clinically and cost-effective medicines and tackling inappropriate antidepressant prescribing.
Ganvir told Webb (pictured) that he appreciated “the way NHS England is now engaging with the community pharmacy network” but said: “No other bit of the NHS interacts with patients like community pharmacy does. We have the most touch points with patients anywhere in the NHS and we seem to be excluded. Medicines optimisation doesn’t seem to include community pharmacy which is crazy.”
Ganvir said NHSE’s failure to include community pharmacy in its medicines optimisation strategy meant patients were not taking their medicines as prescribed and many were ending up in hospital as a result.
“Forty to 60 per cent of medicines are not taken as prescribed, so the biggest intervention the NHS makes by volume and cost, 60 per cent of the time it is, I think the technical words are, ‘a bit pants.’ And (that leads to) eight per cent of all hospital admissions. So, it’s not just ‘a bit pants,’ quite often it’s actually ending up in hospital,” he said.
“The reason for that is patients don’t properly understand what their medicines are for and that’s a failing of every single clinician in the NHS. We don’t talk to patients. As a clinician, I would say we’re all arrogant. We all think we’re bloody God.
“We should be engaging with patients and using what’s in our head to do a translation piece on how medicines are taken. So, is there an opportunity for NHS England to put community pharmacy at the heart of their medicines optimisation strategy?”
Figures are 'embarrassing to all of us'
Ganvir challenged Webb and NHSE to create “a patient-centred, make-every-contact-count adherence service which will directly impact on those terrible 60 per cent and eight per cent figures which are embarrassing to all of us here.”
“That’s where you’ll get your biggest bang for your buck. It’s not (about) script switches, it’s not a meds op committee. It’s utilising the biggest asset the NHS has which is the community pharmacy network,” Ganvir said.
In response, Webb insisted community pharmacy “is key to medicines optimisation because it sees people before the emergence of ill-health.”
“If you can change somebody’s course so they don’t need to take medicines, that’s a profound thing to do,” he said, adding the New Medicine Service “speaks to” Ganvir’s point about the interaction between pharmacies and patients.
“I have a really simple take on this and that is the most cost-inefficient use of resource is a medicine that nobody takes and so, everything that supports adherence to help people derive the benefit they should be getting is really important,” Webb said.
He urged Ganvir not to “read anything” into NHSE’s 16 priorities for medicines optimisation “that’s not engaging for community pharmacies.”
“They are areas of traction for ICBs to look at particular opportunities on the cost side of the equation. I think the great thing about community pharmacy is the value it adds and not just remunerating the cost of intervention all the time,” Webb said.