NHSE unveils new plan to tackle inappropriate prescribing
Patients in England will undergo a personalised review of their medicines with GPs and pharmacists under wide-ranging plans published today by NHS leaders to continue reducing inappropriate prescribing of painkillers and other addiction-causing medicines.
NHS England said its framework, which focuses on five types of medicines including antidepressants as well as high-strength opioids, is designed to optimise personalised care for adults prescribed medicines that are associated with dependence or withdrawal symptoms.
The plan is in five parts. Firstly, healthcare professionals will talk to patients about the intended outcome from prescribing a medicine, its potential benefits, risk and harms and whether to continue, stop or “taper” treatment.
Insisting that “dependence-forming medicines should never be stopped abruptly unless they have been taken for only a short time,” NHSE also said prescribers should talk about deprescribing if a patient’s medicine no longer benefits them, they don’t want to take it or their underlying condition has been resolved.
NHSE said integrated care system service specifications or development plans should provide the scope for healthcare professionals “to practise personalised care such as through dedicated clinics or using structured medication reviews.”
NHSE said two community pharmacy services – the discharge medicines service and new medicines service – can support patients on dependence-forming medicines.
“NHS trusts can refer patients newly started on opioids and other medicines associated with dependence and withdrawal symptoms to the discharge medicines service for review and follow-up by a community pharmacy, to minimise risk of long-term use and give patients extra support,” NHSE said.
Secondly, patients should be offered “alternative interventions and services” when a prescription for a medicine that could trigger dependence and withdrawal symptoms is considered or when an existing prescription is reviewed. Interventions could include referral to a social prescriber, health coaching, peer support, patient education and psychosocial interventions such as psychotherapy. Mental health services including talking therapies for anxiety and depression should also be considered as well as pain clinics and sleep services.
Thirdly, service specifications should support patients who have withdrawal symptoms as a result of deprescribing, allow prescribers to offer them alternative services as well as use multidisciplinary teams to deliver local care and draw on data around prescribing and localised health inequalities.
NHSE said there needs to be “appropriate commissioning of services for patients taking medicines associated with dependence or withdrawal symptoms” and any healthcare professional involved in designing and providing the service should “have access to sufficient education and training on medicines associated with dependence and withdrawal symptoms.”
The fourth part of the plan involves using “a whole system approach and pathways involving multiple interventions” to enhance care for patients and ensure service specifications are produced collaboratively between stakeholders including local authorities and third sector bodies.
Other collaborations to support implementation, NHSE said, should include regional and integrated care board chief pharmacists and regional controlled drugs accountable officers, pharmacists in GP practices, community pharmacists and GPs. NHSE said these stakeholders can work together to develop each other’s knowledge so patients can be effectively supported.
Finally, data on prescribing and local health inequalities should be used to gauge the accessibility of services as well as patients’ experiences and health outcomes within ICS areas. The data should inform action plans to support patients deemed at risk of harm.
NHSE said all five actions must “be effectively prioritised in ICS improvement and delivery plans, including when commissioning services and developing local policies.”
The Royal Pharmaceutical Society said the framework was “a positive step towards improving patient care by supporting medicine reviews and shared decision-making to help people reduce their use of medicines that are no longer providing much clinical benefit.”
NHSE said GPs and pharmacists helped reduce opioid prescriptions in England by 450,000 in less than four years and its latest plan is aimed at continuing that momentum.