Medicines prevent, treat or manage many illnesses or conditions and are the most common intervention in the NHS. Medicines optimisation looks at the value which medicines deliver, making sure they are clinically-effective and the best value for the NHS. It is about ensuring people get the right choice of medicines, at the right time, and are engaged in the process by their clinical team.
The Durham Medicines Optimisation team comprises a team of pharmacists with extensive knowledge who have worked in various sectors of healthcare including community pharmacy, primary care, secondary care, prison service, academia and commissioning.
The team provides dedicated support and advice on all aspects of medicines and prescribing to clinicians working in Primary Care Networks across County Durham to improve the safe and effective use of medicines, and to enable the best possible outcomes for our patients. We also support the work of the wider North East & North Cumbria Integrated Care Board (ICB) across County Durham in commissioning appropriate and targeted services that involve medicines use.
Our responsibilities include:
- Antibiotics and antimicrobial stewardship
- Supporting the treatment of long-term conditions such as diabetes and COPD
- Reducing medicines waste
- Assessment of medicines related patient safety incidents
- Supporting the COVID-19 and Flu Vaccination Programmes
- Supporting and implementing local campaigns, such as our current campaign – Painkillers Don’t Exist
- Assisting in the development and implementation of;
– Clinical guidelines
– Shared care guidelines
– Patient group directions
- A joint medicines formulary across primary and secondary care in County Durham
- Participation in various committees
- Monitoring of prescribing data across County Durham
Any queries relating to medicines optimisation can be directed to firstname.lastname@example.org
Any pharmaceutical representatives who wish to see a member of the medicines optimisation team, please contact the MO team for a request form at the above email address.
Primary Care Networks
Since the NHS was created in 1948, the population has grown and people are living longer. Many people are living with long term conditions such as diabetes and heart disease, or suffer with mental health issues and may need to access their local health services more often.
To meet these needs, practices have begun working together and with community, mental health, social care, pharmacy, hospital and voluntary services in their local areas in primary care networks (PCNs).
Primary care networks build on the core of current primary care services and enable greater provision of proactive, personalised, coordinated and more integrated health and social care.
The Durham Medicines Optimisation team will support the PCNs by:
- Providing support in the contracting / employment of pharmacy staff
- Supporting the training of Pharmacists and Pharmacy Technicians employed by the PCNs
- Develop medicines optimisation workplans which align with local and national priorities
- Provide peer support and education to the pharmacists and pharmacy technicians at bi-monthly meetings
- Work with the GP Prescribing Leads in supporting the PCNs with the delivery of medicines optimisation
Structured Medication Reviews and Medicines Optimisation
Structured Medication Reviews (SMRs) are a NICE (National Institute for Health and Care Excellence) approved clinical intervention that helps people who have complex or problematic polypharmacy. SMRs are designed to be a comprehensive and clinical review of a patient’s medicines and detailed aspects of their health and are delivered by facilitating shared decision making conversations with patients aimed at ensuring that their medication is working well for them.
From April 2020 each PCN will use appropriate tools to identify and prioritise patients who would benefit from a Structured Medication Review, which will include those:
- in care homes
- with complex and problematic polypharmacy, specifically those on 10 or more medications
- on medicines commonly associated with medication errors
- with severe frailty, who are particularly isolated or housebound patients, or who have had recent hospital admissions and/or falls
- using potentially addictive pain management medication
Patients who may benefit from a structured medication review of their medicines will be invited to talk about this with their healthcare professional. The review can help to identify any medicines that are no longer needed or any that need the dosage changed. Health professionals should work with the patient to establish if they have had or have any risk factors for developing adverse drug reactions and whether any monitoring is needed.
Area Prescribing Committee
The Area Prescribing Committee (APC) is responsible for the clinical decision making and advice in relation to prescribing and medicine management in services commissioned by County Durham and Tees Valley plus Hambleton, Richmondshire & Whitby and provided by County Durham and Darlington Foundation Trust (CDDFT), North Tees & Hartlepool NHS Foundation Trust (NTFHT), South Tees NHS Foundation Trust (STFT), Tees Esk and Wear Valley NHS Foundation Trust (TEWVFT), and the Local Authorities in County Durham & Tees Valley, and all general practice members.
The County Durham and Tees Valley APC is responsible for approval of new drugs, extending the use of existing formulary drugs to new indications and for the production of the County Durham and Tees Valley Formulary — which provides details of medicines approved for use in County Durham, Darlington, Teesside and parts of North Yorkshire. Decisions around new drug requests take into consideration safety, clinical effectiveness, and cost-effectiveness relative to other treatment options for the condition under discussion, as well as the potential available budget. Decisions will be made on fully published trial data only.
Please find a link to the County Durham & Tees Valley APC website here.
Formulary & Guidelines
The County Durham & Tees Valley shared formulary and guidelines (for healthcare professionals) can be found using the following links
County Durham & Tees Valley Formulary
Shared Care Guidelines & Transfer of Prescribing Policies
A shared care drug is one that:
- is required to be initiated by a hospital consultant/specialist and
- requires a period of stability and monitoring under the care of the hospital consultant/specialist prior to prescribing responsibility transferring to the GP
This means that initial prescriptions will be provided by the hospital specialist.
Once a shared care agreement is in place the responsibility of monitoring of the drug and/or condition is shared between the specialist and the GP, however the patient will remain under long-term review with the hospital.
Shared Care Guidelines are developed alongside an Area Prescribing Committee (APC) and provide clear guidance to GPs and hospital specialist prescribers regarding the procedures to be adopted when clinical prescribing responsibility for a patient’s treatment with a shared-care drug is transferred to the GP.
Patient Group Directions
Patient Group Directions (PGDs) provide a legal framework that allows some registered health professionals to supply and/or administer specified medicines to a pre-defined group of patients, without them having to see a prescriber (such as a doctor or nurse prescriber). Supplying and/or administering medicines under PGDs should be reserved for situations in which this offers an advantage for patient care, without compromising patient safety.
Organisations must be in possession of PGDs that are appropriately signed and fully authorised, unsigned copies are not the legal document and are for information purposes only.
A full list of current PGD’s which have been produced to support the national immunisation programme across Cumbria and the North East can be found here.
Primary Care Rebate Schemes
Primary Care Rebate Schemes (PCRS) are contractual arrangements initiated by pharmaceutical companies, directly or via third party companies, which offer retrospective financial rebates on particular branded medicines. The availability of a scheme does not influence the inclusion of specific medicines in care pathways or formularies.
A prescriber’s first responsibility is to act in a patient’s best interests. Financial considerations come second. Participation in any PCRS should be agreed at a statutory organisational level, not agreed at GP practice level. Once agreed, a rebate scheme becomes a contractual agreement between the manufacturer and an NHS legal entity, usually an Integrated Care Board (ICB).
From April 2021 to June 2022, County Durham had the following primary care rebate schemes in place:
|AirFluSal Forspiro (Fluticasone Propionate / Salmeterol)||1st April 2022 to 31st March 2023|
|Apidra Insulins||1st April 2022 to 31st March 2023|
|Clenil Modulite (Beclometasone Dipropionate)||1st April 2022 to 31st March 2024|
|Firmagon (Degarelix)||1st January 2022 to 31st December 2022|
|Insuman Insulins||1st April 2022 to 31st March 2023|
|Longtec (Oxycodone)||1st April 2020 to no specified end date|
|Sereflo (Fluticasone Propionate / Salmeterol)||1st April 2022 to 31st March 2024|
|Xaggitin XL (Methylphenidate)||24th September 2019 to no specified end date|
|Slenyto (Melatonin)||1st April 2021 to 31st March 2024|
|Inhixa (Enoxaparin)||1st June 2021 to 31st May 2023|
|Fostair NEXThaler (Beclometasone dipropionate / Formoterol)||1st August 2021 to 31st July 2023|
Community Pharmacy County Durham (CPCD) represents community pharmacy contractors in Durham and Darlington. The committee consists of Pharmacists representing private contractors, public companies, and Pharmacists employed by contractors. The CPCD is an independent organisation within the NHS which negotiates on behalf of community pharmacy with NHS England, Public Health Durham, Public Health Darlington and local ICB place based to ensure that the pharmaceutical service meets local needs.
Please find a link to their website here which gives information on the bank holiday opening hours of community pharmacies across County Durham, your nearest community pharmacy with contact details and local pharmacy news.
The services listed below are offered by all pharmacy contractors as part of the NHS Community Pharmacy Contractual Framework (CPCF).
- Dispensing of Medicines & Appliances
- Repeat Dispensing
- Clinical Governance
- Discharge Medicines Service (DMS)
- Public Health: Promotion of Healthy Lifestyles
- Support for Self Care
- Disposal of Unwanted Medicines
There are eight Advanced Services within the NHS Community Pharmacy Contractual Framework. Community pharmacies can choose to provide any of these services as long as they meet the requirements set out in the Secretary of State Directions.
- Community Pharmacist Consultation Service (CPCS)
- New Medicine Service (NMS)
- Flu Vaccination Service
- Hepatitis C Testing Service
- Hypertension Case-Finding Service
- Appliance Use Reviews (AUR)
- Stoma Appliance Customisation (SAC)
Smoking Cessation Service
Please find a list of contact information for community pharmacies across County Durham and Darlington stocking palliative care medicines here.