Report comment

I note that Dr Forde is the founding director of a Medicines Management Service, selling services to the NHS. HSJ - These types of conflicts of interests should be made more clear to readers, as these articles, while in this case making some valid, contructive, generalisable points, could be seen as advertorials.

While it is interesting to note some of the benchmarking in the article, some of which is inexplicable and indefensible clinically, it does not allow for differences in populations (acknowledged by the author), SOME of which could be relevant; not least deprivation, prevalence of long term conditions and historic disease management in both primary and secondary care.

The currently agreed priorities of Medicines Management teams and indeed their support from GP practices - which can be variable and in some (thankfully less frequent now) cases obstructive - is essential to high impact changes sticking. A result we all work towards. CCGs can obtain support purely for the purpose of producing cost savings in the primary care dugs budget, but this would devalue the wider professional input of doctors, pharmacists, nurses and technicians into prescribing decision making across health and social care economies.

Medicines Management teams also work in a wide variety of the areas where medicines are used, including: service redesign, secondary care contract monitoring and management, policy development and implementation, managed introduction (and exit) of drugs and therapies across the health economy to ensure patient orientated outcomes are at the heart of high quality, safe, effective and cost effective care.

We also look at areas which may not be fully appreciated by emergent CCGs, such as the accountable officer for controlled drugs, practitioner poor performance, community pharmacy development and contract management, Local authority medicines policies and managing and developing primary care enhanced services for all professions, to name a few.

CCGs must realise that cost savings are one very important part of Medicines Management, but as we move into the brave new world of Medicines Optimisation, an investment in prescribing could and should lead to better management of patients' conditions and consequent quality improvement and safety gains. These will undoubtedly lead to better long term conditions management, reduced exacerbations and so admissions to hospitals, thus savings of a greater magnitude may come from other budgets in addition to prescribing efficiency.

Current NHS employed Medicines Management teams are very efficient compared to the prices quoted by Dr Forde at £500 per day (equivalent to a salary of £115K). By using a full skill mix of GP leads, Pharmacists, technicians and in some areas dieticians and nurses, the cost of providing a full service is on average, in Greater Manchester, £191 per day (range £170 - £230). This cost includes the full NHS employment costs and modest travelling and other expenses.

When CCGs are deciding whether to employ, buy from a CSO or an external supplier they should consider the outcomes they require for their patients, and the value they attach to that, not just the windfall savings they can make in a prescribing budget.

Andrew White
Head of Medicines Management, NHS Bolton
Medicines Management Project lead, NHS Greater Manchester.