Providers and commissioners need to focus on making sure they achieve value for money on drugs rather than cutting overall spend, the government’s pharmaceutical spending efficiency expert has told HSJ.

In an exclusive interview Clare Howard, the national lead for the medicines use and procurement in the quality, innovation, production and prevention programme, said the rise in patients with long term conditions taking multiple drugs meant the total pharmaceutical bill would not be reduced in future.

She told HSJ there was a need for a “step change” from medicines management, which was often perceived as being “just about” the primary care prescribing budget, to medicines optimisation.

“[Medicines optimisation] is about getting the maximum value from the £13bn we spend on medicine… [The medicines bill] is not going to decrease, it’s going to increase. The imperative is not what we spend per person or what the total bill is, it’s about getting value for money.”

A HSJ analysis of QIPP plans earlier this year found primary care trust clusters were planning to take £389m out of their drugs spend over the next three years, equivalent to 9 per cent of all planned local QIPP savings.

Clamping down on variation in GP prescribing and increasing the use of generic drugs were the main targets for savings, alongside reducing waste and reviewing prescriptions for patients in care homes.

Asked whether there was scope to reduce the prescribing and secondary care drug budgets, Ms Howard said: “There is waste, there is inappropriate prescribing. It’s not to say that will go away, we need to keep an eye on that.  

“My view on medicines optimisation is there is so much more that we need to do… Between 30 and 50 per cent of patients don’t take their medicines as intended. If you don’t address that it doesn’t really matter what drug you pick.”

Ms Howard told HSJ the two key differences between management and optimisation would be in engaging with patients to support them in taking medicines correctly and a move to a more collaborative relationship with industry.

She acknowledged the shift from looking at in-year savings on drugs to longer term savings, often realised across the wider health system rather than individual organisations, was complex. However, she said many areas of the country were already beginning to see success with schemes such as “gain sharing”.

Ms Howard said the NHS Commissioning Board would look at the levers that could be put into the system to facilitiate this. The interaction between the quality outcomes framework for GPs and the community pharmacy contract would be explored while there would be moves to align the incentives open to acute trusts and commissioners.

Medicines optimisation was mentioned in the white paper that preceded the Health Act and has been identified as priority by commissioning board chief executive Sir David Nicholson.

Chief pharmacist Keith Ridge has asked the National Institute for Health and Clinical Excellence to look at producing a quality standard around medicines optimisation.

Speaking at the Pharmacy Management National Forum last week, Mr Ridge said medicines optimisation was central to an outcome driven quality system.

Mr Ridge gave the example of Warfarin, an anticoagulant drug which is a significant cause of medicines related admissions to hospital. He said use of new oral anticoagulants could reduce these admissions and lead to a reform of anticoagulation services.

“This is not medicines management repackaged; it’s a much more sophisticated model,” he said.