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If QIPP is only about cost cuts we will have missed the point

By Kate Towers, BPharm

Smithan/Dreamstime.comQIPP has to be seen as a whole piece of work, not just a mechanism for cutting costs. This was the opinion given by Chris Green, director of pharmacy at Countess of Chester Hospital NHS Foundation Trust, at the United Kingdom Clinical Pharmacy Association’s autumn symposium held in Leicestershire (18–21 November 2011). “If we focus on cost cutting,” Dr Green said in a plenary session, “we will only deliver about 40% of [the savings] needed.”

And he was not the only one who urged delegates to remember the entire “quality, innovation, productivity and prevention” agenda. Martin Stephens, national clinical director for hospital pharmacy in England, believes that “quality” is where the real efficiencies in the NHS will be made. “In this climate of QIPP, we are looking to drive up quality with innovation so that we can release resources to meet the growing demand,” he said in the same session.

He thinks that, for pharmacists, optimising medicines use is where the biggest prizes will be found. “Between five and maybe seven per cent of hospital admissions result from things going wrong with medicines. So it is clear that if we can get to grips with medicines use, in an even more positive way than we are, then there are resources to be released so that we can care for an even greater number of patients,” he said.

Optimising medicines use

According to Mr Stephens, optimising medicines use is what the Department of Health expects from pharmacy, and it is what the NHS needs. And, although he acknowledges that medicines optimisation is not a new idea, Mr Stephens believes that pharmacists can build on what has already been done in three main ways.

The first is ensuring that care centres around the patient: “I don’t think we have sufficiently placed the patient at the centre of what we do — we are too product focused and not patient focused enough.”

Second, he believes that medicines optimisation must be a multidisciplinary goal: “That’s the challenge –— we need to get together with nurses and doctors and make sure that we engage with our patients and get things right.”

According to Mr Stephens, the third way to drive medicines optimisation is by focusing on outcomes, such as preventing avoidable hospital admissions and decreasing length of stay.

Mark Tomlin, consultant pharmacist for critical care at University Hospital Southampton NHS Foundation Trust, described practical ways to bring about change in line with QIPP. He believes that pharmacist prescribing offers one way forward: “I’m a great believer in pharmacist prescribing because I think that’s a new way of making change happen. It’s much easier to implement a new guideline by prescribing it yourself and demonstrating how it should be done.  

“At Southampton about 20% of the pharmacists are now prescribers. That is a strategy that we are pushing forward . . . and the junior doctors welcome it. The senior doctors welcome it — they are a little bit more resistant but, when you work with them, they accept the change and see it as the way forward because the challenge is large.”

More work to be done

Although there are many initiatives pushing ahead, others still have a way to go. According to Dr Green, information transfer is one of the latter. “We need good integrated patient data. I can go on holidays in, pretty much, any country in the world and go to a bank and draw money out. But I can’t find out very easily what medicines a patient is taking from their GP or community pharmacy without using the telephone or faxing a request form,” he said.

He also highlighted the need to do more to reduce waste: “Locally, we estimate that 60,000 items are returned to pharmacy each year. All that work generated in ordering, receiving, dispensing, distributing and returning that stock — [the waste is] a real shame.”

Take-home message

All three speakers agreed that QIPP provides great opportunities for pharmacy, provided that the profession looks beyond the bottom line.

Mr Tomlin summed it up well: “QIPP sometimes gets presented as ‘save money, save money, save money’, but I would emphasise . . .

go back to what these words mean. Quality: take out errors. Innovation: think of new ways of working.  Prevention: there are things we can do to stop people getting ill. Productivity: working smarter not harder.”

Citation: Clinical Pharmacist URI: 11090879

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