To receive a presentation in respect of medicine management arrangements and practice in place across Rotherham.
Consideration was given to a presentation presented by NHS South Yorkshire in respect of medicine management. The presentation addressed the range and scope of medicine management activity in Rotherham. The presentation outlined the remit of the NHS South Yorkshire, Rotherham Place Medicines Management as well as strategic aims and therapeutic pathways.
Among successes highlighted in the presentation, reduction in antibiotics prescribing had taken Rotherham from a high prescriber pre-pandemic to a below average prescriber during pandemic without returning to pre-pandemic levels. In terms of challenges, it was noted that staff turnover made it challenging to work with care homes. The context behind medicine shortages was explained, with the likelihood of more shortages to manage in near future due to the low prices for drugs in the UK. It can happen that a drug can be sold elsewhere for a higher price, which interrupts the supply to the UK. It was also noted that variation exists in support across heart failure treatments, and the Place were working to address these inequalities.
In discussion, Members expressed interest in hearing more about therapeutic alternative, and whether alternatives have worked for the patients in terms of quality. The response from the Head of Medicine Management noted that alternatives can reduce costs, but there can be variation because each batch is slightly different. It was confirmed that sometimes generic medicines can be this way. Nevertheless, where these medicines are used to treat chronic conditions such as in rheumatology, the services were not hearing of relapses.
Members expressed interest in the Care Hydration Project and asked to hear more about culture in care homes. The response from the Head of Medicine Management described a previous wound care project that had to stop for reasons of economics because as soon as a staff member had been trained, they had left. It was early days, of the Care Hydration Project, but the training had been well received. Because interventions are well received, it was clear that there was appetite for more support. Hydration is key for training.
Members sought further clarification around pain management approaches that are not pharmacological. The response noted that Rotherham has need of psychologists and pain specialists. Funding was in place for designated pain specialist nurses, and these had been identified. The commissioning process was described and the timescale for delivery was projected to go live in January 2023. The service would be patient-led, for patients who are working with their GPs to try a different approach.
Members expressed a desire for more information around measures of performance. The response averred that performance is most certainly monitored in terms of prescribing against disease registers. It was observed that no practice wants to be at the wrong end of the graph. Feedback is provided to the practices, identifying the highest rates of antibiotic prescribing, and narrowing down to individual practices that appear to under-medicate heart failure. In terms of diabetes control, it was known which practice was the best and the worst. This information prompted self-reflection by the practices and was well received. It did lead to improvement because people want to do a good job.
Clarification was requested regarding whether this monitoring was applicable to all ages including children. The response confirmed that all ages were monitored, and this included work with children. The work with children included medicalising problem feeders, prescribing of antibiotics for children, as well as working to ensure children are not overprescribed inhalers.
Members sought assurances that cases were not being misdiagnosed where there was lack of expertise. The response noted that cow’s milk protein allergy was the highest rates in Europe. By the time the patient had been referred, very few have had to be referred on to paediatricians. This means that the treatment is working. Key Performance Indicators for this pathway with GPs were such that a dietician needed to see them quickly. 90% of patients were seen within two weeks of going to the GP. Feeding problems was an area for future work.
Members expressed concerns regarding over-prescribing of a particular opioid drug. The response noted that prescriptions were slightly above the national average. It was noted that the concerns were shared, and it was understood that chronic pain is important to manage because it impacts on quality of life and causes depression.
Members requested additional details regarding social prescribing across the Place. The response indicated use of social prescribing as early intervention much as we do as a noteworthy achievement. The mobile app and programmes such as Get Healthy Rotherham have been in use, and the Place continues looking at these interventions much more in management of chronic pain.
Members requested more information around how medicines can be duplicated resulting in waste, and how medicines waste could be reduced. The response noted that sometimes drugs are duplicated because sometimes medicines are lost. It can happen that people’s drugs may not move with them from ward to ward in the hospital. When this happens, sometimes it is easier to get a new prescription.
Members requested further information regarding prescription of medications for ADHD. The response provided information around ADHD local pathways, which were quite robust. Patients sometimes go to alternative providers to get their initial diagnosis. The number of diagnoses were increasing and the medication prescriptions were increasing. It was noted ADHD can be difficult to manage, especially among over-medicalised long-term patients.
1. That the report be noted.