(Title Image: National Assembly of Wales)
Public Accounts Committee
Medicines Management (pdf)
Published: 20th March 2018
Chair’s Statement, Nick Ramsay AM (Con, Monmouth)
“What we found during this inquiry was a system needing to change and a system not able to maximise its potential. Despite the Welsh Government support for greater use of pharmacists in primary care, this is not being realised –the Chief Pharmaceutical Officer told us over a 1,000 consultations a month are taking place with pharmacists –but this equates to approximately only 250 a week and these levels are nowhere near enough to achieve real system change.”
1. Medicines are being over-prescribed; doctors and pharmacists aren’t entirely to blame
There’s been a 46% increase in the number of prescription items dispensed over the last 10 years and the cost of medicines to the Welsh NHS is in the region of £800million.
The Committee said that due to the overall costs involved, all health boards need to do more to stress just how important good medicines management is, with the Chair summarising that, “Everyone on the Committee has had experiences of relatives or friends or constituents ending up with medicine cabinets full of medicines and the difficulties of getting items taken off repeat prescriptions.”
Wasted medicines are estimated to cost the NHS anything between £8.7-10million a year – based on separate figures from the Wales Audit Office and Welsh Government.
2. The Welsh Government’s goal of a bigger role for pharmacists isn’t being realised
There were calls for IT systems to be better interlinked between GPs and pharmacists, so pharmacists can get an idea of the clinical background to prescriptions, such as why medicines have been prescribed and why they’re necessary.
Pharmacists are being encouraged to engage with patients on medicines management issues, wider health issues such as minor illnesses (to take pressure off hospitals and GPs) and vaccinations – but there’s been some “pushback” from patients who question their advice precisely because “they’re not GPs”.
As a result, there are only 1,000 pharmacist consultations per month across the whole of Wales. However, there’s “positive evidence” relating to use of pharmacists in primary care clusters to take over some of the roles of the GP (such as stopping a medicine or re-authorising).
3. Prescription errors put people in hospital
One of the more startling figures from the inquiry was that up to 50% of all hospital admissions involve a prescribing error; the problem may not be fully understood due to how admissions are coded as part of an international classification system.
The Committee recommended an academic-led review to properly understand the scale of medicine-related hospital admissions.
4. Should over-the-counter medicines no longer be prescribed?
One of the headline recommendations is the above; at the moment all prescriptions are free in Wales, but this includes prescriptions for routinely-available over-the-counter medicines such as paracetamol, ibuprofen, Calpol etc.
Some surgeries in the Cardiff & Vale health board are already taking steps to not prescribe over-the-counter medicines, explaining their decision in a letter to patients. Patients in a focus group broadly agreed with this but suggested that the prescription itself highlighted to a patient the clinical need for them to take the medicine.
There were also practical reasons why over-the-counter medicines are prescribed; an example’s given of an elderly patient with arthritis who needs to take 8 paracetamol tablets a day and would need to buy a standard-sized box seven or eight times a month to get that dose.
The NHS in England has issued guidance stating that over-the-counter medicines would no longer be prescribed for 33 short-term, minor illnesses – the Committee believes the Welsh NHS should consider doing the same.