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Structured opioid and gabapentinoid reviews become compulsory for PCNs


opioids


PCNs will be required to offer structured medication reviews (SMRs) to patients taking opioids and gabapentinoids from today, NHS England has confirmed.

NHS England yesterday published a suite of documents related to the network DES for 2021/22, including ‘minor updates’ to the SMR requirements that ‘reflect evolving clinical policy’.

A new FAQ document said: ‘From April 2021, SMRs should be offered to all patients identified and prioritised within the groups listed in the DES service requirements, using appropriate tools. 

‘This explicitly includes patients on any opioid, gabapentinoid; benzodiazepine; or z-drug.’

Accompanying SMR guidance outlined other patients eligible for the service from October 2020, the original date that the introduction of the service was postponed to due to the pandemic.

These ‘must include’ care home residents, those taking 10 or more medications, on medicines ‘commonly associated’ with errors and with ‘severe frailty’ – alongside those using ‘one or more potentially addictive’ opioid, gabapentinoid, benzodiazepine or z-drug medication. 

The FAQs reiterated that although SMRs should be offered to ‘all’ eligible patients ‘identified and prioritised’, the ‘actual’ number of reviews offered is ‘determined and limited’ by clinical pharmacist capacity.

However, it added that PCNs must ‘demonstrate all reasonable on-going efforts to maximise that capacity’.

And the guidance said: ‘PCNs and commissioners must discuss and agree a reasonable volume of SMRs on this basis if a PCN has not been able to secure sufficient clinical pharmacist capacity to offer initial, follow-up and reactive SMRs to all identified patients in the required cohorts. 

‘In estimating available capacity, CCGs and PCNs should acknowledge that clinical pharmacists have a variety of responsibilities and not all of their hours should be spent on SMRs.’

The reviews, which could take ‘considerably longer than an average GP appointment’, can be conducted remotely ‘where deemed clinically appropriate’, it added.

The FAQ also confirmed that clinical pharmacists employed by other organisations such as trusts can carry out SMRs on behalf of PCNs, but that pharmacy technicians cannot complete the reviews.

SMRs could be the ‘ideal opportunity’ for other ‘brief’ interventions around falls and frailty, alcohol, smoking, physical activity and weight management, the guidance added.

PCNs must also collaborate with wider medicines optimisation efforts locally, in particular around antimicrobial medicines, medicines that can cause dependency, metered-dose inhalers, where a lower-carbon alternative may be appropriate and nationally-identified medicines of ‘low priority’, it said.

And they must work with community pharmacies to connect patients with the New Medicine Service, which supports adherence to newly-prescribed medicines for asthma, COPD, type 2 diabetes, high blood pressure or blood-thinning, it added.

Practices have until 30 April to inform their CCG if they wish to opt out of this year’s DES, NHS England said.

It added: ‘The CCG will work with the remaining practices in the PCN to consider the consequences, including whether the PCN remains viable.’

Practices signed up for 2020/21 will automatically be enrolled in the 2021/22 DES, but those with changes to their membership information must ‘notify the commissioner by 30 April 2021 to seek approval of those changes’, NHS England said.

And practices not signed up last year who wish to opt in to the DES must do so by the same date, it added.

The SMR service, which was originally due to be introduced from April 2020 under the network DES, was postponed just before the UK entered lockdown in March.

However, GPs were told in May that the service would be introduced in care homes as part of the pandemic support package provided to them.

First introduced in 2019’s network DES, the proposals were diluted in February following concerns from GPs over the additional workload they would create – along with the controversial plans around care homes.

Announcing this year’s updates to the GP contract, the BMA and NHS England said in January that there would be ‘minor’ updates to the PCN SMR service specification.

Meanwhile, NHS England has said that the four new PCN service specifications due to be introduced this year will be delayed until October ‘at the earliest’.

READERS' COMMENTS [6]

terry sullivan 2 April, 2021 12:55 am

phe=wos and m

get rid

David Church 2 April, 2021 8:51 am

About time these were recognised for the dangers they are :- but will the workload and funding come from the secondary care services that started these drugs recklessly?

Dermot Ryan 6 April, 2021 3:39 pm

Some of the most overused and useless drugs in the armamentarium. Any new patient should have a psychiatric assessment prior to going on them; pain clinics are the biggest cause dishing the out like sweeties; non existent pyscho-somatic disorders diagnosed to support their prescription e.g. fibromyalgia. The profession has become dangerously complicit in handing out these nocebos.
On the other hand unless the services are available to take these difficult patients on with physical and psychological support then it will all be a waste of time.

Patrufini Duffy 6 April, 2021 10:40 pm

Americans = unhappy.
How many SMRs do hospitals undertake? Probably, get a healthy tariff for it.

David Banner 7 April, 2021 12:14 am

Yet another disastrous own goal by NHSE. If you want quick easy wins on opioids, ban GPs from prescribing CDs, insist on secondary care following up their initiations on a Shared Care basis, and blast social media with messages to see your doctor if you want to reduce your medication.
But no, instead we get the inevitably work intensive and largely useless mass reviews by (often non existent) pharmacists contacting reluctant patients who will either refuse to reduce or return to their GPs in droves to have their doses increased.
This will be a massive paper exercise in pharmacological futility. For most patients on these drugs the ship has sailed, it’s the next generation of users we should protect. If patients know that their GP can still prescribe stronger medication, they will demand it. It would be so sweet to be able to say to the next 30 year old sciatic Likely Lad that “I would love to prescribe you pregabalin or tramadol, but my hands are tied”. But no, instead we’re landed with a bureaucratic box-ticking time-guzzling charade.

James Cuthbertson 8 April, 2021 12:53 pm

Does there need to be any evidence of actually reduced prescribing or do the reviews just need to go ahead? Where is the evidence this costly intervention provides any benefit whatsoever?