More medicines optimisation in community pharmacy could reduce GP pressure
Expanding medicines optimisation services in community pharmacy would save the NHS billions of pounds and reduce pressures on GPs, an analysis by health economists has concluded.
Modelling done by the York Health Economics Consortium calculated potential savings of £1.2bn if pharmacists did more medication reviews, polypharmacy clinics, personalised action plans and COPD education and advice.
Commissioned by the National Pharmacy Association, the analysis – based on results from published studies – found wider use of prescribing reviews for people taking 10 or more medicines could result in net savings of nearly £620m.
Making structured medication reviews available in community pharmacy has the potential to save a large amount of GP practice time, the report found.
But GP experts pointed out that evidence of benefit of such schemes was of variable quality and studies often short-term.
It suggested this would be particularly successful if targeted at people currently taking potentially addictive medicines – a population estimated at over six million but with only 16% receiving structured medication reviews in 2023/24.
The team calculated it costs around £34 for a community or practice-based pharmacists to carry out a structured medication review compared with £147 for a GP.
They said there was not enough capacity in primary care to deliver structured medication reviews to all the groups recommended by NICE and specified in the DES contract, such as those with severe frailty.
Even taking into account that many of these reviews are integrated into other 10-minute appointments, expanding the role of community pharmacy to carry them out would save over 45,000 clinical hours in primary care and increase the eligible population receiving them, the report found.
Routine provision of personalised asthma action plans in community pharmacy could prevent hospital visits and deaths and generate additional cost savings of over £70 million, the report found.
On a more conservative estimate if community pharmacy was able to increase the proportion of asthma patients who had a personalised plan from 50% to 70%, it would save the NHS £33.7 million, it said.
Their report also concluded that better implementation of the NHS Discharge Medicines Service could release nearly an extra million days currently spent in hospital beds.
But for this to be realised, there would need to be a focus on increasing integration of community pharmacies into the rest of the healthcare system, including access to shared electronic health records and full integration into neighbourhood teams, the report concluded.
It also pointed to the PINCER trial from 2012, which showed that pharmacists working with GP practices were able to reduce medication errors and prescribing safety issues.
‘However, there has been no systematic implementation of PINCER in general practice since then despite the evidence base on its effectiveness’, the report found suggesting barriers to implementing it at scale.
Nick Hex, lead researcher for the project at York Health Economics Consortium, said: ‘Our report shows that more investment in community pharmacist support could result in very substantial benefits to patients and better value for money for the NHS.’
Professor Azeem Majeed, a GP and professor of primary care and public health at Imperial College London, said he did not agree with the authors’ conclusions.
‘The evidence used to reach this conclusion is often short-term, small-scale, and of variable quality. More robust, long-term, and consistent evaluations (especially economic studies) are needed.
He added that the actual costs of a GP doing a structured medication review would be a fraction of that quoted given the annual funding for each general practice in England is about £170 per patient for all the services they provide.
‘Pharmacists play an important role in the NHS but their impact will be maximised when they are embedded within clinical teams in general practice or NHS Trusts.
‘Efforts to turn community pharmacies into “mini general practices” risk duplication of services, fragmentation of care, and promotes inefficiency, and represent the wrong direction for patient care.’
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READERS' COMMENTS [4]
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“ The team calculated it costs around £34 for a community or practice-based pharmacists to carry out a structured medication review compared with £147 for a GP.”
What? £147 is the global sum – and then some. This does not seem believable
If review by GP costs £ 147, and a Pharmacist review costs £ 34, then the total cost for every Pharmacist review, including the essential and consequantial review by the GP to change the prescription, and then discuss with the patient, and then review again because of effects of the change, plus blood tests due to dose changes, would cost £34+147+147+56 (bloods=56), total is £ 384 for every pharmacist review completed. Yes, that is far more than a year of GMS costs. Needs proper accounting!
I too do not understand the figures that have been reproduced by this report. They don’t make any sense. I did however look into the actual report, and the breakdown of figures appears to include qualification costs. This surely is a one time cost and not an ongoing cost? The report also states that the cost of a GP review is £49. Again, the figure includes qualification costs. We are definitely not getting paid these sums of money. Is this an underhand way of trying to say that doctors are just too expensive in general and can be substituted by cheaper lesser trained options? This is fantasy accounting with an agenda!
Others have pointed out the nonsense of the cost figures.
But just to echo David’s point: there is only a saving if you assume that the medication review by pharmacist removes the need for a GP medication review. This is far from certain. In my anecdotal experience, pharmacists tend to be more interventionist than GPs – more likely to make a change from “good enough” prescribing to “textbook perfect” prescribing. Every change of prescription comes with a risk of new problems, real or perceived. And whom does the patient contact to deal with those problems? I think we all know.