The AHSN Network is helping to tackle system-wide challenges relating to polypharmacy with the launch of a new national medicines programme, commissioned by NHS England.
Polypharmacy simply means ‘many medicines’. Medicines benefit billions of people around the world and appropriate polypharmacy can extend life expectancy and improve quality of life. However it can also be a significant burden for people trying to manage multiple medicines regimes and they can also be harmful. Someone taking 10 or more medicines is 300% more likely to be admitted to hospital.
Through the AHSN Polypharmacy Programme: getting the balance right, the 15 AHSNs are creating regional communities of practice to support local health systems and primary care colleagues to identify people at potential risk of harm due to the medicines they are taking and to support better conversations with patients.
The programme is helping healthcare professionals put national policy into practice, including recommendations from the 2021 National Overprescribing Review and the NHS Patient Safety Strategy. It will also support delivery of structured medication reviews and medicines optimisation, introduced as part of the Primary Care Network (PCN) Direct Enhanced Services Contract 2021-22.
The AHSN Polypharmacy Programme is based on three core principles:
- Population health management
Using data (NHSBSA polypharmacy prescribing comparators) to understand population health risks and support prioritisation of patients for a structured medication review. - Education and training
Running local Polypharmacy Action Learning Sets (ALSs) to upskill the primary care workforce to be more confident about stopping unnecessary medicines. - Public behaviour change
The testing and evaluation of public-facing interventions to challenge and change public perceptions of prescribing and encourage patients to open up about medicines.
Clare Howard is the Clinical Lead for the AHSN Polypharmacy Programme. Clare is a senior pharmacist with a long history of working on polypharmacy, and is chair of the National NHSBSA Polypharmacy Comparators Group, lead author of the Royal Pharmaceutical Society’s polypharmacy guidance and co-developer of the Polypharmacy Action Learning Set programme.
Commenting on the launch of the new national programme, Clare Howard said: “We’re incredibly excited to be starting work on our polypharmacy programme, which is set to create regional communities of practice across the country who will continue to drive this important work long after the programme itself is completed.
“While we’re only part of the solution in tackling the issues around polypharmacy, we’ve set ourselves some ambitious outcomes we want to achieve. We aim to increase routine use of NHSBSA data to identify and prioritise patients for review and increase confidence amongst healthcare professionals to safely stop medicines identified to be inappropriate or unnecessary.
“We also recognise that patients and the public need to play a key role in helping to address the problems caused by polypharmacy, and we hope to drive a change in patient expectations and encourage them to ask questions and anticipate being much more involved in regular conversations and shared decision-making conversation about their medicines.”
As a patient prescribed multiple medicines, Paul from Tadley welcomes the increased focus on shared decision-making with patients: “Many people in England, like me, are on lots of medicines,” he explains. “It is essential that health care professionals make the time to listen to patients and their concerns about the medicines they take. Sometimes this can mean changing dosage or reducing the number of medicines taken.
“It is equally vital that the patient agrees to use the treatments as directed. All decisions about medicines should be a partnership between the prescriber and the patient. This promotes patient’s wellbeing and health improvement, whilst reducing waste in both costs of unused drugs and more complicated care later. I am delighted that the AHSN Network is working on this and that the patient voice is fundamental to the work they are doing.”
Several national partners are providing guidance and oversight to the programme through representation on the national programme board. These include NHS England and NHS Improvement, Age UK, the Royal Pharmaceutical Society and Leeds University.
Heidi Wright, Policy and Practice Lead for England at the Royal Pharmaceutical Society said: “As the most common health intervention, it is more important than ever to help people get the most from their medicines, boost patient safety, and deliver best value for the taxpayer.
“I look forward to working with the AHSN Network on this challenge and the pharmacy profession’s key role in tackling problematic polypharmacy and supporting shared decision making between the prescriber and patient.”
Tom Gentry, Senior Lead for Health and Care Policy at Age UK added: “Everyone should be confident that the medicines they’re taking are making a real difference to their health and wellbeing. Unfortunately, we know this isn’t always the case with older people, especially if they are taking multiple medications and have been on them for a long time.
“Older people must always have access to the treatments and support they need to stay well. We are pleased to support the work of the AHSN Network in helping to ensure more older people are taking the medications that are right for them.”
Find out more about the national AHSN Polypharmacy Programme here or contact Amy Semple, Programme Manager at a.semple@nhs.net.
To find out more about delivery of the Polypharmacy programme in your regional and to get involved in a community of practice or action learning set, please get in touch with your local AHSN.
The AHSN Network is a member of the Accelerated Access Collaborative, a unique partnership between patient groups, government bodies, industry and the NHS. Together we deliver ambitious programmes to ensure the NHS is in the best place to improve patient outcomes and reduce health inequalities through research and innovation.