A simple screening question with the potential for massive reduction in medicines wastage with subsequent individualised care, environmental and cost saving benefits.
- New model of care asking a simple screening question.
- 1049 individual months of unused prescription items were identified during pilot, equivalent to £11000 wasted.
- Predicted cost saving of £3529 and 549 Kg CO2 emissions prevented over the next 12 months.
Dr Deb Gompertz, is a complex Care GP, and the Clinical Lead for South Somerset Complex Care, who joined the NHS Clinical Entrepreneur Programme in 2021. As a former Population Health Fellow her focus is person centered care, collaborative working and changing practices with environmental impact.
‘Medicines account for 25% of CO2 emissions within the NHS in England each year, and £300 million pounds is wasted on medicines that are thrown away or stockpiled’
The role of the Complex Care GP in South Somerset is to perform holistic assessments of patients’ needs within their homes. These patients include people who have recently been discharged from hospital, had frequent admissions to hospital and/or are involved with multiple services.
During the teams’ assessments, they identified a large number of patients not adhering to their medication as prescribed, resulting in a large amount of wastage. This was only apparent from asking to see the patient’s medication and would not have been identified otherwise.
Resulting from this information, the team developed a new model of care, simply asking to see a person’s medication in their own home during existing visits by community staff; called “Show me your meds, please?”. In the first pilot, the team identified 40 patients not adhering to their prescribed medicine regime, this accounted for 1 in 4 of people assessed.
‘In the first 40 patients identified not adhering to their medication, they identified over 1049 individual months of unused prescription items.’
Viewing medication is not part of the normal medication review, however when the team perform this simple task, they identify a cohort of the population that are at increased risk from adverse events from erratically taking medication, poor optimisation of long-term conditions, and missed diagnosis (e.g. dementia). Additionally, this group of people are not necessarily being picked up by the normal SMR, with less than half being housebound or on more than 10 medications.
As a result, from the initial 3-month pilot, medication regimes were simplified in more than 50% of cases, 39 medications were stopped providing predicted cost saving over the next 12 months of £3529 and 549 Kg CO2 emissions prevented. Additionally, social prescribing was initiated in 30% of cases and new cognitive impairment was identified in 35% of cases, which allowed the team to feedback to primary care, to discuss the most appropriate follow up for the patient, supporting admission avoidance.
“The impact of the NHS CEP has been amazing for me!”
Deb Gompertz
The NHS Clinical Entrepreneur Programme has helped Deb to build confidence, networks and provided the opportunity for introductions with national directors. She has been able to learn from peers, has a ‘fantastic’ mentoring relationship and has built friendships.
Additionally, whilst on the programme, Deb has applied and been successfully granted funding from the Healthier Futures Action Fund, she has learnt a new language necessary for creating change and is hoping to lose her imposter syndrome.
Deb’s 3 key lessons learned are self-belief, enablers and conditions for success are to have a clear goal with an amazing team and communication and sensitivity in this work is extremely important.
Looking to the future
This pilot study has demonstrated the positive impact for patients, the environment, and the NHS from asking a simple screening question by community staff on routine visits. The teams next steps are to expand the project into different settings, to further PCN’s and explore publishing research.
If you are interested in supporting ‘’Can I see your meds, please?’’ or for more information please follow the links below.
TRANSFORMING HEALTHCARE THROUGH INNOVATION
