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 to reduce medicine wastage in the NHS, aligning with the Net Zero strategy.
- 1049 individual months of unused prescription items were identified during pilot, equivalent to £11,000 wasted.
- Predicted cost saving of £3,529 and 549 Kg CO2 emissions prevented over the next 12 months.
Dr Deb Gompertz is a complex care GP, Deputy Honorary Secretary at the British Geriatrics Society and Cohort 6 Clinical Entrepreneur. As a former Population Health Fellow her focus is person centred care, collaborative working and changing practices with environmental impact.
Founded in 2021, “Show me your meds, please?” is a simple screening question which allows community staff to see a patient’s medication and raise concerns if non-adherence is identified.
‘It has been estimated £300 million of NHS prescribed medicines are wasted each year.’*
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.
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 £3,529 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.
“People need to be looked and assessed holistically. We need to address health, social and mental health together to look at the whole person. A third of the people we identified had undiagnosed cognitive impairment and being proactive in this group may prevent deterioration. We altered medication regimes, prescribing for the person not the illness, fitting the medication to their care package.”
Deb Gompertz
As the project progressed with the support of the NHS Clinical Entrepreneur Programme, Dr Gompertz and the team applied and was successfully awarded funding from the Healthier future action fund. The team have then worked closely with 3 key populations including a retirement village, home visits and acute trusts, to assess which environments best suit this intervention. They have also conducted presentations and talks to the residents at the retirement village to empower them to understand their medications better. This has resulted in more local pharmacy involvement and the reduction of medication being disposed.
‘In the first 40 patients identified not adhering to their medication, they identified over 1049 individual months of unused prescription items.’
The NHS Clinical Entrepreneur Programme has provided Dr Gompertz with the education, guidance, and support to learn the language necessary for creating innovative change within the NHS.
The mentoring relationship has taught her valuable lessons around personal development, goal setting and has built her confidence in public speaking and pitching. Dr Gompertz has now been able to present to audiences of over 200 individuals, which she wouldn’t have been able to do before including talks to ICB’s, PCNs, and national conferences plus the NetZero BMJ conference, and has been published in the Prescribing journal.
The network has given her a family of support and a crucial space for learning from others experiences and best practice. Through the programme she has been provided with the opportunity of introductions with national directors, funding, and collaborations, which have helped “Show me your meds, please” develop and move forward.
“The impact of the NHS CEP has been amazing for me; I would not be where I am today without it.
The networking, support, encouragement, and mentoring have been the key ingredients for me to gain success. I have had exposure and have been able to pitch to key national NHS leaders which has supported and moved forward my work.The mentor scheme has been particularly valuable for me with public speaking and presentations.”
Dr Deb Gompertz
Looking to the future
The pilot study 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, including further retirement villages, using the initial findings to scale this method.
The team are also exploring a partnership with Royal Mail Health which was identified through the NHS Clinical Entrepreneur Programme, to explore how postal workers can raise concerns around health and wellbeing, when visiting numerous homes and delivering post.
If you would like to learn more about “Can I see your meds, please?” or you are interested in supporting the team, email Dr Deb Gompertz at deborah.gompertz@ydh.org.uk
For more information, please click on the links below:
References:
- https://www.england.nhs.uk/long-read/nhs-clinical-waste-strategy/
- https://www.england.nhs.uk/wp-content/uploads/2015/06/pharmaceutical-waste-reduction.pdf
- Tackling the climate crisis – recommended learning for healthcare staff – TEL blog (hee.nhs.uk)
TRANSFORMING HEALTHCARE THROUGH INNOVATION
