PIF’s Sophie Randall was at NHS England’s Medicines Value Programme Patient Group meeting held in London on 26 September 2018. Her blog below outlines the need for patients to ask more about their medicines:
Medicines Value Programme – The NHS wants people to ask more about their medicines at the same time as it plans to bring the spiralling hospital drug budget under control by switching to a new wave of biosimilars. ‘It’s OK to ask’ is an information campaign we are likely to see more of in the coming year.
The NHS wants to have new conversations with patients about medicines. “Put simply, medicines are the NHS’s biggest intervention but we don’t do them well” said Deputy Chief Pharmaceutical Officer, Bruce Warner, recently.
Spending on medicines is increasing faster than NHS funding (see Fact box at the end of this blog), so there is a real need to get better value from the money spent.
Conversation 1 – The brand switch
Reduce reliance on branded products. The NHS has used this method to curb medicines spend in primary care. Now there is a potential for a £200 million annual saving when the patent for Humira, the world’s no 1 earning drug, ends this month. To maintain patient care and cut costs by using cheaper alternatives is a win/win in NHS terms.
What does this mean for 47,000 people with inflammatory bowel disease, rheumatoid arthritis and psoriasis who use the product?
The NHS is clear it can’t just switch people to the new biosimilars without having the shared decision-making conversation first. To do that high-quality information is fundamental.
“How similar is a biosimilar?” is a now familiar question. NHS England has consulted with patient groups on how to communicate the issue and it has listened to patients and patient groups on important issues relating to formulation.
Helen McAteer, Chief Executive of Psoriasis UK, suggests NHS staff avoid alarm bell language including ‘cheaper alternative’ that may imply lower quality and encouraged careful consultation around product switches. With the right message she thinks patients may see switching to a biosimilar as ‘doing their bit for the NHS’.
Conversation 2 – My medicine and my life
Switch isn’t about formulation. It shouldn’t be at the expense of patient experience and wider patient support and information needs.
Humira is self-injected at home. McAteer stressed the home delivery system for new products needs to be as good.
The injection device needs to be as good or better (particularly for people with arthritis and dexterity problems). Dosing frequency needs to be similar given the current 12% intentional non-adherence rate.
Importantly, the information and support that drug companies offer must be of the same standard and the new companies must also support the biologics registries for each disease area.
Conversation 3 – Sharing is caring
“Ultimately, the best value biologic in psoriasis is the one that works. We don’t want clinicians prescribing a sub-optimal TNF when new biologics might be better” said McAteer.
Effectiveness is very important in psoriasis, it’s a life-long condition where it is common for people to wait for up to 15 years for referral to a dermatologist. With a diagnosis peak in their early 20s many people adopt negative coping behaviour – they avoid going out, use alcohol and gain weight.
The entire patient journey needs a shared care approach to earlier treatment and treatment choice.
Conversation 4 – Decisions are an interaction
Shared decision making should be an interaction. Healthcare professionals “should only prescribe the medications patients want and need” said Wasim Baqir, NHS England. People (patients and carers) need to question medications in a positive but challenging way, particularly when multiple medications are involved.
The Wessex Academic Health Science Network has launched the Meet Mo campaign, a series of animations to encourage patients with multiple medications to have a pharmacist review.
Clare Howard, of the Network, says the core patient message is about safety, reducing the burden of multiple medications and reducing risk of harm. A person taking 10 or more medications is 300 times more likely to end up in hospital.
People need to ask questions, prescribers need to listen. Yet we know this isn’t happening. People take the medicine home and either don’t take them or don’t take them properly. A culture change is needed.
Conversation 5 – ‘I’ve got issues’ and ‘It’s OK to ask’
People have ‘unresolved issues with their medicines’ and they don’t discuss them with healthcare professionals, according to Graham Prestwich, who describes himself as “a Yorkshire lad who talks to people on buses and in pubs”. Graham has been involved in more formal focus group with patients on non-adherence, supported by the Yorkshire and Humber Academic Health Science Network.
People need to talk about these unresolved issues, he said “The therapeutic v toxic effect is different for everyone, so we really need to listen to individual patient experience”.
The result of his patient engagement work is the Me and My Medicines campaign, launched in Leeds in April, which provides a charter for patients to ask questions. It is patient-created, patient-led and makes it clear people can ask about unresolved issues with their meds.
The campaign is encouraging people to talk about their issues with prescribers and pharmacists and it has a handy list of questions to get started. You can download the charter here and make an appointment for a chat with the doctor. Remember, It’s OK to ask.
- The NHS spends £17.4 billion a year on medicines, £1 in every £7 spent by the NHS.
- 5-8% of hospital admissions are medication-related, and many are preventable.
- Anti-microbial resistance is second only to terrorism on the risk register.
- Up to 50% of patients don’t take medicines as prescribed.
- 1 million people take 8 or more medications a day (mostly older people).
- Spending on hospital medicines has doubled from £4 billion to £8 billion in six years.
- NHS spending has just been increased by 3.4%.
Posted on Thursday, 04th October 2018