How a green light to switch lanes could drive medicines’ optimisation

David Englefield, managing director at Spirit Healthcare, describes how CCGs can take the fast track to saving money on prescribing

If someone offered your CCG immediate savings on its prescribing budget, you’d probably bite their hands off. And if you knew those annualised savings could, ultimately, amount to a six-figure sum – with a good chunk of achievable ‘in-year’ from the point a formulary change is implemented – you’d no doubt leap into action. And why not? After all, with medicines’ optimisation a high priority across the NHS, who wouldn’t jump at the chance to realise quick, simple and meaningful savings – whilst still maintaining the highest standards of clinical care? You might think it’s a no-brainer but, in reality, a surprising number of CCGs in England are failing to grasp this very real opportunity to make quick and sustainable savings. It’s time to speed things up.

One option – which is neither new nor complex – is a ‘switch programme’, where appropriate patients in high-cost disease areas are moved to cheaper treatments without impacting their clinical outcomes. Such programmes remain one of the most effective tools for medicines management teams to save money. Sadly, over the years, unethical practices by rogue providers has blighted the reputation of switch programmes across the NHS. However, done properly – with an effective implementation partner to ensure formulary change happens on the ground – CCGs can secure major savings that satisfy their obligations for medicines’ optimisation.

Evidence reinforces the promise. For example, in 2015/16, two CCGs in Greater Manchester each realised savings of around £10K every month simply by switching suitable type 2 diabetes patients to a preferred system of blood glucose monitoring. In this example – and many others across a range of therapy areas and treatments – savings accrued quickly, in-year, and have been sustained in the longer-term without compromising patient outcomes.

However, despite the benefits, the evidence and the simplicity of switch programmes, many NHS organisations have been slow to grasp the opportunity. Worse still, even in proactive CCGs which have identified potential savings, and outlined plans to help recover them, bureaucracy or cultural inertia has sometimes meant that programmes take too long to be agreed, signed off and enacted. It’s a perfect exemplar of shooting oneself in the foot. The long wait for a green light deprives CCGs of the opportunity to make in-year savings and leaves medicines management teams stuck in the slow lane. The sooner you switch lanes, the quicker those savings can be realised.

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The potential benefits of switch programmes can be significant; they can unlock – and sustain – real savings, simply and quickly. However, fittingly, speed is of the essence. If CCGs are to take advantage of simple, affordable models of medicines’ optimisation they must pick up the pace of their decision-making – or risk allowing cost-saving opportunities to be held up behind a red light of bureaucracy and inertia. It’s time to switch lanes and take the faster route to medicines’ optimisation.

Switch programmes present real potential to accelerate medicines’ optimisation, but they have to be done well; that’s why it’s often best to work with a trusted partner to help you identify the opportunity, rationalise your formulary and implement the change at the practice level. To ascertain if a potential switch partner is trustworthy, ask yourself:

Does your chosen partner have experience?

If your partner has run successful implementation programmes in the past, they will be able to link-up medicines management teams from across the country to share their interpretation of the value of that work. Peer-to-peer discussions within medicines management can help to build trust in that partner and drive further success.

Does your chosen partner have evidence of effectiveness?

A partner with documented or, even better, published evidence of successful implementation programmes can help you to distinguish those who can effectively make a difference; evidence of tangible, realised and proven results is invaluable! A good partner will be open, transparent and collaborative. They’ll work with you to develop an implementation strategy that’s based on a clear patient demographic and robust terms of engagement. They’ll support this with systems, processes and infrastructure to help practices train and switch appropriate patients. Fundamentally, the best partners will have a proven methodology and evidence of implementing successful programmes across the NHS.

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