PCN DES: How can the Polypharmacy Prescribing Comparators help Primary Care Networks to meet the DES requirements?
From 1 October 2020, a PCN is required to:
“use appropriate tools to identify and prioritise the PCN’s patients who would benefit from a structured medication review (referred to in this Network Contract DES Specification as a “SMR”), which must include patients:
These patients should be offered a structured medication review.”
Highlighted by the NHS England guidance, the NHS BSA Polypharmacy Prescribing Comparators (the polypharmacy comparators) were developed by a group of GPs and pharmacists in Wessex working with NHS BSA analysts. Following their launch, they have been helping practices and PCNs to prioritise which of their patients may be at greatest risk of harm from problematic polypharmacy.
The polypharmacy comparators consist of measures which show practices and PCNs how many patients they have on eight or more, 10 or more, 15 or more, and 20 or more, medicines.
The polypharmacy comparators also identify patients taking a combination of medicines known to increase risk of harm, such as multiple anticoagulants or medicines which, when taken together, can increase risk of cumulative anticholinergic cumulative side effects, increasing the risk of falls, confusion, constipation and other issues. See the medicines safety portal for more information.
In November 2019, this work was recognised nationally by winning a HSJ Patient Safety Award.
How do you access the polypharmacy comparators?
PCN pharmacists across England can access the polypharmacy comparators via ePACT2. To register or access ePACT2, visit here.
Why are we doing it?
The NHS BSA Polypharmacy prescribing comparators are available to all CCGs and GP practices in England. The comparators enable GP practices and CCGs to;
Our data shows that, where used to full effect, CCGs and Practices are able to reduce the rate of polypharmacy in patients at greatest risk.
What’s happening in Wessex?
Wessex AHSN (on behalf of the AHSN Network) led the work to develop the NHS BSA Polypharmacy Prescribing Comparators and are the official custodian of the work. It steers the Polypharmacy Prescribing Comparators working group which meets quarterly to advance work in this area and develop more comparators for publication and use.
Since their official launch in 2017, WAHSN has supported CCGs and GP Practices in their adoption and spread. WAHSN has also started to provide GP Practices with individualised reports through the Active Learning Sets. These ‘data packs’ help GP Practices to identify areas to prioritise but also encourage conversations around how they are doing compared to their peers. These reports and engagement around the Comparators help WAHSN ‘start a conversation’ in a safe sharing environment.
Through this engagement locally WAHSN was able to further identify that GPs' need support in better understanding high-risk medications and their risk in the elderly. This has helped develop e-learning modules on University Hospital Southampton’s Medicines Information e-learning portal with an Anticholinergic module under development.
For information on the Polypharmacy Action Learning Sets see here.