South East London ICS efforts to tackle overprescribing recognised on the HSJ Awards shortlist
The Health Service Journal (HSJ) has revealed the shortlist for its annual awards, which celebrate excellent service in health and care, improving patient outcomes and driving innovation in the sector. We’re delighted that South East London ICS has been shortlisted in the Medicines, Pharmacy, and Prescribing Initiative of the Year category for our work on tackling overprescribing using a whole systems approach.
Overprescribing describes situations where a medicine is provided when use of the medicine is inappropriate given the patient’s wishes or specific circumstances, or where there is a better non-medicine alternative. It is a complex problem arising from weaknesses in the local prescribing system and existing culture.
The overprescribing programme is our strategic response to implement 20 cross-system recommendations in the National Overprescribing Review. SEL ICS chose polypharmacy (the use of eight or more medicines in a single patient) as a top priority as part of the 16 national medicines optimisation opportunities. Many south east London neighbourhoods have higher ethnic minority populations, face above-average rates of deprivation, and have lower literacy levels, compounding intersectionality in health inequalities from overprescribing. Polypharmacy can have adverse effects on patients, with patients who are taking 10 or more medicines being 300% more likely to be admitted to the hospital for an adverse drug reaction.
Our goal is to change the culture of overprescribing and establish the systems and resources needed to reduce patients’ exposure to it. This will both improve patient outcomes by matching patients to better-suited treatment options for their circumstances and reduce harm, health inequalities, medicinal waste, financial inefficiencies, and the negative environmental impact of overprescribing.
Our whole-systems, social mobilisation approach is driving the transformational change needed to address the key causes of overprescribing, including designating dedicated leadership and working with system partners and community assets. This approach encompasses a mix of mini-projects across system partners and engagement with the public, both through community groups and through patient engagement. In February, we had a visit from Sir Stephen Powis, NHS England’s National Medical Director, in which professionals, patients, and senior NHS England representatives were able to come together and discuss overprescribing.
On the digital end, Let’s Talk Health and Care South East London, a public-facing platform on our website, allows for sharing information and updates about the project with residents and carers as well as receiving feedback from them through surveys and chat rooms. The creation of more honest and open conversations about medicine use is crucial in combatting overprescribing, and empowers patients to be able to convey their priorities during decision-making regarding their health. This far-reaching collaboration is the distinguishing feature of our programme, and we plan to deliver a public awareness campaign and a community pharmacy waste avoidance project following this work.
In 2023/24, the project delivered substantial estimated savings in medicine expenditure and indirect savings in reducing adverse reactions and hospital admissions associated with taking 10 or more medicines. Moreover, SMRs for over-65s taking 10 or more medicines increased to 28.99%. Pharmacy teams and practitioners were also able to access training on facilitating shared decision-making with patients to reduce overprescribing. Overall, the project contributes substantially to our wider ICS objectives of improving population health outcomes, tackling inequalities, enhancing productivity, and supporting socioeconomic development.
The winners of the HSJ Awards will be announced during the awards ceremony at Evolution London on 21 November 2024.