Centralising systems and standardisation

The combination of growing demand, financial restraints and workforce pressures presents an increasingly tough challenge for practices to maintain standards of care. Working at scale provides the opportunity to improve processes and focus on patient outcomes without draining resources from individual practices, supporting greater resilience in primary care settings. With Care Quality Commission inspections on the horizon, Symphony Healthcare Services (Symphony Healthcare) sought to ensure its practices are compliant with regards to their high risk medication monitoring.

Improving processes around high risk medication monitoring

Some medicines prescribed by GPs, such as insulin for diabetes or lithium for some mental health conditions, are considered 'high risk'. This means they could cause patients harm if not prescribed, monitored, and administered with due diligence.

At scale working allows Symphony Healthcare to detect areas for improvement in high risk medication monitoring at its practices and address them, share best practice, and develop standard operating procedures. Using the searches available in its clinical system as a base, Symphony Healthcare has created a scorecard to provide a snapshot of performance across multiple indicators. These include high risk medications, safety alerts and possible missed diagnoses of conditions such as diabetes.

Practice performance is reviewed at monthly meetings, and where indicators are below target, actions are put in place to improve. These actions include:

  • Drug monitoring: The majority of these indicators require up to date tests to ensure the medication is providing the right intervention and there are no adverse effects. Some patients require medication reviews to discuss usage. A standard operating procedure for recalling patients has been developed, which covers proactively inviting them in when monitoring tests are due and reactively reminding them when issuing prescriptions. It also includes reducing prescription length for non-responders.
  • Missed diagnosis: Patients are reviewed by a clinician and informed of new diagnoses if appropriate.
  • Long term health conditions: Some patients are recalled to ensure monitoring is in line with the most up to date guidance. Others are reviewed by long-term condition nurses to ensure their condition is well managed.
  • Safety Alerts: Patients are reviewed and prescriptions either stopped, switched to an alternative or informed of the risks of taking the medication.

Symphony Healthcare has used other at scale provisions, such as its medicines management hub, to monitor indicators on behalf of the practice and act on them by, for example, reducing doses or switching medications.

The medicines management hub team comprises prescription clerks, medication optimisation assistants, apprentice pharmacy technicians and pharmacy technicians. They work closely with the practice and primary care network pharmacists. The hubs process prescription requests for the practices, reconcile medications, and conduct medication reviews.

Best practice is shared across sites. For example, patient information letters on certain medications have been imported into each clinical system for practices to send.

In using its data and analytics capacity to enhance the support available to patients, hundreds of patients have been appropriately monitored, reviewed, and informed of any risks relating to their medication, helping to reduce unwarranted variation across practices.

The effective management of high risk medicines demonstrates the opportunities available in primary care to treat and manage conditions such as diabetes. This benefits the wider health and social care system by reducing the likelihood of additional treatment in acute settings.