Month: April 2024

The Cheshire and Merseyside initiative, aimed at aligning medication guidelines, has enhanced medication management practices across the region. By improving consistency, streamlining processes, increasing transparency, and promoting continual improvement, the project ensures safer and more effective medication usage, thereby contributing to the overall quality of healthcare delivery in Cheshire and Merseyside. 

Background

With the establishment of the NHS Cheshire and Merseyside Integrated Care Board (ICB), there arose a need to unify the existing Cheshire and Merseyside formularies.

A ‘formulary’ in the context of medicines management is essentially a list of approved medicines for use within a healthcare organisation, like a hospital. Its primary function is to specify which medicines are sanctioned for use under specific circumstances.

NHS Midlands and Lancashire Medicines Management Optimisation team, based in Liverpool, serves as the administrative support team for the newly formed Cheshire and Merseyside area prescribing group (CMAPG) and its five subgroups. The NHS Cheshire and Merseyside ICB acknowledged the expertise of the Medicines Management Team and entrusted them to lead the harmonisation project, with five pharmacists involved in the process.

Formulary harmonisation refers to the process of aligning and integrating medication guidelines from different healthcare organisations or regions. In the case of Cheshire and Merseyside, this initiative aims to unify the medication formularies of these areas, ensuring that healthcare providers have consistent and standardised guidelines for medication use. By harmonising the formularies, the project aims to improve patient safety, enhance the quality of care, and streamline medication management processes across the region.

Action

A set of rules was devised, drawing from common scenarios identified through a review of sections from both legacy formularies. These rules aim to ensure consistency in the review of chapters. In cases where an appropriate action is unclear, matters are escalated to a harmonisation working group.

A paper outlining the general process and rules and defining when actions would be referred to the working group for review and how the information would be incorporated into the harmonised formulary was approved at CMAPG in August 2023. It was then presented to the ICB clinical effectiveness group for consideration and approval, ensuring support and endorsement from the ICB.

The paper outlined the following steps:

• Establish the governance, membership, and purpose of the working group

• Develop draft formulary chapters as reviews are completed

• Present finalised chapters to the CMAPG with a summary of the rationale

• Publish the completed formulary

Impact

The membership of the working group has been established to include pharmacists from primary and secondary care in both Cheshire and Merseyside. The governance and purpose of the group, which convenes monthly, have been agreed upon.

Spreadsheets have been created for each chapter, containing the positions from both the legacy Cheshire and Merseyside formularies, along with individual columns for each matching rule.

Drugs that cannot be matched using the harmonisation rules are compiled into reports for discussion by the harmonisation working group and decisions made during these meetings are documented.

In cases where a decision cannot be reached by the working group, both legacy positions are retained in the new harmonised formulary until a full formal chapter review is conducted by the Formulary and Guidelines subgroup. These reviews are conducted promptly after a chapter is harmonised. As the project progresses, the team continues to identify more harmonisation rules, updating the working document accordingly.

The Cheshire and Merseyside formulary harmonisation project has improved medication management across the region by improving consistency, streamlining processes, increasing transparency, and promoting continual improvement. These outcomes not only ensure safer and more effective medication usage but also contribute to the overall quality of healthcare delivery in Cheshire and Merseyside.

Feedback

Colleagues working on the harmonisation of two historic formularies within Cheshire and Merseyside have undertaken significant work in terms of planning, system consideration, engagement, and delivery of work to date. The team have been flexible in their approach, welcomed feedback with a focus and commitment to get the job done and to deliver the best outcomes for patients, clinicians and the system. The task has not been simple but the commitment, teamwork and leadership within the team has been excellent.

Susanne Lynch | Chief Pharmacist | NHS Cheshire and Merseyside

In this three-segment podcast sequence, part of our Inside MLCSU series, we discuss the lessons learnt from the Clive Treacey Review about the struggles of the health and care system to meet the needs of an individual with learning disabilities (LD). The discussion panel includes Beverley Dawkins OBE, the Independent Chair of the Review; Hafsha Ali, digital transformation lead at NHS Midlands and Lancashire (ML); and special guest Elaine Clarke, Clive’s sister and lifelong advocate.

You can also join Elaine, Beverley and Hafsha in person on 23 April 2024 at NHS England Midlands’ event “Clive’s Way – See the Person, Hear the Family, Recognise the Ambition”. This free conference about the lessons from the Clive Treacey Review invites commissioners, providers and professionals working with people with a learning disability and autistic people in health and local authorities and third sector organisations across England.

Intro to the series

Clive Treacey faced living with LD and epilepsy, desiring a full life, but was often overlooked by the system. He was deprived of his liberty in the last ten years of his life, experiencing institutionalisation. As his mental health and physical condition deteriorated, he died at 47. It was evident that opportunities to aid his independence were missed. In response, his family initiated a campaign named “Clive’s Story,” aiming to inspire change for individuals in similar situations to be treated with more dignity and respect.

Tune in to “Inside NHS Midlands and Lancashire” online at Audio Boom, or download the episode via Spotify, Apple Podcasts, and Amazon Music to listen to the podcast.

Episode 1: About Clive’s childhood

Clive was determined to never let his suffering hinder him and was an incredible artist. His biggest gift was his heart. Unfortunately, epilepsy seizures became a dominant part of his life. Following his diagnosis, he was excluded from mainstream education within the first 12 months, marking the beginning of his deprivation of independence. It was thought that simply accommodating his education on the ground floor of the school he was at could have helped, but instead, he was sent to a school for children with greater needs.

Educational journey and challenges

Despite continuing his education, his illness created significant barriers. He faced challenges and restrictions that he couldn’t understand or accept. After college, he went through a series of 16 placements, moving because the placements he was at couldn’t cope with his illness. There was a placement that he was doing well at, but squabbles over funding put an end to that placement.

Evidently, the places Clive was sent to were completely unacceptable, highlighting a lack of planning in his care. People with LD often do not receive prompt diagnosis or appropriate care, with symptoms frequently misattributed to other causes – in this case, Clive’s epilepsy, leading to late or incorrect diagnoses.

Clive’s last ten years and his hospitalisation

Clive spent the last ten years of his life moving between hospital settings, with hopes of rehabilitation dashed by issues like missing equipment, lack of trained staff, and chaotic care records. This culminated in an unfortunate event leading to his death on 21 January 2017, where emergency staff could not resuscitate him effectively and could not provide the emergency service to the correct post code to attend promptly.

Episode 2: The aftermath of Clive’s death

The family was shocked by the autopsy results, which seemed to bear no relation to their knowledge and understanding of the circumstances surrounding Clive’s death. The inquest into his death highlighted systemic failures. After three years of campaigning by Clive’s family, NHS England commissioned a review, delivered by NHS ML, with Beverley Dawkins appointed as the independent chair.

Episode 3: The review and its impact

The review, published in December 2021, made 52 recommendations across ten themes. It aimed to influence not only NHS England but the entire healthcare system. The campaign to implement these findings has been vigorous, with the team striving to create a movement for change across disciplines. The family has been at the centre of delivering the review.

Continued efforts and future plans

The focus remains on ensuring Clive’s story prompts systemic reflection and change, moving beyond mere action completion to genuinely influencing healthcare practices. The NHS ML team, along with Clive’s sister Elaine, forms a ‘conscience group’ to drive and account for this change, keeping Clive’s story and spirit at the heart of their efforts.

NHS ML continues to work with NHS England and Clive’s family to affect change across nationwide health systems.