WHILE’S WORD
Rising health-care costs within limited resources Alison While Emeritus Professor of Community Nursing, King’s College London, Florence Nightingale Faculty of Nursing and Midwifery and Fellow of the QNI
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Cogora (2015) General Practice prescribing trends in England and Wales, 2014 Annual Review. http://www.cogora.com/ gp-trends-2014 (accessed 18 May 2015) Levinson W, Kallewaard M, Bhatia RS et al (2014) ‘Choosing Wisely’: a growing international campaign. BMJ Qual Saf 24(2): 167–74. doi:10.1136/bmjqs-2014-003821 Malhotra A, Maughan D, Ansell J et al (2015) Choosing Wisely in the UK: the Academy of Medical Royal Colleges’ initiative to reduce the harms of too much medicine. BMJ 350: h2308. doi:10.1136/bmj.h2308 NHS Scotland (2012) Polypharmacy Guidance October 2012. bit.ly/1Ld0vgA (accessed 18 May 2015) National Institute for Health and Care Excellence (2015) NICE guidelines [NG5] Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes. www.nice.org.uk/guidance/ng5 (accessed 18 May 2015)
310
❛Success [of Choosing Wisely] depends not only on changing doctors’ attitudes but also those of other health professionals and patients, thereby reducing the pressure to order an investigation or therapy at every patient consultation.❜
Alison While
© 2015 MA Healthcare Ltd
he General Election has removed the uncertainty regarding the resourcing and strategic direction of the NHS. Clearly, there is no bottomless pit for funding and health services will need to increase efficiency so that the extra £8 billion promised meets the anticipated increased costs. No doubt there will be sniping between the different political parties and professional groups as each seeks the limelight for managing the growing demand created by an ageing population, coupled with increased public expectations within limited national resources for the delivery of free health care at the point of need. Recent NHS GP prescribing data (Cogora, 2015) illustrate the challenge, with the cost of prescriptions rising from £8.91 billion in 2013 to £9.16 billion in 2014. While branded products, such asVentolin, continue to be widely prescribed, in line with best practice, 82% of prescriptions from English and Welsh GPs named the ‘active ingredient’, thus permitting the dispensing of generic medications at huge savings to the NHS budget. However, 2 prescribing trends were noted: a 10% increase in strong opioids thought to be related to increased addiction, and a 12% increase in nutritional products, including infant formulae, associated with increased levels of allergies and intolerance. An ageing population is also associated with polypharmacy, that is, the existence of multiple treatments to manage comorbidities. Polypharmacy may be necessary, however, it is not without risk and sometimes arises because no medication review has removed unnecessary treatments (NHS Scotland, 2012). Indeed, the National Institute for Health and Care Excellence (NICE) (2015) drew a distinction between appropriate and problematic polypharmacy in its medication optimisation guidelines.These guidelines not only recommended timely medication reviews, but also patient involvement in the decisions relating to their treatments so that their values and preferences are incorporated into prescribing decisions. Engagement with patients relating to treatment decisions, including not having unnecessary investigations and treatments, forms part of the international ‘Choosing Wisely’ initiative launched in the UK by the Academy of Medical Royal Colleges (Malhotra et al, 2015). Choosing Wisely started in the USA where it was estimated that 30% of health-care costs were unnecessary and did not improve care nor clinical outcomes (Levinson et al, 2015). However, its success depends not only on changing doctors’ attitudes but also those of other health professionals and patients, thereby reducing the pressure to order an investigation or therapy at every patient consultation. In the UK, the Choosing Wisely programme will identify the top five lists of tests or interventions of doubtful value (Malhotra et al, 2015) which will form the basis for rebalancing discussions regarding risks and benefits and perhaps the decision to do nothing rather than persist with ingrained practices. Community nurses may also like to identify their top five activities or interventions that add little value to health-care delivery.The freed-up resources could then be diverted toward cost-effective activities for patient benefit. BJCN
British Journal of Community Nursing June 2015 Vol 20, No 6
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 18, 2015. For personal use only. No other uses without permission. . All rights re
Rising health-care costs within limited resources Alison While Emeritus Professor of Community Nursing, King’s College London, Florence Nightingale Faculty of Nursing and Midwifery and Fellow of the QNI
T
Cogora (2015) General Practice prescribing trends in England and Wales, 2014 Annual Review. http://www.cogora.com/ gp-trends-2014 (accessed 18 May 2015) Levinson W, Kallewaard M, Bhatia RS et al (2014) ‘Choosing Wisely’: a growing international campaign. BMJ Qual Saf 24(2): 167–74. doi:10.1136/bmjqs-2014-003821 Malhotra A, Maughan D, Ansell J et al (2015) Choosing Wisely in the UK: the Academy of Medical Royal Colleges’ initiative to reduce the harms of too much medicine. BMJ 350: h2308. doi:10.1136/bmj.h2308 NHS Scotland (2012) Polypharmacy Guidance October 2012. bit.ly/1Ld0vgA (accessed 18 May 2015) National Institute for Health and Care Excellence (2015) NICE guidelines [NG5] Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes. www.nice.org.uk/guidance/ng5 (accessed 18 May 2015)
310
❛Success [of Choosing Wisely] depends not only on changing doctors’ attitudes but also those of other health professionals and patients, thereby reducing the pressure to order an investigation or therapy at every patient consultation.❜
Alison While
© 2015 MA Healthcare Ltd
he General Election has removed the uncertainty regarding the resourcing and strategic direction of the NHS. Clearly, there is no bottomless pit for funding and health services will need to increase efficiency so that the extra £8 billion promised meets the anticipated increased costs. No doubt there will be sniping between the different political parties and professional groups as each seeks the limelight for managing the growing demand created by an ageing population, coupled with increased public expectations within limited national resources for the delivery of free health care at the point of need. Recent NHS GP prescribing data (Cogora, 2015) illustrate the challenge, with the cost of prescriptions rising from £8.91 billion in 2013 to £9.16 billion in 2014. While branded products, such asVentolin, continue to be widely prescribed, in line with best practice, 82% of prescriptions from English and Welsh GPs named the ‘active ingredient’, thus permitting the dispensing of generic medications at huge savings to the NHS budget. However, 2 prescribing trends were noted: a 10% increase in strong opioids thought to be related to increased addiction, and a 12% increase in nutritional products, including infant formulae, associated with increased levels of allergies and intolerance. An ageing population is also associated with polypharmacy, that is, the existence of multiple treatments to manage comorbidities. Polypharmacy may be necessary, however, it is not without risk and sometimes arises because no medication review has removed unnecessary treatments (NHS Scotland, 2012). Indeed, the National Institute for Health and Care Excellence (NICE) (2015) drew a distinction between appropriate and problematic polypharmacy in its medication optimisation guidelines.These guidelines not only recommended timely medication reviews, but also patient involvement in the decisions relating to their treatments so that their values and preferences are incorporated into prescribing decisions. Engagement with patients relating to treatment decisions, including not having unnecessary investigations and treatments, forms part of the international ‘Choosing Wisely’ initiative launched in the UK by the Academy of Medical Royal Colleges (Malhotra et al, 2015). Choosing Wisely started in the USA where it was estimated that 30% of health-care costs were unnecessary and did not improve care nor clinical outcomes (Levinson et al, 2015). However, its success depends not only on changing doctors’ attitudes but also those of other health professionals and patients, thereby reducing the pressure to order an investigation or therapy at every patient consultation. In the UK, the Choosing Wisely programme will identify the top five lists of tests or interventions of doubtful value (Malhotra et al, 2015) which will form the basis for rebalancing discussions regarding risks and benefits and perhaps the decision to do nothing rather than persist with ingrained practices. Community nurses may also like to identify their top five activities or interventions that add little value to health-care delivery.The freed-up resources could then be diverted toward cost-effective activities for patient benefit. BJCN
British Journal of Community Nursing June 2015 Vol 20, No 6
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 18, 2015. For personal use only. No other uses without permission. . All rights re
