In line with the NHS Long Term Plan, each ICS should be the nucleus for tailored medicines optimisation strategies at the ‘system’ level to advance national goals, with tactics adapted to local needs at a ‘place’ level 1. With this in mind, where will medicines optimisation teams sit? Will it be at a system, neighbourhood or place level? What are the challenges to evaluating the value of new medical innovations at a ‘whole system level’?

Many localities are still developing internal structures, but it appears that medicines optimisation teams will sit at a system level.

Current medicines management managers describe the changes as an “evolution, not a revolution”. There is not expected to be a big shakeup in the processes around medicines optimisation decision-making committees and people are likely to remain the same as the NHS ‘lifts and shifts’ those with the right expertise to the system level. However, there are still massive regional differences between localities in terms of their progress, with some medicines management personnel still awaiting clarification around their future roles as the July 2022 deadline looms.

Challenges stated by heads of medicines management:

• Mindsets need to shift to ensure decisions are made to benefit the whole system. When CCGs were formed there was optimism that decisions would be clinically-led but in reality, financial situations meant that decisions were often commissioning-led.
• Anecdotal feedback suggests that current joint formulary committees and decision-making units in some localities may not currently be fit for purpose and unable to make these more system-led decisions. ICSs need to take this opportunity to adapt moving forward.
• The main focus of an ICS is to reduce inequalities or unwarranted variations; heads of medicine optimisation will need to understand these larger geographic areas which may include some very diverse population needs e.g. differences in poverty, disease prevalence, ethnicities etc. Close collaboration with primary care networks (neighbourhoods) and Integrated Care Partnerships (places) will be important to success at a place level.
• For a truly collaborative approach and for decisions not to benefit one organisation at the expense of the whole system, power and politics will have to take a side-step. In areas with a dominant Trust or with a number of powerful hospitals, strong leadership of the new provider collaborative will be required.
• Many specialised areas are moving to the ICS from national commissioning where there may not be the right specialisms in terms of expertise and staff. It is currently unclear how this gap will be bridged.

Conclusion:

There are still many uncertainties surrounding medicines management, but for now, managers continue to focus on the day job, catching up due to COVID and concentrating on budgets, QIPP and incentive schemes. What does seem certain is that current personnel will be redeployed to sit at a system level if they have not already.

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