Case Studies

Developing Community Pharmacy Payment Systems Gibraltar Health Authority

The Gibraltar Health Authority were keen to improve the timeliness and accuracy of their local Pharmacy Payment Systems. MLCSU were commissioned to develop a be...

The Gibraltar Health Authority were keen to improve the timeliness and accuracy of their local Pharmacy Payment Systems. MLCSU were commissioned to develop a bespoke system to improve efficiency and accuracy.

Enabling increased prescribing collaboration across Merseyside

MLCSU’s Liverpool medicines management and optimisation (MMO) team manages the Pan Mersey Area Prescribing Committee (PM APC), established in 2013. Wirral CCG, ...

MLCSU’s Liverpool medicines management and optimisation (MMO) team manages the Pan Mersey Area Prescribing Committee (PM APC), established in 2013. Wirral CCG, Wirral University Teaching Hospital NHS Foundation Trust (WUTH), Cheshire and Wirral Partnership NHS Foundation Trust and Wirral Community Trust became members of PM APC in 2018.

Sue Ryder Medicines Governance Review

The Sue Ryder charitable organisation has a portfolio of 10 services, one hub site and central support delivering palliative and neurological care services acro...

The Sue Ryder charitable organisation has a portfolio of 10 services, one hub site and central support delivering palliative and neurological care services across the UK. In early 2020, the organisation's clinical governance group approached MLCSU to scope out what support and advice we could offer in terms of medicines management and medicines governance across the organisation.

Electronic Repeat Dispensing: Increasing Uptake

During the COVID 19 pandemic, NHS England required an immediate increase in the uptake of Electronic Repeat Dispensing (eRD). This case study outlines the respo...

During the COVID 19 pandemic, NHS England required an immediate increase in the uptake of Electronic Repeat Dispensing (eRD). This case study outlines the response and support provided to primary care.

Improving medicines safety in care homes

NHS England and NHS Improvement commissioned MLCSU to deliver its Medicines Optimisation in Care Homes pilot project across The Black Country and West Birmingha...

NHS England and NHS Improvement commissioned MLCSU to deliver its Medicines Optimisation in Care Homes pilot project across The Black Country and West Birmingham Sustainability and Transformation Partnership

Incontinence medication reviews offer major patient benefits

The long-term prescribing of anticholinergic drugs has been associated with an increased risk of cognitive impairment, dementia and mortality. Clinicians have b...

The long-term prescribing of anticholinergic drugs has been associated with an increased risk of cognitive impairment, dementia and mortality. Clinicians have been advised to consider offering patients 'drug holidays' for short periods to assess whether there has been any natural remission of the condition, whether the drugs are still effective and whether there is a continued need for treatment.

Supporting a successful launch of proxy medicines ordering

A national programme to support the roll out of proxy ordering - which allows care homes to order online repeat medication on behalf of their residents - has be...

A national programme to support the roll out of proxy ordering - which allows care homes to order online repeat medication on behalf of their residents - has been launched to help reduce the current high workload of primary care and care home staff. The Black Country and West Birmingham Clinical Commissioning Group (CCG) deployed extra pharmacy staff to work with GP practices and care homes to set up a local system.

Electronic repeat dispensing in Halton and St Helens

MLCSU Medicines Management and Optimisation services were approached to support with the implementation of NHS England’s Electronic Repeat Dispensing service ac...

MLCSU Medicines Management and Optimisation services were approached to support with the implementation of NHS England’s Electronic Repeat Dispensing service across Halton CCG and St Helens CCG. The aim was to increase the uptake and understanding of Electronic Prescription Services (EPS) and Electronic Repeat Dispensing (eRD) to assist with the implementation of NHS England’s project in this specific area.

Improving the quality and cost of blood glucose monitoring across the Mersey

In 2014-15 the eight Pan-Mersey CCGs spent £4.569million on blood glucose meter (BGM) strips, with mean strip cost being 25.75p. There are many different brands...

In 2014-15 the eight Pan-Mersey CCGs spent £4.569million on blood glucose meter (BGM) strips, with mean strip cost being 25.75p. There are many different brands of BGM strips, and many are effective and acceptable to patients and cost less than 20p per strip. The most expensive strips can cost up to 32.6p per strip. Reducing the mean strip cost to 20p or less for Pan Mersey would provide a cost improvement of over £1m per annum. Pan-Mersey CCGs proposed the creation of a guideline that recommended high quality, lower cost BGM strips that could be adhered to by primary and secondary care prescribers in their area.

Optimising integrated care medicines in Wirral

An estimated five per cent of all hospital admissions are related to medication, with half of those being preventable. It has also been suggested that 50 per ce...

An estimated five per cent of all hospital admissions are related to medication, with half of those being preventable. It has also been suggested that 50 per cent of medication is not taken as directed, leading to waste. Wirral Clinical Commissioning Group (CCG) commissioned us to undertake a 12-month integrated medicines optimisation project to address these issues locally

Providing workforce resource and expert pharmacy support to Nightingale hospital

The Nightingale Hospital North West (NNW) is a temporary hospital based at the G-Mex Manchester Central Convention Complex. It forms part of the wider North Wes...

The Nightingale Hospital North West (NNW) is a temporary hospital based at the G-Mex Manchester Central Convention Complex. It forms part of the wider North West response to COVID-19 and it aims to enhance the resilience of NHS organisations in the region. The hospital first opened in April 2020, and since reopening in October, has been providing acute bed capacity to allow other hospitals to treat the more serious patients affected by COVID-19.

Supporting NHS England’s consultation on prescribing of low value medicines

NHS England (NHSE) wanted public and patient views and opinions on proposals to limit the prescribing of 18 products considered relatively ineffective, unnecess...

NHS England (NHSE) wanted public and patient views and opinions on proposals to limit the prescribing of 18 products considered relatively ineffective, unnecessary, inappropriate or unsafe for routine prescription in NHS primary care.

Supporting a consultation into prescription of medications available over the counter

The NHS spent approximately £569 million on prescriptions for medicines for minor conditions, which could have been purchased over the counter (OTC) – this cons...

The NHS spent approximately £569 million on prescriptions for medicines for minor conditions, which could have been purchased over the counter (OTC) – this consultation outlined proposals to stop or limit the prescribing of these prescriptions. NHS England commissioned our Medicines Management and Optimisation Team and Communications and Engagement Team to support the consultation.

Supporting Prescribing Improvements on the Isle of Man

NHS hospitals and health service commissioners in England and Wales are legally required to fund treatment with a positive Technology Appraisal (TA) recommendat...

NHS hospitals and health service commissioners in England and Wales are legally required to fund treatment with a positive Technology Appraisal (TA) recommendation from The National Institute for Health and Care Excellence (NICE), usually within three months of publication. On the Isle of Man, similar legislation is not in place so adoption of NICE TAs is not mandatory. However, some have received formal approval and some have been adopted into current practice without formal review. The Department of Health and Social Care (DHSC) of the Isle of Man commissioned MLCSU’s Medicines Management and Optimisation (MMO) Team to scope its current position regarding NICE TAs and how this could be aligned with the Pan-Mersey formulary’s legally mandated position of implementing all positive NICE TAs.

Improving anti-coagulant prescribing in Warrington

Direct oral anti-coagulants (DOAC) have now increased greatly as one treatment choice over the alternative warfarin. This is because they do not require the int...

Direct oral anti-coagulants (DOAC) have now increased greatly as one treatment choice over the alternative warfarin. This is because they do not require the intense monitoring needed for warfarin. Patients on a DOAC will only require more routine monitoring once a year or every three months, depending on their renal function. Risks that need to be considered with taking a DOAC include under or over coagulation and continuing treatment for longer than necessary. It is important to check that those prescribed for atrial fibrillation (AF) are correctly read-coded to be on the AF register for their practice in order to ensure correct follow up.

Pharmacy Initiatives Supporting COVID-19 Pandemic Response

Production of shared guidance and PMO Pharmacy leadership for End of Life Care, Care Homes (North West Cell) and website information.

Helping Patients Get The Most Benefit From Their Medicines

We worked with NHS Greater Preston and NHS Chorley and South Ribble CCGs to give patients a greater understanding of their medicines. We used resources from the...

We worked with NHS Greater Preston and NHS Chorley and South Ribble CCGs to give patients a greater understanding of their medicines. We used resources from the Me and My Medicines campaign developed in Leeds. The campaign includes The Medicines Communication Charter and encourages patients and their carers to ask questions about their medicines to help them get the most benefit.

Medicines Safety Assurance Tool (MSAT)

National organisations such as NHS England, NICE and MHRA share safety alerts and good practice guides to minimise harm from medication errors. Commissioners an...

National organisations such as NHS England, NICE and MHRA share safety alerts and good practice guides to minimise harm from medication errors. Commissioners and clinical leads need systematic ways of assessing medicines safety and engaging with providers across their population. There is considerable scope in primary care and across the interface with secondary care for consistent and assured implementation of safety alerts.

Improving patient safety with face-to-face medication reviews at a Cheshire GP practice

Western Avenue Medical Centre in Chester, with a patient population of just under 4,000, was keen to increase patient safety by conducting face-to-face medicati...

Western Avenue Medical Centre in Chester, with a patient population of just under 4,000, was keen to increase patient safety by conducting face-to-face medication reviews with patients.

Improving patient care and reducing costs with a polypharmacy review

Birmingham South Central Clinical Commissioning Group commissioned our pharmacist-led Polypharmacy Review Service to carry out a three-year polypharmacy review ...

Birmingham South Central Clinical Commissioning Group commissioned our pharmacist-led Polypharmacy Review Service to carry out a three-year polypharmacy review starting October 2016. This continued after the CCG merged with Birmingham CrossCity and Solihull CCGs to form Birmingham and Solihull CCG in April 2018.

Improving the repeat ordering process to reduce medicines waste in Warrington

The increasing cost of drugs and amount of medicines waste within the NHS due to over-ordering of medicines, stockpiling and unused medicines was raised by our ...

The increasing cost of drugs and amount of medicines waste within the NHS due to over-ordering of medicines, stockpiling and unused medicines was raised by our CCG clients. Warrington Clinical Commissioning Group (CCG) asked our Medicines Management and Optimisation (MMO) team were asked to support reductions in medicines waste. We decided to test whether patients ordering their own repeat prescription directly from the GP practice rather than a third party ordering on their behalf would improve safety and reduce medicines waste.

Introducing patient-led repeat ordering of medicines in Wirral

Wirral Clinical Commissioning Group (CCG) was wasting an estimated £2.2million every year on unused or partially used medication. The CCG asked our Medicines Ma...

Wirral Clinical Commissioning Group (CCG) was wasting an estimated £2.2million every year on unused or partially used medication. The CCG asked our Medicines Management and Optimisation (MMO) team to implement changes to the way repeat medicines were ordered locally. The aim was to reduce the amount of wasted medicines and to improve patient safety issues due to stockpiling medication.

Optimisation of inhaled corticosteroids for COPD patients in West Cheshire

RightCare data for West Cheshire Clinical Commissioning Group (CCG) published in 2016 showed high incidences of flu and pneumonia and high levels of prescribing...

RightCare data for West Cheshire Clinical Commissioning Group (CCG) published in 2016 showed high incidences of flu and pneumonia and high levels of prescribing spend on inhaled corticosteroids (routinely within the top 10 cost drugs for each practice). Furthermore, West Cheshire CCG prescribing costs for tiotropium were the highest in England. This project set out to improve patient care by optimising the prescribing of inhaled corticosteroids in COPD patients.

Wirral care home medication review leading to improved pharmaceutical care

Medicines wastage in England has been estimated to cost £300million each year. Of this, £24million is medicines disposed of unused by care homes. To tackle this...

Medicines wastage in England has been estimated to cost £300million each year. Of this, £24million is medicines disposed of unused by care homes. To tackle this, we decided to test the effectiveness of an intensive care home medication review.

Improving use of medicines across Merseyside – Pan Mersey Area Prescribing Committee

The Pan Mersey APC is a professional group consisting of GPs, pharmacists and other key healthcare professionals. It seeks to identify and champion the best use...

The Pan Mersey APC is a professional group consisting of GPs, pharmacists and other key healthcare professionals. It seeks to identify and champion the best use of medicines taking into account cost effectiveness, quality, equity and above all, patient safety.

Pharmacy support to Lancashire and South Cumbria COVID-19 vaccination programme

The Lancashire and South Cumbria Integrated Care System (ICS) set up a System Vaccination Operation Centre (SVOC) and a Management and Coordination Organisation...

The Lancashire and South Cumbria Integrated Care System (ICS) set up a System Vaccination Operation Centre (SVOC) and a Management and Coordination Organisation (MCO) to run the COVID-19 vaccination programme. The ICS required pharmacy oversight to the programme to ensure the safe and effective use of vaccines in line with regulations. Pharmacist leadership was required to support the SVOC and MCO functions.

Achieving the best from Primary Care Network Pharmacy Teams

When a newly established Primary Care Network (PCN) covering thirteen GP Practices in the Northwest of England approached MLCSU for strategic and clinical suppo...

When a newly established Primary Care Network (PCN) covering thirteen GP Practices in the Northwest of England approached MLCSU for strategic and clinical support, MLCSU responded by developing a tailored package of year-long support that included clinical supervision, joined-up work planning and strategy development. MLCSU aimed to ensure the PCN achieved its Network Contract Direct Enhanced Services (DES) and Investment & Impact Fund (IIF) targets

Evaluating the national Medicines Optimisation in Care Homes programme

The national Medicines Optimisation in Care Homes (MOCH) programme (2019-21) supported 336 pharmacists and pharmacy technicians to improve their expertise in un...

The national Medicines Optimisation in Care Homes (MOCH) programme (2019-21) supported 336 pharmacists and pharmacy technicians to improve their expertise in undertaking medication and system reviews in care homes.

Boosting GP community pharmacy consultations

The GP Community Pharmacy Consultation Service (CPCS) is a national pharmacy service to enable patients to get care for minor ailments from their community phar...

The GP Community Pharmacy Consultation Service (CPCS) is a national pharmacy service to enable patients to get care for minor ailments from their community pharmacy instead of the GP practice. In 2021, MLCSU was commissioned by NHS England and NHS Improvement to support implementation of the NHS CPCS service across the East of England from February to July.

Success in setting up community pharmacy services

The Birmingham and Black Country Clinical Commissioning Groups (CCGs) requested our help with managing locally commissioned community pharmacy services. Several...

The Birmingham and Black Country Clinical Commissioning Groups (CCGs) requested our help with managing locally commissioned community pharmacy services. Several schemes were prioritised: Pharmacy First, COVID-19 Urgent Eye Care service, Specialist Palliative Care Drugs service and the Intravenous Antibiotic Supply service.

Improving high-dose opioid prescribing

There is no evidence for efficacy of high dose opioids (>120mg/day morphine equivalent) in long-term pain. The Faculty of Pain Medicine has advised that increas...

There is no evidence for efficacy of high dose opioids (>120mg/day morphine equivalent) in long-term pain. The Faculty of Pain Medicine has advised that increasing opioid load above this dose is unlikely to yield further benefits but exposes the patient to increased harm Opioids Aware | Faculty of Pain Medicine (fpm.ac.uk).

Black Country Integrated Medicines Optimisation Committee

Integrated care systems (ICSs) are bringing major changes in how health and care services are planned, paid for and delivered. The Black Country ICS has been se...

Integrated care systems (ICSs) are bringing major changes in how health and care services are planned, paid for and delivered. The Black Country ICS has been setting up an Integrated Medicines Optimisation Committee (IMOC) to foster partnerships and optimise the use of medicines across the system.

Improving quality of care in a nursing home through medicines management

Having identified medicines-related issues at a nursing home, colleagues from Lancashire County Council requested support from MLCSU’s Medicine Optimisation Car...

Having identified medicines-related issues at a nursing home, colleagues from Lancashire County Council requested support from MLCSU’s Medicine Optimisation Care Home (MOCH) team.

Empowering people living with pain to explore alternatives

Flippin’ Pain is a public health campaign that engages with individuals and communities affected by persistent pain and empowers them through a better understan...

Flippin’ Pain is a public health campaign that engages with individuals and communities affected by persistent pain and empowers them through a better understanding. This is essential to delivering change in the approach to pain management across whole systems.

Increasing patient referrals into the National Diabetes Prevention Programme

Between June 2021 and March 2023, NHS Midlands and Lancashire CSU (MLCSU) were commissioned by the Black Country and West Birmingham CCG (subsequently the Black...

Between June 2021 and March 2023, NHS Midlands and Lancashire CSU (MLCSU) were commissioned by the Black Country and West Birmingham CCG (subsequently the Black Country ICS) to support GP practices increase referrals into the National Diabetes Prevention Programme (NDPP).

Preventing cardiovascular diseases through lipid therapy modification

Lakeside Healthcare Group, a multi-site GP partnership in Cambridgeshire, Lincolnshire and Northamptonshire, secured funding to review more than 1,000 at-risk p...

Lakeside Healthcare Group, a multi-site GP partnership in Cambridgeshire, Lincolnshire and Northamptonshire, secured funding to review more than 1,000 at-risk patients for primary and secondary prevention of cardiovascular disease (CVD). They asked NHS Midlands and Lancashire CSU (MLCSU) to identify high-risk patients, offer lifestyle advice, and undertake remote clinical reviews to optimise their lipid therapy using NICE-approved pathways.

Inhaler prescribing errors: Identifying risks and improving patient safety

Inhaler prescribing errors are frequently overlooked, leading to duplicate inhaler ingredients from the same drug group being prescribed and an increased risk o...

Inhaler prescribing errors are frequently overlooked, leading to duplicate inhaler ingredients from the same drug group being prescribed and an increased risk of adverse effects for the patient.

Improving the safety of patients prescribed clozapine

NHS Midlands and Lancashire CSU’s Medicines Management and Optimisation Team collaborated with a local mental health trust to address the issue of inadequate do...

NHS Midlands and Lancashire CSU’s Medicines Management and Optimisation Team collaborated with a local mental health trust to address the issue of inadequate documentation of clozapine, a high-risk medication, in primary care patient medication records.

Stopping over medication of people with a learning disability, autism or both (STOMP)

In a collaboration between NHS England’s Specialist Pharmacy Service and NHS Midlands and Lancashire CSU set out to address the over medication of people with a...

In a collaboration between NHS England’s Specialist Pharmacy Service and NHS Midlands and Lancashire CSU set out to address the over medication of people with a learning disability, autism or both.

Scaling non-medical prescribing services for enhanced patient care

Our Medicines Management Optimisation team has improved patient care by improving processes and automating tasks to ensure timely access to medications and main...

Our Medicines Management Optimisation team has improved patient care by improving processes and automating tasks to ensure timely access to medications and maintain safety through competency assessments among healthcare professionals.

Cheshire and Merseyside Formulary Harmonisation

With the advent of the NHS Cheshire and Merseyside Integrated Care Board (ICB), there was a need to harmonise the legacy Cheshire and legacy Merseyside formular...

With the advent of the NHS Cheshire and Merseyside Integrated Care Board (ICB), there was a need to harmonise the legacy Cheshire and legacy Merseyside formularies. ML Medicines Optimisation Team provides the secretariat for the newly established Cheshire and Merseyside Area Prescribing Group (CMAPG) and the five subgroups that feed into the APG. Previously, ML has provided the secretariat for the Pan Mersey Area Prescribing Committee and subgroups. ML develop a project group with NHS Cheshire and Merseyside ICB and aligned five pharmacists from the ML team to support the harmonisation project.

Wirral Medicines Optimisation in Care Homes (MOCH) project

Nationally care home residents take an average of 7 medicines each day. With each additional medicine comes an increased risk of prescribing, monitoring, dispen...

Nationally care home residents take an average of 7 medicines each day. With each additional medicine comes an increased risk of prescribing, monitoring, dispensing and administration errors, adverse drug reactions, impaired medicines adherence and compromised quality of life for patients.

NHS ML Prescription Ordering Direct Service

A Prescription Ordering Direct (POD) service was established for Staffordshire & Stoke-on-Trent Integrated Care Board. A responsive, patient-centred POD service...

A Prescription Ordering Direct (POD) service was established for Staffordshire & Stoke-on-Trent Integrated Care Board. A responsive, patient-centred POD service can reduce prescription costs, reduce prescription waste and improve medicines safety. A POD service can save valuable NHS funds by reducing GP workloads, thus improving access to clinicians and allowing them to devote more time to complex patient needs.

NHS England Advanced Community Pharmacy Smoking Cessation Service - Royal Wolverhampton NHS Trust (October 2022 – January 2023)

NHS England (NHSE) wanted to implement an adapted Ottawa Model of Smoking Cessation in secondary care trusts in England enabling patients to receive inpatient s...

NHS England (NHSE) wanted to implement an adapted Ottawa Model of Smoking Cessation in secondary care trusts in England enabling patients to receive inpatient smoking cessation treatment and support as part of routine care. NHSE commissioned NHS Midlands & Lancashire to support implementation by working with various stakeholders within secondary care, primary care & local authority (this case study highlights implementation in Wolverhampton).

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Case Studies