One year on: better care for all
We made recommendations about improving the management and treatment of lung disease.
The Taskforce has set up a medicines optimisation working group to drive forward the implementation of the treatment recommendations.
“The Taskforce has made progress in its first year, but we recognise that much work remains to be done. We’re pleased that medicines optimisation is one of the priority areas identified by NHS England’s respiratory team and that a working group has been set up. We look forward to working with them to make further progress towards the implementation of our recommendations. We are also pleased to be partnering with the UK Inhaler Group to support the review of inhaler competency.”
“A priority for the Taskforce must be supporting steps towards formalising an enhanced role for community pharmacists at a time of significant change for them. Community pharmacists play a key role in supporting lung health in the community, and are keen to do more to share GPs’ workload through primary care networks.”Sheila Edwards, British Thoracic Society and Dr Anna Murphy, British Pharmaceutical Society – Co-Chairs of the Taskforce for Lung Health medicines optimisation working group
Lung volume reduction surgery
Recommendation 3b: Establish clear best practice in assessment, referral and regular monitoring of people with advanced chronic obstructive pulmonary disease (COPD) and advanced breathlessness who would benefit from a lung volume reduction procedure.
NHS England has recently considered whether to expand access to lung volume reduction (LVR) procedures for people with emphysema. The policy would have allowed any hospital with the right multidisciplinary team to deliver LVR. Unfortunately, LVR was not prioritised as part of this review, losing out to treatments ranked higher in terms of benefit to patients and cost-effectiveness.
The Taskforce is disappointed that LVR has not been made more widely available, especially as there are so few current treatment options for patients. The policy is being considered again by NHS England and we are pressing for approval so that patients can have this treatment in hospitals across the country.
To make the case for investment in lung volume reduction interventions, the Taskforce has written to key decision makers at NHS England and NHS Improvement. The Taskforce has received a reply setting out that the Clinical Priorities Advisory Group recognises the evidence of the effectiveness of LVR, and believes the case for expanding access had been strengthened for this second review.
Improve inhaled therapy
Recommendation 3d: Improve inhaled therapy, by developing a clear pathway for accurate prescribing and adherence, and promoting new technology such as smart inhalers.
Using medicines correctly (medicines optimisation) features in the NHS Plan. NHS England has set up a working group, which is looking at supporting appropriate prescribing of medication and appropriate inhaler use, and preventing avoidable acute admissions and deaths from poor self-management. The Taskforce is working closely with the NHS England working group.
The Taskforce medicines optimisation working group has met with the UK Inhaler Group (UKIG), a coalition of not-for-profit organisations and professional societies with an interest in promoting the correct use of inhaled therapies. The Taskforce is supporting a review of the UKIG competencies to set, assess and support standards for health care professionals who prescribe inhalers and check how patients are using them.
The Taskforce is carrying out a review of patient-facing materials for inhaler use. This will involve gathering patient feedback to identify the best available resources for the NHS to promote to patients, and whether there are any gaps in available resources which the Taskforce could help to fill.
The Taskforce welcomes the reference in the NHS Plan that pharmacists in primary care networks will undertake a range of medicine reviews, including educating patients on the correct use of inhalers. Improving awareness of good inhaler technique among all health care professionals is a priority for NHS England. We will continue to make the case for community pharmacists to be able to carry out inhaler technique checks and to play a continued role in medication reviews.
We have also met the Pharmaceutical Services Negotiating Committee to make the case for community pharmacists to be involved in reviewing patients’ medicines and supporting patients with their inhaler technique. The Taskforce will work to ensure that this is complemented with the necessary funding and training for community pharmacists to do this to a high-quality standard.
“Doctors are quick to prescribe steroids rather than checking to see if I have the right inhalers or if I am using them correctly.”Lauren, who lives with asthma
“My medication plan has helped consultants see how my treatment may not be working and needs adjusting or if my medicines need stepping up.”Julie, who lives with with asthma
In Northamptonshire GP practices are being supported to conduct effective annual reviews with their respiratory patients
A pilot scheme in Northamptonshire is supporting GP practices by making available a team of specialist respiratory nurses to improve lung health in the county. Four senior nurses are carrying out high level face-to-face COPD and asthma checks, including inhaler technique, and checking for accurate diagnosis in line with national guidelines. They are also able to refer to other services, such as pulmonary rehabilitation, and provide training and mentoring to practice staff.
The initiative is being led by National Services for Health Improvement and there is no extra cost to GP practices, who are required to carry out annual checks.
Lisa Riddaway, Senior Strategic Commissioning Manager and NHCP Programme Lead (Respiratory), and Dr Az Ali, a GP in Wellingborough, say the initiative will address clinical variation that exists around the county, as well as providing an additional resource to GPs. In the first 6 months, already 15 practices (out of 70) have taken up the offer and the first data is now being assessed to measure its impact.
Recommendation 3e: The government and pharmaceutical industry should work together to improve access to anti-fibrotic drugs for idiopathic pulmonary fibrosis (IPF), cystic fibrosis transmembrane conductance regulator (CFTR) modulators for cystic fibrosis and monoclonal antibody treatments for severe asthma.
The Taskforce was informed by the National Institute for Health and Care Excellence (NICE) in the summer of 2019 of a review of the technology appraisal for anti-fibrotic drugs. We wrote a jointly-signed letter of support for the review with Action for Pulmonary Fibrosis, a Taskforce member. We highlighted the urgent need for the eligibility criteria for IPF patients able to access these drugs to be extended. This would enable patients with no other treatment options to slow disease progression to be able to access to these drugs before their lung function reaches a significant level of decline. We are awaiting information on NICE’s next steps.
After successful and sustained campaigning by the Cystic Fibrosis Trust, a Taskforce member, we are delighted that in October 2019, NHS England announced they have approved access to precision drugs for people with cystic fibrosis.
The Cystic Fibrosis Trust are delighted that thousands of people with cystic fibrosis will finally be able to access precision medicines on the NHS. We have campaigned hard alongside our community for 4 years to secure access to these life-saving treatments, that will help to transform and extend the lives of around 50% of those living with the condition.
We remain committed to campaigning for new and future medicines for all affected by cystic fibrosis across the UK.”Lynsey Beswick, Public Affairs and Advocacy Manager, Cystic Fibrosis Trust
NHS Medicines Use Review and NHS New Medicines Services
Recommendation 4e: Expand the delivery of NHS Medicines Use Review (MUR) and NHS New Medicine Services in pharmacies and remove the cap on the number of these they can deliver.
The new Community Pharmacy Contractual Framework for 2019-20 to 2023-24 has been published by the Department of Health and Social Care but it prioritises new clinical roles in reviewing patients’ use of medicines above the contribution community pharmacy can make. The Medicines Use Review Service will be phased out between now and 2021, and the Structured Medication Reviews (SMRs) will instead be carried out by clinical pharmacists in primary care.
The Taskforce has discussed with NHS England the importance of keeping the flexibility and access currently offered to patients by community pharmacists in reviewing medicines. We are due to meet NHS England’s chief pharmaceutical officer in early 2020 to discuss how medicines reviews could work better for people with lung disease. We would also like to see community pharmacists, as well as clinical pharmacists, able to carry out the new reviews in future.
We have established links with NHS England’s SMR working group and have met the Royal Pharmaceutical Society representative on this group to share our views for how the new SMR can work best for respiratory patients.
“PSNC is delighted to be a member of the Taskforce for Lung Health. We have seen the benefits of the Taskforce in bringing together the respiratory community with one united voice, and we are delighted to now be a part of this important piece of coalition work.”Simon Dukes, CEO of the Pharmaceutical Services Negotiating Committee
“Medication reviews make it possible for us to spend time with our customers to discuss their care.”Usha, community pharmacist in west London
“Once I decided to quit my pharmacist gave me the help I needed and I was able to stop within 10 days. I haven’t smoked since.”Andrew, who lives with COPD and diabetes
Recommendation 3f: Fully implement British Thoracic Society (BTS) home oxygen therapy guidelines to improve use of home and ambulatory oxygen. Fully implement the NICE quality standard on idiopathic pulmonary fibrosis (IPF) to ensure patients have access to beneficial home and ambulatory oxygen therapy.
Ensuring health care professionals are both aware of, and are able to implement, the existing home oxygen therapy guidelines is essential. BTS, a member of the Taskforce, has been working with a range of stakeholders to amplify this message and the Taskforce continues to support this work.
The BTS website and the Respiratory Futures programme have a range of Quality Improvement tools and best practice examples. These aim to disseminate key messages from the guidelines and to support effective implementation. The resources include oxygen alert cards, policy and activity templates for adaptation for local use, and educational slide sets for both doctors and nurses and allied health care professionals.
The Respiratory Futures website also includes a number of key features where practitioners have shared their experience of introducing oxygen wrist bands and also standardising discharge process for paediatric home oxygen.