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Waste Not

Waste Not
8 December 2014

NHS South Worcestershire Clinical Commissioning Group (CCG) has a large geographical footprint which includes both urban and rural areas. The Governing Body is clinically-led, including GPs, a registered nurse and a secondary care clinician, all of which have day-to-day knowledge of the health problems that residents face.

NHS South Worcestershire Clinical Commissioning Group (CCG) has a large geographical footprint which includes both urban and rural areas. The Governing Body is clinically-led, including GPs, a registered nurse and a secondary care clinician, all of which have day-to-day knowledge of the health problems that residents face.

In order to maintain active engagement of all member GP practices across south Worcestershire and to respond effectively to the healthcare needs of local communities, the practices are organised into four distinct locality groups based around Droitwich, Evesham, Malvern Hills and Worcester City. 
Why waste medicines? 
The value of waste medicines has been a concern for many years. Based on a Department of Health report the NHS in England spends an estimated £300 million a year on medicines that are never used or are partially used and it’s estimated that around half of the UK population do not take or use their medicines as prescribed. Of this it’s estimated that £1.8million of unused medicines are returned in South Worcestershire each year. 
For the Evesham locality, where the majority are dispensing practices, the GPs were seeing themselves how much unused medication gets returned to their dispensaries. Dr Julia Lloyd, a GP at Abbey Medical Practice in Evesham explained that: “Many patients do not realise that once they have taken their medicines away from the dispensary, they cannot be reused for other patients even if returned unopened.” 
As well as being a waste of valuable resources, unwanted medicines in the home may mean that patients are not getting the benefit they could from their prescriptions. The Evesham locality therefore agreed to set up a project to consider how waste medicines and the associated lost health costs could be addressed. 
A project team, which included a GP and practice managers from the locality as well as a CCG director and a pharmacist from the medicines commissioning team, met to brainstorm ideas. Practices also involved their patient participation groups. The name Project Octopus came about because the initial brainstorming came up with many potential arms (or tentacles) of work within waste medicines. 
The project
While there were many potential areas that could be addressed it was agreed to focus two main areas:
Reviewing repeat prescribing systems and policies in practices.
Education campaign for the local population.
To review the repeat prescribing process, an audit tool has been developed to enable practices to check whether they are working to the standards set out in the General Medical Council (GMC) Good Practice in Prescribing Medicines. 
For the education campaign the key message to the public was “only order what you need” and to reinforce the message to patients to speak to a healthcare professional if they are not taking medicines as prescribed or have any concerns. 
The team worked with the marketing company Dynamic which is linked to the National Waste Medicines Campaign to ensure that the messages reached as many people as possible. It was also felt that this partnership would bring the benefit of experience in the field. A campaign was agreed for the month of October 2014. 
The key messages of the campaign were:
Patients should only order the medicines that they need.
Wasted medicines waste money.
Unused medicines cannot be recycled.
Patients should discuss their medication with their GP or pharmacist on a regular basis.
Posters and leaflets were developed and tailored to meet the needs of the diverse population of Evesham and surrounding area, with materials translated into Polish and Lithuanian. To reinforce the message about wasted money the leaflets included examples of ways in which the money could be put to better use including more nurses, treatment for Alzheimer’s disease and hip replacements.
Although the campaign was targeted at a wide range of the local population, there were a few key audiences that the messages were aimed at:
Patients – primarily over the age of 60 who were on free repeat prescriptions and had medicines that they never used.
Doctors and pharmacists – the support of healthcare professionals who impact on patients is fundamental for the campaign to succeed.
Carers/care workers – carers who look after people who can’t collect their own medicines.
Prior to launching the campaign practices and pharmacies conducted a survey to establish the understanding of the public on the issue of unused medicines. This will be repeated after the campaign to provide information on the impact of the project on understanding and attitude. 
Waste Campaign
Campaign materials and leaflets were displayed across the area in GP practices and community pharmacies and a number of publicity events were held in GP practices and supermarkets. These were very successful, with members of the public engaging with the team to discuss the issue and provide views from the local community. The communications team at the CCG provided support to ensure that the campaign also featured in the local press.
Barn Close Surgery in Broadway hosted an event on their premises. The practice manager Christine Milton commented: “We are very pleased to be involved with this campaign as we regularly receive bags of medications returned to us from patients. This happens for a variety of reasons and we want to do all we can to ensure patients do not order medications they have no intention of using. We urge patients to speak to their doctor or nurse if they are not taking or using their medications appropriately. The most expensive medication is the one that is never used.”
Dr Neil Townsend, a GP at the practice said: “I think people are unaware that wasted medicines directly affect waiting lists and other NHS services. With a limited budget the health service cannot afford to be spending money on unused or unwanted medicines. The campaign will hopefully make people aware of the importance of only ordering medicines they need and encourage them to discuss openly with medical staff if they have concerns or do not want medicines they have been prescribed.” 
What now?
Initial findings from the campaign show that approximately 20% of those who filled in a questionnaire stated that they have medicines left over and the more items that they have on repeat prescription increased the chance of them having unused medicines. A full evaluation of the campaign is currently taking place, which will include a feedback survey for all GP practices and pharmacies that were involved. This feedback will be circulated to all stakeholders. Findings from the repeat prescribing audit will be used to share good practice and focus further work on repeat prescribing processes. The success of the campaign will also be assessed and the most effective elements will be incorporated into other campaigns across other localities in south Worcestershire and the other CCGs within Worcestershire.

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