Five years on: Better care for all

Co-chair of Medicines Optimisation foreword

Since its inception in 2018, the Taskforce for Lung Health’s Medicines Optimisation working group has achieved a great deal, shaping respiratory best practice through collaboration with NHS England, and helping to expand usage of vital antifibrotics, improving patients’ lives and lessening the burden of their conditions.

The last year has built upon the success of the previous four. Collaboration between Taskforce members Asthma + Lung UK and AstraZeneca shows great promise in tackling access issues for biologics for severe asthma, addressing disparate health outcomes for thousands. The Taskforce has also furthered its work on SABA overuse, updating our guidance though a paper on SABA overuse to working group members in 2023. This set out policy calls on asthma, including recommendations that SABA overuse be more tightly defined, and that changes to prescribing be made for the sake of patient health.

As the Taskforce concludes its first five years, we are amending our ways of working, moving toward a more dynamic approach and restructuring some of our working groups.

Medicines Optimisation will become Treatments, continuing our drive to improve use of medications for patients, but looking more closely at the barriers preventing universal, equitable access to medicines. This will mean the working group is geared more toward influencing and advising on process, ensuring that medicines are able to come onto the market more smoothly and that available treatments are accessible for all patients, regardless of where they live.

The Co-Chairs of the Medicines Optimisation Working Groups:

  • Darush Attar, Pharmacist and Executive Committee Member of the Primary Care Respiratory Committee
  • Anna Murphy, Respiratory Specialist Pharmacy Lead and Committee member of the Primary Care Pharmacy Association

Within the new Treatments working group, we will have sub-groups set to address more specific barriers:

  • Community Pharmacy – continuing our work on pharmacy access, diagnosis and prescribing, highlighting the need for greater investment in this valuable part of the health service.
  • New Medicines – a new sub-group focusing on access to innovative medicines including biologics.
  • Vaccinations – a new sub-group focusing on vaccination for common conditions such as RSV, refining and streamlining the vaccination approvals process and championing preventative public health.

There will also be a task-and-finish group continuing work on inhaler recycling.

The new Treatments working group holds great promise and sets the tone for the Taskforce’s new approach; operating with focus to drill down to the core of key issues within respiratory health on behalf of patients. Treatments will hold its inaugural meeting in spring 2024.

Recommendation 3d: Improve inhaled therapy, by developing a clear pathway for accurate prescribing and adherence, and promoting new technology such as smart inhalers 

Throughout its fifth year, the Taskforce has continued to champion the importance of clearly-defined patient pathways and has continued its work on addressing high prescribing rates for short-acting beta-2 agonist (SABA).

Taskforce member Asthma + Lung UK and our industry partner AstraZeneca have continued to support the Accelerated Access Collaborative’s work in this area and have presented evidence to the working group showing the disparate levels of bio-penetration (access to biologics for treatment) across England. This data shows a considerable range, but room for improvement across the board: in some Integrated Care Boards (ICBs) only 2% of applicable patients can access biologics, while in others 29% have access. This is a key area of interest for the Taskforce moving forward and will be the focus of a dedicated sub-group.

The Taskforce produced a paper in 2023 outlining its views on community pharmacy, highlighting the role it can play in better diagnosis and inhaler technique correction services if more adequately funded. The Taskforce also presented a paper on SABA overuse to working group members in 2023. This outlined five key policy calls on asthma, including recommendations that SABA overuse be more tightly defined (the threshold being reduced to use of three or more SABA inhalers annually), and that SABA-only prescribing be replaced by concomitant ICS prescribing where appropriate, in line with recommendations by Global Initiative for Asthma.

Recommendation 3e: The government and pharmaceutical industry should work together to improve access to antifibrotic drugs for idiopathic pulmonary fibrosis (IPF), cystic fibrosis transmembrane conductance regulator (CFTR) modulators for cystic fibrosis and monoclonal antibody treatments for severe asthma 

The hard work of the Taskforce and its members, including Action for Pulmonary Fibrosis, is shown through our work on this objective. 2022 saw NICE extend the lung capacity range for nintedanib, an antifibrotic used to treat progressive fibrosing interstitial lung disease and idiopathic pulmonary fibrosis. This translated into updated guidance from February 2023, meaning that patients with these conditions can now access this treatment earlier in their condition’s progression.

We are delighted by this strong progress and will continue to work with partners and Taskforce members to ensure patients with IPF receive clear communications about what it means to them. 

In June 2022, we welcomed the publication of the NHS Accelerated Access Collaborative’s Consensus Pathway for Severe Asthma. This aims to improve access to asthma biologics by supporting improvements in treatment pathways so that more patients receive specialist care at the right time. Taskforce industry partner AstraZeneca this year presented data on national bio-penetration (access to biologics for treatment) data, showing low national levels overall and disparity between the access available.

We are monitoring implementation of the pathway to ensure patients with severe asthma receive the right treatment at the right time. This is a key area of interest for the Taskforce moving forward and will be the focus of a dedicated sub-group.

Though subject to delay, the NICE/SIGN/BTS diagnosis, monitoring and chronic asthma management guidance publication is expected in late 2024. The Taskforce will continue to support our member, Asthma + Lung UK with any engagement it has in the consultation process. 

Recommendation 4d: Promote and signpost people living with lung disease, families and carers to support groups which are run in joint leadership between people affected by lung disease and health care professionals

Through the brilliant work of our members, the Taskforce is fortunate to be able to signpost patients to health advice and patient support groups, and offer guidance regarding the health service and the care they need and deserve.

2023 saw the Taskforce invite seven new patient representatives to join our meetings, each kindly volunteering their time and sharing their vital insights into their condition and experiences. Along our existing patient and carer representatives, these new Taskforce members shape our ways of working and outline what true success looks like for respiratory patients.

Over 2023’s working group meetings, the Taskforce has signposted to health advice from our member Asthma + Lung UK, heard from our member the Cystic Fibrosis Trust on their goals and ongoing campaigning, and from our member Action for Pulmonary Fibrosis on their engagement with specialist centres. The Taskforce also spoke in community group meetings, engaging directly with patients and carers, and promoting our members’ health advice and services.

Recommendation 4e: Expand the delivery of NHS Medicines Use Review and NHS New Medicine Services in pharmacies and remove the cap on the number of these they can deliver 

The Taskforce’s Community Pharmacy sub-group will continue its work under the Taskforce’s new ways of working from 2024 onwards, making the case for a greater role for pharmacists in the diagnosis and management of people with lung conditions.

We were disappointed to not see respiratory measures included in the Department for Health and Social Care’s Primary Care Recovery Plan, launched in May 2023. This plan does, however, show that government realises the great work done by pharmacists, the benefits community pharmacy afford patients, and that making better use of them could relieve pressures on general practice.

The Taskforce produced a paper in 2023 outlining its views on community pharmacy, evidencing the need for inclusion of pharmacy-first respiratory care and illustrating the benefits of integrating some existing services such as the New Medicine Service into clearly-defined patient pathways.

In the wake of the continued net loss of pharmacies into 2023, we are continuing our call for effective reform to funding models. We welcome the continued engagement between the Taskforce and Community Pharmacy England (formerly the Pharmaceutical Services Negotiating Committee) and understand that all efforts to make greater inclusion of respiratory diagnosis and care in community pharmacy hinge upon greater funding.

With no mention of respiratory care within the Autumn Statement 2023, the Taskforce will continue to hammer home this point, and others, as we move toward a general election.