Two years on: better care for all

We made recommendations about improving the management and treatment of lung disease. Here’s what’s happened in 2020.

Comment from the Medicines Optimisation Working Group Co-Chairs

The pandemic has resulted in a significant interruption to healthcare services’ ability to deliver timely, comprehensive and accurate support to patients with regards to their medicines. In many cases annual reviews and inhaler checks have been suspended or replaced with remote checks where it is more difficult to review patients’ technique. Yet there is a stronger case than ever to make sure that patients are taking their prescribed medication correctly so that they can avoid unnecessary hospital admissions, as this may place them at a greater risk of contracting COVID-19.

We worked closely with the NHS England and NHS Improvement (NHS E & I) Medicines Optimisation working group last year to reiterate the importance of ensuring all healthcare professionals who deliver inhaler technique training are properly trained to do so. We also worked with this group to develop a joint policy position paper on how best to deliver effective remote inhaler technique checks. The NHS E & I group has now become the Consolidated Inhaler working group and we will continue to explore the best ways to work with them to pursue our priorities.

We are also coordinating with NHS E & I, the Pharmaceutical Services Negotiating Committee (PSNC) and other partners to make the case for an enhanced role for community pharmacists in managing respiratory patients and their medications.

There are some encouraging signs that there will be improved access to anti-fibrotic drugs following the ongoing influencing work of our Taskforce member, Action for Pulmonary Fibrosis.

Co-Chairs of the Taskforce for Lung Health medicines optimisation working group:

  • Sheila Edwards, British Thoracic Society
  • Dr Anna Murphy, British Pharmaceutical Society

Recommendation 3b: Establish clear best practice in assessment, referral and regular monitoring of people with advance chronic obstructive pulmonary disease (COPD) and advanced breathlessness who would benefit from a lung volume reduction procedure

We are pleased that NHS England have recently approved lung volume reduction treatments for people with severe COPD. It means that reduction surgery or endobronchial valve placement will now be available round the country for everyone that could benefit. 

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

In 2020, the Taskforce has reviewed and revised the UK Inhaler Group (UKIG)’s Seven Steps to Success competency document for teaching patients correct inhaler technique. The UKIG is a coalition of not-for-profit organisations and professional societies with an interest in promoting the correct use of inhaled therapies. The Taskforce is undertaking media and wider promotional work to encourage the uptake of the UKIG’s competency document for health care professionals who prescribe inhalers and check how patients are using them.

We have also completed a review of materials that have been designed to help patients with using their medicines correctly.  The results were shared with the NHS E & I Flexible Learning working group and the Taskforce is encouraging the NHS and other stakeholders to promote the best available resources in their forthcoming patient education tool and more widely.

The Taskforce is using the Respiratory Outcomes Tool ‘heat maps’ data, that shows geographical variation in prescriptions for SABA, to demonstrate that in many areas there is worrying over-prescribing and over-reliance on SABA. We are compiling this information for policy makers and individual prescribers across certain Clinical Commissioning Groups (CCG) in a format that we hope will help to instigate important changes. Our initial focus has been with the five worst performing CCGs to explore what they feel the most useful approach will be, for the Taskforce to then roll-out the briefing packs to more local areas in 2021.

We have also worked with the Chief Pharmaceutical Officer and PSNC to host a workshop setting out the ways in which people with lung disease currently use community pharmacists, and how this could be adapted in the future to better meet the needs of patients. The workshop has been informed by a Taskforce research project that gathered the experiences of more than 2000 patients. We will continue to develop this work in 2021.

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

This year we have continued to support Action for Pulmonary Fibrosis in campaigning for improved access to anti-fibrotic drugs for all patients with IPF. There has been encouraging feedback from policy makers and we are hopeful that 2021 will bring positive changes. 

Early stage IPF patients need regular lung function tests so they can start anti-fibrotics as soon as their lung function drops to the eligibility threshold. Since the pandemic has reduced the number of lung function tests being carried out in hospitals, Action for Pulmonary Fibrosis has successfully secured getting the NHS to give priority access to these tests to early stage IPF patients. 

Recommendation 3f: Fully implement British Thoracic Society (BTS) home oxygen therapy guidelines to improve use of home and ambulatory oxygen. Fully implement the National Institute for Health and Care Excellence (NICE) quality standard on idiopathic pulmonary fibrosis (IPF) to ensure patients have access to beneficial home and ambulatory oxygen therapy

The British Thoracic Society and the Respiratory Futures programme continue to promote uptake of their Quality Improvement tools and best practice examples to support health care professionals to be aware of, and apply best practice in the use of home oxygen.

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

Medicines Use Reviews (MURs) will be phased out by the end of 2020/21 and the funding allocated to other service developments. The Taskforce remains committed to enhancing the role of pharmacists in managing and supporting respiratory patients. Our work in 2020 has included continued influencing of NHS E & I to make the case for community pharmacy involvement in primary care networks, as we believe they have a key role in supporting patient medicine reviews and educating people on the correct use of inhalers. COVID-19 has further reinforced the valuable role that pharmacists play within their local communities.

In 2020, we responded to the NHS consultation on Structured Medication Reviews, reiterating the case for an enhanced role for pharmacists. We have also made our case in meetings and at events to other relevant stakeholders for why the Taskforce wants to see community pharmacists able to carry out a medication review function. We have spoken to the PSNC to make the case for community pharmacists to be involved in reviewing patients’ medicines and supporting patients with their inhaler technique. Early in 2019, we submitted a response outlining the changes we would like to see to the asthma domain of the Pharmacy Quality Scheme, and we continue to push for this.