‘This novel approach, which we are piloting, involves people reviewing their medicines one-to-one in a 3/4 hour session with health professionals (a nurse prescriber and a pharmacist). It is is working really well.
We keep no notes and concentrate on providing the people with their own notes in the form of a written list of things to check out. We also give advice on trusted sources of information including www.medsinfo.guru/ and on questions to ask their doctors. We ensure people are aware of their rights under the NHS Constitution and the (not so well known) NICE ‘Kindness’ Guidelines.
Because our partnership approach encourages people to trust us, we can discuss whether or not the medicines prescribed are actually being taken (after all 50% of all of us don’t take medicines as prescribed). This can include if any medicines are borrowed, use of any herbal medicines etc., dietary supplements, over the counter medicines, any which have been stopped but the doctor doesn’t know this or any which are bought over the internet, and we can give advice on this. The most important thing being that people share this information with their prescriber.
We don’t take a position on any approach if it’s safe and it works (backed up here by my own experience).
This service tackles two key areas:
Firstly, this starts to address is the fact that specialists in different areas of medicine only ever review the medicines they have prescribed. So people end up with a continuation of medicines they don’t need and often meds. which make things worse. By going through this in some detail, led by the person themselves who is free to ‘tell their story’, we are helping them make changes.
Secondly, it helps bring out the things people don’t normally tell their doctors (we all do this). In the jargon this is called ‘intentional non-adherence’). This increased trust and openness seems to be because we deliver these reviews as part of larger project led by users of services, so by the time we see people they have built up a degree of trust in the process. Of course it helps greatly that we do not take notes, instead giving the action plan directly to the person we are seeing.
I’m pleased to say doctors are very receptive to our work, as it helps them too when people come to appointments with a clear list of things they want to deal with. I was struck recently by a TV ‘fly on the wall’ programme about Harley Street practitioners and realised the service we are providing here would cost hundreds of pounds in a private setting. Additionally there could be pressure to link to other chargeable services, whereas our motto is ‘let’s get it right, sometimes less is more’.
We are taking this to a second pilot with local GPs as the cost savings are potentially significant. At a minimum I believe the service pays for itself. (That gets the commissioners interested. For me it’s about people’s whole lives).
Our approach fits so well with the idea of people being their own ‘project manager’. In fact I often used this analogy with people I saw when I was an assertive outreach nurse. The results can be amazing