Tell us about your experience of taking many medicines

The SEL Overprescribing program is a strategic response to the National Overprescribing Review Report aimed at addressing overprescribing. It adopts a whole systems approach to tackle the multifaceted causes as well as weaknesses in local prescribing systems and existing prescribing cultures that create overprescribing, with the ultimate goal of ensuring that SEL patients receive medications only when necessary and suitable for their individual circumstances and needs.

Overprescribing is when people, such as those with multiple long-term conditions are taking medicines to manage their conditions that are not necessarily helpful or are not addressing what matters to them about their health.

Since last year June 2023, NHS South East London Integrated Care System (SEL ICS) Overprescribing Team have been engaging with people and communities across south east London to help us jointly address the issue of overprescribing.

The aims and objectives is to reduce overprescribing so that people in south east London are only prescribed medicines when there are no alternative treatments, for example:

A person prescribed a medicine for one long-term condition and subsequently develops another long-term condition such as kidney disease which means the medicine taken for the first one could affect them adversely.

To better understand people’s views and experience of taking many medicines and what is important to them, the team focused on an engagement programme of events in Bexley, Bromley, Greenwich, Lambeth, Lewisham and Southwark to:

• Engage with patients and communities about how we jointly tackle overprescribing to implement recommendations we involved people, carers and various groups and organisations.
• Raise awareness about overprescribing, to gain insights on people’s understanding and to transform how we care for patients; ensure a culture where patients voices are heard, and decisions are shared.
• Work collaboratively with SEL borough engagement teams, local community, and voluntary organisations to help identify specific groups / communities with higher risks of overprescribing to contact to gain insight of local people, patients, carers and clinicians experiences, the triggers and behaviours that encourage or lead to overprescribing.

The engagement programme of events involved:

Let’s Talk Health and Care (LTH&C) an online engagement community platform that enabled residents living in the boroughs to hear more about the project, share ideas, discuss important topics, provide feedback and the opportunity to get involved.

The project page ‘Tell us about your experience of taking many medicines’ was launched on the LTH&C platform on 23 June 2023 which included an online anonymised survey for people taking 5 or more medicines and their carers to complete which included multiple questions: age, conditions, gender and ethnicity and a discussion forum for participants to get involved and participate in conversations about taking many medicines. The survey explored individuals’ experiences of taking many medicines and their attitude towards overprescribing. In total, there were 117 survey responses of which 78 responses reflected the inclusion criteria of those taking 5 or more medicines.

Webinars two online webinars were hosted in July 2023 over a lunchtime and evening session for participants to find out more about the project, ask questions, feedback on what works well and what could be improved. All participants including those that had expressed an interest but were unable to attend were sent the presentation and a feedback form for us to hear more, to help plan future events and the option to get involved with the discussion forums to share their experience of taking medicines. You can read more about the webinars here

At these sessions participants welcomed hearing more about overprescribing, talked openly about their medicines and shared their own personal experiences as well as for the people that they care for. You can read the key themes and what we heard from local people here

Based on the discussions and feedback received from the webinars and recognising that overprescribing can disproportionally affect people from Black, Asian, and Minority Ethnic communities and people living in deprived neighbourhoods, we extended our engagement programme to include outreach visits to groups that expressed an interest in the project that welcomed a visit.

During the summer months (August to October 2023) these groups were visited: Ajoda Group, Greenwich, Greenwich Bengali Women’s Group, Bromley Asian Cultural Association, The Diamond Club, Ethnic Mental Health Carers Forum, Lewisham Irish Community Centre, Southwark Carers and Southwark Pensioners Forum. We also attended a community event, Ageing Well festival, Lambeth and a residential care home, Glebe Court, Lewisham attended by residents and carers.

For these events, we talked to members / participants on a 1-1 and in a group setting about their experience of taking many medicines and handed paper copies of the survey for people to fill in and to share with their family and friends.

Outreach visits facilitated maximum participation. The groups visited expressed a keen interest to engage by talking about their medicines and sharing their experiences as well as for those people that they care for. Feedback was received from over 200 residents and carers. You can read more about the groups regarding the feedback, themes, findings and learning here

A patient’s story learn more by watching Eileen Doyle’s video below, a patient’s story about the impact that SEL Overprescribing Team had on her life following an outreach visit that she attended. Hear how Eileen improved her health after engaging conversations with her GP about the effects of taking many medicines during a structure medication review (SMR). For more information about how to prepare for a SMR click here

In addition to the outreach visits, the Overprescribing project patient engagement work was presented at NHS South East London Integrated Care Board, Engagement Assurance Committee by Lelly Oboh, SEL Lead Pharmacist on 26 September 2023 to the committee members and also at the Royal Pharmaceutical Society Annual Conference on 10 November 2023 to pharmacists and patient engagement advocates from all over the UK. Both presentations covered the aims and objectives of the engagement work and showcased how the Let’s Talk Heath and Care online community platform, webinars and outreach have been instrumental to highlight the themes, feedback and insights about the issues that matter most to our patients and their carers when taking medicines.

A further update on the patient engagement work was presented at NHS South East London Integrated Care Board, Engagement Assurance Committee by Lelly Oboh, SEL Lead Pharmacist on 19 March 2024 to committee members.

The contributions received from participants to the project has helped us to learn more about your understanding and experience of taking many medicines and to identify the support that you might need to improve our services so that you and others are prescribed only the medicines that are useful to you. You can read the presentation here

Next steps

The full feedback results from the patient engagement work continues to be to draw out the key themes which will inform the changes, strategies, training and education needed to reduce overprescribing.

We, therefore, understand from the themes that arose from engagement that key issues we need to address from this project include:

• the importance of active dialogue and communication between patients, doctors, and carers about their medicines including professionals being able to listen and patients and carers being empowered to raise issues.
• the importance of shared decision making with patient.
• the need to review prescribed medicines regularly and for people to know about medicines reviews.

In response to what we have heard, the programme team is:

• developing a clear workplan, including creating good working relationships with other programme boards and committees as well as Local Care Partnerships to deliver relevant aspects of the plan.
• building on the learning from successful local or national initiatives to develop and implement high impact evidence-based interventions to reduce overprescribing.
• developing metrics and performance monitoring to track progress.

The project team will disseminate the findings from the engagement work and continue to engage with patients and communities through the SEL ICB Community of Practice for Polypharmacy in partnership with Health Innovation Network (HIN) to ensure this work is patient centred, incorporates the patient voice so we deliver what matters most to them when taking medicines.

If you have any questions please email at: lambethmedicines@selondonics.nhs.uk or engagement@selondonics.nhs.uk