IPMO – Is it really the best thing since sliced bread?

Since I started my career in medicines optimisation some 25 years ago, both working in the NHS and then with the NHS, there has never been a more exciting time for transforming and integrating the potential of pharmacists within the medicines and patient pathway.

Why? The Integration of Pharmacy & Medicines Optimisation (IPMO) is a policy and initiative grounded in common-sense and a long-overdue emphasis on medicines as the core of most LTCs and the need to take an integrated and system-wide approach to managing this.

Pharmacists are already the third largest workforce in the NHS and by 2024, there will be an army of 7,000 PCN Clinical Pharmacists alone (estimated at about 3,500 currently) and all newly qualified pharmacists will be prescribers. Personally, I feel the most important letters are the MO- the medicines-related optimisation opportunities and preventing the clinical inertia and overwhelm.

In a cruel twist of fate, this long-awaited next stage (following the IPMO pilots of 2018), has come at the worst time with the pandemic and entire healthcare system focussed on the vaccination mobilisation programme and recovery of the associated healthcare complications. This means that the current voluntary “lead” role is unlikely to have the capacity, dedication, accountability and bandwidth to drive and deliver this- even if they do have the skills and vision to do so. This causes a back-to-front process- like buttering your bread BEFORE you put it in the toaster. It seems somewhat perilous to me that the current voluntary lead role will have to galvanise the local stakeholders and develop an outline costed delivery plan, including creation of new ICS Chief Pharmacist role. Surely the ICS Chief Pharmacist role needed to come first in order to develop and own the ICS level IPMO strategy and then be accountable for the delivery plan? It is what it is, as they say, but it needs to be recognised that this flaw in the IPMO formulation and implementation poses a potential and serious threat to its success.

Below is my critique and some predictions regarding IPMO:
  1. IPMO is finally the medicines arm of an integrated system. However, this is going to take leadership and real vision alongside effective project management
  2. The wider NHS to date has little awareness and even less readiness on IPMO plans currently, but it is likely to gain momentum as we approach September 2021 when more detailed and costed ICS plans need to be submitted to deliver the priorities ( submitted in June)
  3. The ambition of the local ICS priorities and delivery plan will be determined by the vision and ambition of the ICS Chief Pharmacist and their ability to take stakeholders with them. It will be interesting to observe where this leadership role will come from- commissioners or providers. My suspicion is that they will generally come from provider
  4. Pharmacists across the pathway will have a growing importance and relevance as the medicines experts and IPMO reinforces a future vision of this. Not only will their numbers multiply, but their influence and power as a collective, as well as individuals, will do so too
  5. There will be stronger “tripartite working” to drive local innovation irrespective of setting; primary, secondary and community and this will depend on the ability of local pharmacy stakeholders in integrated care systems to overcome their historical baggage for the wider good
  6. The artist formerly known as CCG Medicines Optimisation will still remain both involved and instrumental in decision-making on medicines and commissioning of pathways at place-level
  7. Local decisions on which clinical and LTC pathways and areas of medicines optimisation will be strongly influenced and driven by the Primary Care Networks particularly PCN Clinical Directors and Senior PCN Pharmacists
  8. Community Pharmacists will have a growing role in supporting the patient pathway in long term conditions at all stages of the pathway including detection, treatment, monitoring and optimisation. Expect an increasing emphasis on supporting independent prescribers who are not being utilised within community pharmacy as well as strong service development at local level beyond the existing vehicles of Discharge Medicines Service ( DMS), New Medicines Service ( NMS) and Community Pharmacy Consultation Scheme (CPCS)

As Keith Ridge, Chief Pharmaceutical Officer says in the foreword to the guidance document from September 2020, following COVID, “This guidance is about how to build on this refreshing teamwork more systematically to help improve and transform pharmacy and medicines optimisation.” Let’s hope sectors across pharmacy can energise themselves to think differently and across the patient pathway to fulfil this possibility and that we are not left with the stale loaves of the past.

If you are a key pharmacy stakeholder in an ICS keen to see this IPMO initiative to succeed, but struggling with stakeholder engagement or getting the strategy off the ground, then contact us for a  4D facilitated session to help your system-wide team to develop a “plan for the plan” in a structured and collaborative way

If you are a pharma or devices company and haven’t yet explored or planned your engagement with target pharmacists, Soar Beyond has the expertise to help you develop your Pharmacy Activation Strategy for 2022 and beyond. Having a cohesive and coherent medicines optimisation strategy and value offer to support pharmacy pathway integration will be vital to Pharma industry success and it will be important for you to know which way your bread is buttered!


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