The NHS needs to start thinking about the use of medicines as an investment rather than as a spending issue, according to Jonathan Mason, National Clinical Director for Primary Care and Community Pharmacy at the Department of Health.

We have to change our focus and think about the value that we place on medicines, Mr Mason told the Link Gov third annual national QIPP (Quality, Innovation, Productivity and Prevention) symposium in Liverpool last week.  Value-based pricing (VBP) is coming, and we need to think about whether we are willing to spend more on a new drug which will provide better outcomes or keep on going with the cheaper options, he said.

"If you focus purely on driving down spending, costs will ultimately increase and quality decreases. But a focus on quality, on continuous improvement, will improve quality and also drive down costs," said Mr Mason.

“Deciding on where to invest - and disinvest - that will be the real challenge,” he added.

Mr Mason also told the conference that the NHS in England spends £8 billion on medicines in primary care each year, and another £4 billion on medicines in hospitals and outpatient care, yet all the evidence shows that between one-third and a half of all medicines are not being taken as prescribed, or taken at all. This is a "huge problem," he said.

Medicines are "a classic example of silo thinking" in the NHS, and of doing things "to" people rather than "with" them, he said, and failing to explain to patients why they need to take their medicines as directed leads to problems such as multiple prescribing. 5% of emergency hospital admissions are due to adverse reactions, Mr Mason told the conference.

Dr Jill Loader, associate director for medicines management at NHS South West Strategic Health Authority, also emphasised the need to improve the return on investment (ROI) for NHS England's £12 billion annual drugs bill. We cannot look at medicines in isolation, and we need patients to become partners in decisions about medicines and take responsibility for taking them correctly, she said. 

But research shows that just 16% of patients starting on a new medicine say that, after four weeks, they are taking the drug as prescribed, are experiencing no problems and feel that they have all the information they need, she said. In contrast, 10 days after starting a new medicine, 61% of patients feel that they are lacking information and half will have reported a problem.

Moreover, 45% of incorrect use of medicines being taken for long-term conditions is due to intentional non-compliance by patients, and unless we start addressing these social factors we will not get the ROI from modern medicines, or the health gain, said Dr Loader.