Aligning PCN medicines work with ICB objectives

Written by the Virtual Pharmacist clinical team

Integrated care boards and Primary Care Networks are measured on overlapping things and describe them in different language. An ICB talks about population health, health inequalities, system spend and outcomes at scale. A network talks about lists, clinics, capacity and what happened this week. Medicines work is one of the few areas where the two translate cleanly, because the same activity produces both a clinical outcome and a system number.

Networks that make that translation explicit tend to find conversations with their ICB easier, and tend to be first in line when discretionary support is going. This is a practical guide to doing it.

What ICBs are consistently interested in

Priorities vary by system, and the local joint forward plan is always the authoritative source. Across systems, though, the medicines-related themes that recur are reasonably stable:

• Prescribing safety and quality, particularly high-risk medicines and monitoring.
• Prescribing efficiency, meaning outcomes per pound rather than simply lower spend.
• Long-term condition outcomes, especially cardiovascular, diabetes and respiratory.
• Health inequalities, usually expressed as variation between populations rather than an overall average.
• Unplanned admissions, where medicines are a contributing factor more often than the headline numbers suggest.
• The care interface, particularly what happens to medicines on discharge.

A network’s medicines work touches every one of those. The gap is usually the reporting unit: the network reports its activity in units the ICB does not use.

Translating activity into system language

The translation is mostly a matter of reporting the effect rather than the effort. A few worked examples:

• Instead of “we completed 180 structured medication reviews”, report the number of patients whose high-risk combination was resolved, and the proportion of the eligible cohort now reviewed.
• Instead of “we ran a monitoring recall”, report the proportion of patients on high-risk drugs within their monitoring interval, and how that moved.
• Instead of “we cleared the discharge letter backlog”, report median time from letter received to medicines reconciled, and how many reconciliations changed a prescription.
• Instead of “we reviewed our care home patients”, report the same measures split by care home, which is where variation usually shows.

None of this requires new data collection. It is the same work, counted at the outcome end rather than the activity end.

Inequalities: the split that changes the conversation

The single most useful thing a network can do to align with ICB priorities is to report its medicines measures split by population rather than as an average. Deprivation quintile, ethnicity, care home residence, housebound status, or simply by practice.

The reason is straightforward. A network average tells an ICB very little it cannot already see. The same measure split by quintile tells it where variation sits, which is the thing it is accountable for and often cannot see from system-level data. A network that arrives with that split is contributing something the ICB does not already have.

It also tends to change what the network does next, because variation is usually more actionable than an average.

Prescribing efficiency, framed usefully

Prescribing spend is an area where network and ICB interests can look opposed and mostly are not. The framing that works is outcomes per pound rather than spend reduction, because it is both more accurate and easier to defend clinically.

Work that fits that framing includes reviewing patients on medicines with limited ongoing benefit, addressing waste where quantities and cycles do not match how patients actually take their medicines, and aligning to local formulary choices where the clinical outcome is equivalent. Each of those has a spend consequence that an ICB will recognise, and a clinical rationale that stands on its own.

The distinction matters when someone asks why a change was made. A change made because the formulary said so is hard to defend to a patient. The same change made because the outcome is equivalent and the local system agreed the choice is straightforward.

Getting into the conversation earlier

Networks that align well usually do a small number of unglamorous things:

• Read the joint forward plan and quote it back. Using the ICB’s own priority language in a network report is a low-effort, high-return move.
• Send something before it is asked for. A short quarterly medicines summary, unprompted, positions the network as a source of information rather than a recipient of requests.
• Volunteer for the pilot. Discretionary support tends to go to networks that have already demonstrated they can deliver something and report on it.
• Name the constraint honestly. An ICB can sometimes solve a capacity problem it has been told about. It can never solve one it has not.

What this needs from the medicines team

Practically, it needs someone who can build and run the searches, hold the reporting cycle, and produce the same measures each quarter so a trend exists. That is a modest amount of time, but it has to be reliable time, because a measure reported once is an anecdote and the same measure reported four times is evidence.

This is the kind of work that suits a pharmacy team with capacity that does not get pulled into the urgent list, whether that team is in-house or commissioned. We describe how the reporting side works in practice in our case studies.

A reasonable first step

Take one measure the network already produces, split it by deprivation quintile or by practice, and put it in front of the ICB with a short note on what the variation looks like and what the network intends to do about it. That is usually enough to start a different sort of conversation, and it costs an afternoon.

If you want help building the measures or the reporting cycle, get in touch.