An Update on Regional Medicines Optimisation Committees

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Four Regional Medicines Optimisation Committees (RMOCs) for England (London, North, South and Midlands & East) formally came into being in 2017. Their role: to provide advice and make recommendations on the optimal use of medicines to benefit both patients and the NHS. The four committees operate as a single framework with recommendations from each committee valid across England. An underlying principle is to reduce the duplication of work undertaken by Area Prescribing Committees (APC), Clinical Commissioning Groups (CCGs) and Trust Drug and Therapeutic Committees (DTC) / Medicines Management Groups (MMG) which can result in differing outcomes and variation across the NHS.

The purpose behind the RMOCs is to have key decision makers in each geographical area to share best practice, avoid duplication and advise on proposals to improve patient outcomes. The status of RMOC recommendations and all other outputs are advisory, and do not affect the statutory legal responsibilities and duties of NHS organisations. In addition, RMOCs are expected connect into the wider assurance mechanisms and delivery systems in respect of commissioners and providers, to help inform the use of local and national levers to input recommendations.

Structure and Operations

Governance is overseen by the Medicines Optimisation Oversight Group (MOOG) supported by the NHS England Specialist Pharmacy Service (SPS).

Work streams for the RMOC are developed in reference to the Medicines Value Programme1, through horizon scanning of new medicines and by a submission of a topic via the SPS website. The Medicines Optimisation Priorities Panel (MOPP) generates the work programme and determines the national priority. Both MOOG and MOPP are chaired by the Chief Pharmaceutical Officer for England, Dr Keith Ridge CBE.

RMOC Recommendations and resources

The RMOCs produce once-for-England recommendations and resources to guide on a range of Medicines Optimisation topic areas. These products are for adoption and implementation by NHS organisations regionally and locally to help improve medicines use.

The first wave of RMOC meetings were held from June – September 2017 and each committee discussed the same 3 substantive agenda items – biosimilars, anti-microbial resistance and polypharmacy. Each RMOC noted local actions for implementation and discussion sheets for each region with details of actions are available on the SPS website.2

Examples of RMOC outputs:

  • RMOC (North) has reviewed FreeStyle Libre in November 2017 and issued a position statement produced for Area Prescribing Committees.3 This position statement includes the appropriate patient group, the limitations of the clinical evidence and cost information and stop criteria.
  • In January 2018, the RMOC for London initiated a project to understand the strategies and actions being pursued currently across London in order to reduce inappropriate polypharmacy.4

Current reality

Comments from members of Networks4Health (http://networks4health.ning.com/) suggest that it is still early days for any robust conclusions regarding the outputs from RMOCs and feedback is mixed. The opinion is that RMOCs are high on the political agenda and are here to stay. However further discussion is required at a local level on how individual organisations will build the recommendations into their commissioning processes.

One of the potential setbacks of the RMOCs is that recommendations are national and take no account of local variances and local commissioning intentions/processes. Recommendations have also been made with no details on effective implementation. Within each region commissioning processes vary and are complex and it is still unclear as to how RMOCs will help reduce variation across the NHS at this early stage.

Engagement via STPs is seen as an opportunity to drive forward the implementation of RMOC recommendations. However once again detail on this is still unclear. There are still many lessons to be learned and for RMOCs to be successful there may need to be a shift in mindset and process to ensure their success.

Further reading

  1. NHS England Medicines Value Programme https://www.england.nhs.uk/medicines/
  2. SPS website. Link to implementation and discussion items. https://www.sps.nhs.uk/articles/discussion-sheets-from-first-wave-of-regional-medicines-optimisation-committee-meetings/
  3. FreeStyle Libre positioning statement: https://www.sps.nhs.uk/wp-content/uploads/2017/11/Flash-Glucose-monitoring-System-RMOC-Statement-final-2.pdf
  4. London RMOC survey on polypharmacy:
  5. https://www.smartsurvey.co.uk/s/DZSKW/Regional Medicines Optimisation Committees, Operating Model First Edition, April 2017 https://www.england.nhs.uk/wp-content/uploads/2017/04/regional-medicines-optimisation-committees-operating-model.pdf
  6. Specialist Pharmacy Service, Regional Medicines Optimisation Committees for England https://www.sps.nhs.uk/home/networks/