Welcome to the latest episode of Talking Meds on the PrescQIPP podcast, engaging conversations about medicines-related dilemmas. Today, your host Jonathan Underhill, Medicines Clinical Adviser at PrescQIPP, continues the series within the Talking Meds podcast called ‘Sensible prescribing in Older people with Jonathan and Lucy’. 

Today, Jonathan and Lucy talk about the identification AND sensible management of heart failure with preserved ejection fraction. They discuss how we need to have a different approach than that for heart failure where the ejection fraction is reduced by a significant amount. But that the key is to consider what matters most to people and tailor our approach accordingly. Its guidelines not tramlines!

The importance of ‘sick day rules’ are also discussed – stopping medicines for a short period where volume depletion or a urinary tract infection (UTI) is present.

We also meet Marjory, who has recently been started on dapagliflozin but is admitted to hospital with a raging UTI and delirium. The EMPORER study found that for every 100 people on a flozin, one of them would get a UTI due to the flozin. But this risk may be higher in older people as they are at higher risk of this happening in the first place than those included in the EMPORER study. Medicine is tricky eh?

See the tab for HFPrEF in GP Evidence https://gpevidence.org/ to illustrate this with icon arrays.

Resources mentioned in this episode include:

P Moorhouse, K Rockwood. Frailty and its quantitative clinical evaluation

National Institute for Health and Care Excellence. Urinary tract infection (lower): antimicrobial prescribing

NICE guideline [NG109]Published: 31 October 2018

PrescQIPP bulletin 347. Chronic Heart Failure

PrescQIPP e-learning. Chronic Heart Failure in Adults (pay per use)

A new episode of Talking Meds will be available on the first Friday of the month.
If you have feedback or suggestions for future topics and guests please submit them to [email protected]

PrescQIPP is funded by the NHS for the NHS, and our aim is to improve medicines-related care for patients. We do this by producing high quality evidence-based resources and training, and by facilitating networks between NHS organisations and professionals.

The majority of pharmacists and other healthcare professionals across the UK can access our resources by registering and logging on to our website. If you have any difficulty accessing the website you can email [email protected] and we’ll aim to sort things out for you.

Find out more about PrescQIPP here

Welcome to the latest episode of Talking Meds on the PrescQIPP podcast, engaging conversations about medicines-related dilemmas. 

Today, your host Jonathan Underhill talks to Clare Howard, Clinical Lead for Medicines Optimisation at Health Innovation Wessex, about the development of the Repeat Prescribing Toolkit she led on behalf of the Royal Pharmaceutical Society and Royal College of General Practitioners. 

The toolkit was commissioned by NHS England in answer to recommendation 7 of  the National Overprescribing Review, to help practices improve the consistency of their repeat prescribing processes. There are 1.18 billion medicines prescribed and dispensed in Primary Care in England each year. While most people get their medicines without any issues, there are around 20-30,000 ‘probable avoidable’ harm incidents each year, of which around a quarter are related to medicines. Clare and Jonathan discuss the multiple ways this toolkit can help reduce the risk of these errors.

The NHS is a complex system, and repeat prescribing is a ‘WICKED’ problem (difficult or impossible to fix) as it involves human to human interactions. Clare and Jonathan acknowledge that while you can’t ‘fix’ it and completely prevent any errors, having a structured approach can help reduce the risk of those errors and make for a more efficient process (and happier patients and healthcare staff!)

Resources mentioned in this episode include:

Repeat Prescribing Toolkit:

https://www.rpharms.com/resources/repeat-prescribing-toolkit

National Polypharmacy Programme from Wessex Health Innovation Network

https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy

Get details of upcoming ALS cohorts and book your place here. 

Useful related resources from PrescQIPP:

The PrescQIPP 'Practice Medicines Coordinators' e-learning course is recommended as a training resource for prescription clerks in the RPS/RCGP Repeat Prescribing Toolkit.
PrescQIPP Practice Medicines Coordinators e-learning course (Pay per use)

PrescQIPP Bulletin 325: Empowering patients to manage their repeat prescriptions

PrescQIPP Bulletin 292: Repeat prescriptions

A new episode of Talking Meds will be available on the first Friday of the month.
If you have feedback or suggestions for future topics and guests please submit them to [email protected]

PrescQIPP is funded by the NHS for the NHS, and our aim is to improve medicines-related care for patients. We do this by producing high quality evidence-based resources and training, and by facilitating networks between NHS organisations and professionals.

The majority of pharmacists and other healthcare professionals across the UK can access our resources by registering and logging on to our website. If you have any difficulty accessing the website you can email [email protected] and we’ll aim to sort things out for you.

Find out more about PrescQIPP here

Welcome to the latest episode of Talking Meds and the PrescQIPP podcast, engaging conversations about medicines-related dilemmas. 

Today, your host Jonathan Underhill, Medicines Clinical Adviser at PrescQIPP, continues the series within the Talking Meds podcast called ‘Sensible prescribing in Older people with Jonathan and Lucy’.

Jonathan and Lucy discuss Brenda, an older lady who has become frail and has significant dementia that is affecting her ability to cope with everyday life and living. She has been taking aspirin, originally intended to reduce her risk of a further heart attack, but which hasn’t been thought about for a while. They discuss how clinicians are prone to overestimate benefits of medicines, but underestimate harms. The importance of finding out a patient’s (and their carer’s) expectations are key to sensible prescribing. Sometimes the tablets aren’t worth our precious older people taking them, as the harms may well outweigh the potentially small benefits.

Resources mentioned in this episode include:

GPs’ understanding of the benefits and harms of treatments for long-term conditions: an online survey. Julian Treadwell in British Journal of General Practice. https://bjgpopen.org/content/4/1/bjgpopen20X101016

A brilliant resource to help illustrate likely benefits and harms for some commonly used medicines - GP Evidence https://gpevidence.org/

PrescQIPP webinar recording. How well do GPs understand the benefits and harms of treatments for long term conditions?
Dr Julian Treadwell.
https://www.prescqipp.info/our-resources/clinical-webinars/how-well-do-gps-understand-the-benefits-and-harms-of-treatments-for-long-term-conditions/

A new episode of Talking Meds will be available on the first Friday of the month.
If you have feedback or suggestions for future topics and guests please submit them to [email protected]

PrescQIPP is funded by the NHS for the NHS, and our aim is to improve medicines-related care for patients. We do this by producing high quality evidence-based resources and training, and by facilitating networks between NHS organisations and professionals.

The majority of pharmacists and other healthcare professionals across the UK can access our resources by registering and logging on to our website. If you have any difficulty accessing the website you can email [email protected] and we’ll aim to sort things out for you.

Find out more about PrescQIPP here

Welcome to the latest episode of Talking Meds and the PrescQIPP podcast, engaging conversations about medicines-related dilemmas. 
Today Jonathan Underhill, Medicines Clinical Adviser at PrescQIPP, talks to Dr Mark Horowitz about how to safely stop antidepressants and the importance of tapering dose reduction slowly to reduce the risk of withdrawal symptoms.

Dr Mark Horowitz  is a training psychiatrist and Visiting Lecturer in London, and  the lead author of the Maudsley Deprescribing Guidelines (see below). Mark co-authored the recent Royal College of Psychiatrists’ guidance on ‘Stopping Antidepressants’, and has been commissioned by Health Education England to prepare a teaching module on how to safely stop antidepressants for the NHS (coming soon!). 

Mark has experienced the difficulty of coming off psychiatric medications first hand which has informed much of his work.

Useful sources referred to in this episode include:

Dose response curves/Law of Mass action illustrated here (see figure 1)

https://pharmaceutical-journal.com/article/ld/case-based-learning-safe-withdrawal-and-tapering-of-antidepressants

The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs

https://www.wiley.com/en-gb/The+Maudsley+Deprescribing+Guidelines%3A+Antidepressants%2C+Benzodiazepines%2C+Gabapentinoids+and+Z-drugs-p-9781119823025

RPS members can get free access to the Maudsley Deprescribing Guidelines here:
https://www.vlebooks.com/Account/Logon/RPS

Maudsley Prescribing Guidelines

The Maudsley Prescribing Guidelines in Psychiatry eBook
Register for an NHS England OpenAthens account.

NICE guidelines

NICE guideline on depression in adults – see section 1.4.12 to 1.4.21 for information on stopping antidepressants.

NICE guideline on medicines associated with dependence or withdrawal symptoms - further recommendations on withdrawing antidepressants.

Clinical Knowledge Summary (CKS)

NICE clinical knowledge summary depression

National Polypharmacy Programme

National Polypharmacy masterclass on safely stopping antidepressants

Useful related resources from PrescQIPP:

Clinical Masterclass from August 2024

Antidepressant bulletin 330. September 2023.
https://www.prescqipp.info/our-resources/bulletins/bulletin-330-antidepressants/

A new episode of Talking Meds will be available on the first Friday of the month.
If you have feedback or suggestions for future topics and guests please submit them to [email protected]

PrescQIPP is funded by the NHS for the NHS, and our aim is to improve medicines-related care for patients. We do this by producing high quality evidence-based resources and training, and by facilitating networks between NHS organisations and professionals.

The majority of pharmacists and other healthcare professionals across the UK can access our resources by registering and logging on to our website. If you have any difficulty accessing the website you can email [email protected] and we’ll aim to sort things out for you.

Find out more about PrescQIPP here

Welcome to the 2nd episode of Talking Meds and the PrescQIPP podcast, engaging conversations about medicines-related dilemmas. 

Today your host Jonathan Underhill, Medicines Clinical Adviser at PrescQIPP, introduces a new series within the Talking Meds podcast called ‘Sensible prescribing in Older people with Jonathan and Lucy’. Jonathan and Dr Lucy Pollock outline their plan to share some real patient stories that may help us think about how to ensure we consider what really matters to patients when we are reviewing their medicines.  

Lucy grew up in Northern Ireland, read medicine at Cambridge University and St Bartholomew’s Hospital and is eternally grateful for the advice of an early boss who hoped she would not be offended if he suggested she should become a geriatrician. She trained in general and geriatric medicine in London before taking up a consultant post in Somerset in 2001. She lives with her husband and dog Rose near Langport. They have three grown-up children.  

Lucy writes about her patients, their families and the complicated, funny, sad problems that arise as we age. The Book About Getting Older (2021) and The Golden Rule (2024) are both published by Penguin Random House.  @lucypollock | Linktree

In this episode, Jonathan and Lucy talk how about we need to be really careful when starting some medicines, making sure we are considering some of the potential, perhaps unintended consequences. Lucy tells about her experiences where sometimes the very best of intentions to try and help treat symptoms may lead to ‘prescribing cascades’ and how tricky that can be for our patients.

Useful sources referred to in this episode include:

Introduction to ‘prescribing cascades’ from Canadian Medication Appropriateness and Desprescribing Network: https://www.deprescribingnetwork.ca/blog/prescribing-cascade

BMJ Open Adverse drug reactions, multimorbidity and polypharmacy: a prospective analysis of 1 month of medical admissions

https://bmjopen.bmj.com/content/bmjopen/12/7/e055551.full.pdf

Useful PrescQIPP resources (need to be registered and logged into the website to access):

Polypharmacy and deprescribing webkit
https://www.prescqipp.info/our-resources/webkits/polypharmacy-and-deprescribing/

IMPACT Bulletin 268
https://www.prescqipp.info/our-resources/bulletins/bulletin-268-impact/

Clinical Masterclasses on Multimorbidity, Frailty and Polypharmacy in Older People
https://www.prescqipp.info/our-resources/clinical-webinars/clinical-masterclass-dec-2021/
https://www.prescqipp.info/our-resources/clinical-webinars/clinical-masterclass-jan-2022/

Polypharmacy and deprescribing e-learning (pay per use)
https://www.prescqipp.info/learning/e-learning-courses/course-overview/#polypharmacy

A new episode of Talking Meds will be available on the first Friday of the month.
If you have feedback or suggestions for future topics and guests please submit them to [email protected]

PrescQIPP is funded by the NHS for the NHS, and our aim is to improve medicines-related care for patients. We do this by producing high quality evidence-based resources and training, and by facilitating networks between NHS organisations and professionals.

The majority of pharmacists and other healthcare professionals across the UK can access our resources by registering and logging on to our website. If you have any difficulty accessing the website you can email [email protected] and we’ll aim to sort things out for you.

Find out more about PrescQIPP here

Welcome to the first episode of Talking Meds and the PrescQIPP podcast, engaging conversations about medicines-related dilemmas. Today, your host Jonathan Underhill, Medicines Clinical Adviser at PrescQIPP, talks to Magnus Hird about his role, how he prioritises people for medication review as well as two current safety issues that have recently been in the news.

Magnus is a pioneer of clinical pharmacists working in General Practice and one of the first ever pharmacist independent prescribers. He was one of the first cohort of NPC Trainers, running educational events in the North West. He now works 2 days per week in a busy general practice in Blackpool, with the rest of his week occupied as clinical lead for ambulance commissioning, covering the 999 paramedic emergency service, NHS111 and patient transport services across the northwest, and as a clinical advisor for urgent care to the NHS England regional team. He also runs a smallholding farm in the North West of England (follow his antics on various social media outlets via https://sites.google.com/view/monkhallfarm/home

Jonathan and Magnus discuss what a typical day in general practice could look like for Magnus, how he prioritises his workload, deals with complexity and what particular skills a clinical pharmacist brings to the primary care team. 

Useful sources discussed include:

 PINCER - Pharmacist-led Information technology iNtervention for the reduction of Clinically important ERrors in medicines management

https://healthinnovationwessex.org.uk/projects/56/pincer

 Estimating the economic effect of harm associated with high risk prescribing of oral non-steroidal anti-inflammatory drugs in England: population based cohort and economic modelling study. BMJ 2024;386:e077880

https://www.bmj.com/content/386/bmj-2023-077880

 Asthma: effect of excess short-acting β2-agonist (SABA) inhaler prescriptions on healthcare resource utilisation

Mark L Levy, Toby GD Capstick and Thomas Antalffy

British Journal of General Practice 2024;  74 (745): 374-376.

https://doi.org/10.3399/bjgp24X739089

 NICE Guideline - Asthma: diagnosis, monitoring and chronic asthma management (Expected publication date: 27 November 2024)

https://www.nice.org.uk/guidance/gid-ng10186/documents/450

Useful PrescQIPP resources (need to be registered and logged into the website to access):

Asthma bulletin 251
https://www.prescqipp.info/our-resources/bulletins/bulletin-251-asthma/

PrescQIPP Asthma e-learning course (pay per use) https://www.prescqipp.info/learning/e-learning-courses/course-overview/#ast…

Coming soon on 10th December 1-2pm, a Clinical Masterclass webinar on the updated NICE asthma guideline, due for publication in November - register here:
https://events.teams.microsoft.com/event/00239d7c-d441-4d04-8c62-8ee87783c7…

NSAIDs bulletin 265
https://www.prescqipp.info/our-resources/bulletins/bulletin-265-nsaids/

A new episode of Talking Meds will be available on the first Friday of the month.
If you have feedback or suggestions for future topics and guests please submit them to [email protected]

PrescQIPP is funded by the NHS for the NHS, and our aim is to improve medicines-related care for patients. We do this by producing high quality evidence-based resources and training, and by facilitating networks between NHS organisations and professionals.

The majority of pharmacists and other healthcare professionals across the UK can access our resources by registering and logging on to our website. If you have any difficulty accessing the website you can email [email protected] and we’ll aim to sort things out for you.

Find out more about PrescQIPP here

We are excited to share a clip of our new podcast, 'Talking Meds' with our host Jonathan Underhill and guests, which launces on 20 September.

Talking Meds will be available to listen to via your usual podcast system and a new episode will come out every fortnight, on the first and third Friday of each month.

Jonathan Underhill has a background as a hospital clinical pharmacist but worked for many, many years at the National Prescribing Centre (NPC) developing innovative ways of teaching therapeutics, evidence-based medicine and clinical decision making to prescribers and their support teams. Until recently, he worked at NICE as a consultant clinical adviser in their Medicines Optimisation Team.

Episode 1 launches on Friday 20th September and features guest Magnus Hird to discuss his role, how he prioritises people for medication review as well as two current safety issues that have recently been in the news.

Magnus is a pioneer of clinical pharmacists working in General Practice and one of the first ever pharmacist independent prescribers. He was one of the first cohort of NPC Trainers, running educational events in the North West. He now works two days per week in a busy general practice in Blackpool, with the rest of his week occupied as clinical lead for ambulance commissioning, covering the 999 paramedic emergency service, NHS111 and patient transport services across the northwest, and as a clinical advisor for urgent care to the NHS England regional team. He also runs a smallholding farm in the North West of England (follow his antics on various social media outlets via https://sites.google.com/view/monkhallfarm/home)

Future episodes

• A series on ’Sensible prescribing in Older people with Jonathan and Lucy’, with consultant geriatrician and author Lucy Pollock
• Penicillin allergy de-labelling with Phil Howard OBE
• New NICE Menopause guideline with NICE committee member Hayley Berry
• As well as topics such as the NICE/SIGN Asthma guideline, depression deprescribing and insomnia 

So subscribe now to make sure you don't miss an episode.

A new episode of Talking Meds will be available on the first Friday of the month.
If you have feedback or suggestions for future topics and guests please submit them to [email protected]

PrescQIPP is funded by the NHS for the NHS, and our aim is to improve medicines-related care for patients. We do this by producing high quality evidence-based resources and training, and by facilitating networks between NHS organisations and professionals.

The majority of pharmacists and other healthcare professionals across the UK can access our resources by registering and logging on to our website. If you have any difficulty accessing the website you can email [email protected] and we’ll aim to sort things out for you.

Find out more about PrescQIPP here