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Medicine Reviews (Older People)

I shall probably come to that later in my remarks. There could be an additional burden on GPs and also on pharmacists, and some useful evaluation of the relevant guidelines has been conducted. On the point that I was raising about the QOF and the NSF, I was reassured recently by a written answer from the Minister who will reply to the debate. He told me that the NSF standard had not been superseded. That is good news, but the truth is that the standard has not been achieved either. In a written answer, the Minister told me:"““Historic data for both measures””—" the milestones set in the NSF for older people—"““collected from the 146 PCTs taking part in the programme””—" the national medicines management collaborative programme—"““suggest that there have been significant and sustained improvements in the number and quality of medication reviews.””—[Official Report, 16 June 2005; Vol. 435, c. 642W.]" Where is the evidence to support that contention? Certainly the evaluation of the implementation of the ““Room for Review”” guidance on medication reviews published by the medicines partnership earlier this year does not point to significant and sustained improvement. Part 1 of the evaluation found that only 8 per cent. of primary care trusts had met the NSF standard for annual medication reviews for patients aged over 75. Worse still, just 5 per cent. had met the target for six-monthly reviews for patients over 75 who were on four or more medicines. The NSF milestone for medicine reviews was 2002. That is when this was meant to be in place, albeit with the potential burdens that would arise from it. Even in 2004, 47 per cent. of PCTs were reporting that they would not be able to conduct six-monthly medicine reviews for over-75s on four or more medicines. Delve a little deeper into part 1 of the evaluation and one finds that even in those PCTs that said they were doing it, not every GP practice was actually conducting and taking part in medication reviews. More worrying still, the evaluation found that in the PCTs that had implemented medication reviews, only a minority of reviews were conducted face to face. That type of patient-centred review was therefore being considered by PCTs as ““aspirational””—as a gold standard—and therefore limited to more complex patients. As I am sure the Minister will know, ““Room for Review”” defined four levels of medication review—levels 0 to 3. Of these, level 3 involved the patients in face-to-face discussion about their medicines and therefore offered the opportunity to explore the patient’s views and experiences of using medicines and allowed them to share in the decision-making process about future prescribing—