FOI 2026/1701

Clarification about how medicines optimisation uses patient information

I’m getting in touch because I’ve been trying to understand the response and a little more about how medicines optimisation works across general practice and the ICB (then CCGs). I’m unsure about a few points and would be grateful for some clarification.

I’m not raising a complaint — I just want to make sure I have an accurate understanding of how things operate.

1. From the documents I’ve seen, some medicines optimisation activities appear to be treated as part of “direct care”. I would appreciate it if you could explain how this is determined, and what criteria are used when deciding that this type of work falls within that category.
2. Please could you also confirm the specific basis relied on for accessing and reviewing patient information for medicines optimisation? I know there are different rules depending on the purpose of the activity, so it would be helpful to understand which one (s) were considered and applied.
3. Finally, I would be grateful if you could let me know how (and if so, when) patients were made aware that their information may be accessed by ICB staff for this work.

1. Some GM localities have practice-based medicines optimisation teams who carry out Structured Medication Reviews or Annual Medicines Reviews as part of agreed workstreams with GP practices. (NHS England » Structured medication reviews and medicines optimisation).

As part of a holistic medicines review, medicines optimisation is incorporated into these reviews and would be classified as “direct care”. This would include direct patient care involving shared decision-making about the treatment choice and length.

2. Identifying patients for review will vary according to local population need, national policy, and local guidance.

As part of the QoF framework and PCN Network contract DES, certain patient groups may be prioritised for review, based on unmet need or clinical risk, e.g., patients with long-term conditions such as asthma, diabetes or cardiovascular disease.

In Greater Manchester, we utilise the PINCER indicators to identify patients who may be at risk of harm from medication to prioritise for review as part of the Medicines Safety Programme.

Locally commissioned services, which vary by locality, may also focus on specific cohorts, such as Drugs of Dependence, for review.

Medicines Optimisation should be evidence-based; we make data-driven decisions using searches in GP patient record systems to identify patients that are being prescribed medication outside of NICE guidance, or outside of our agreed GMMMG formulary.

NHSE have also outlined national medicines optimisation opportunities, which guide NHS GM on which medicines optimisation areas to focus on in workplans.

3. Processes for identifying and contacting patients vary by locality; it is usually via text message, letter or direct patient contact. Those processes are set out in a Practice Agreement or Standard Operating Procedure if being carried out by NHS GM Medicines Optimisation Teams.

Any work undertaken by the NHS GM Medicines Optimisation Teams within GP practices is agreed with the GP Practices.