As part of the Patient Safety Collaboratives 2022/23 commission Madeeha Malak, Affiliate Clinical Lead Pharmacist, Health Innovation Manchester has written a blog focussing on the Medicines Safety Improvement Programme and its alignment to the priorities of NHS Greater Manchester and the Integrating Pharmacy and Medicines Optimisation (IPMO) Committee. 

In this blog, Madeeha reflects on the recent programme system engagement session and the progress in working with system partners in an aligned way to deliver improvements for the management ofnon-cancer-related chronic pain and reduce harm from opioid prescribing.  

Opioids are a highly effective class of analgesics (medicines designed to relieve pain) and, when used judiciously, are of great benefit to many people living with pain. However, in the case of ‘chronic non-cancer pain’, when the source of long-term pain does not have a cause that can be treated, opioids can do more harm than good, particularly when used at higher doses.  

Within Greater Manchester there are more patients per 1,000 population not only receiving opioid pain medication (19.71 GM, compared to 17.43 national average) but also for patients who receive opioids for longer than six months (16.22 GM, compared to 13.72 national average).  

There is limited evidence of long-term improvements achieved from opioid use in quality of life or pain relief experienced. However, there is abundant evidence that demonstrates the harms that opioids can cause including: an excessive pain response; impaired immunity; increased risk of falls; constipation; erectile dysfunction; and death. Through the 15 Patient Safety Collaboratives across England the national commission aspires to support: 

• 30,000 fewer people being prescribed oral or transdermal opioids for more than 3 months 
• Of those 30,000; 4,500 people receiving high-dose opioids (high-dose is greater than or equivalent to 120mg oral morphine equivalent) 

At the system engagement session held in June we were fortunate to hear from Lisa who has lived with chronic pain for over 20 years. Lisa’s experiences, personally and as a support worker, highlighted that non-pharmacological interventions are pivotal to improving quality of life for people living with pain.   

Having Lisa’s experiences at the fore of the meeting supported our health and social care clinical and professional leaders and academic partners discuss the approaches to the commission through the lens of the patient.  

The work undertaken by medicines optimisation leads and their supporting teams across the ten localities within Greater Manchester demonstrates the scale of involvement health and care professionals have in managing opioid prescribing and deprescribing, from secondary care initiated treatment post-surgery, primary care medication reviews and social prescribing offers that support social connectivity and manageable activities.  

This year’s commission is being delivered in a truly aligned way with the needs of the system and demonstrates the power of collaboration between the different groups working within the system on reducing harm from opioid prescribing. Working closely with the IPMO to develop and deliver the system engagement session, Claire Vaughan, Head of Medicines Optimisation (Salford) made the call to action for the system and as chair of the IPMO Medicines Safety Group has helped shape the focus of the PSC work into the non-pharmacological support for people being deprescribed opioids and post-operative prescribing of opioids and transfers of care to primary care.    

The project team and I will look forward to working with the system directly on these areas and as one of the 15 PSCs in England  ensuring the great work being undertaken in  Greater Manchester and the ten component places  system-level are shared within the network and to NHS England.  

For more information about the Medicines Safety Improvement Programme within Greater Manchester’s Patient Safety Collaborative please click here or contact simon.hammond@healthinnovationmanchester.com, Programme Development Lead.