Concern over significant NPS MedicineWise changes

NPS MedicineWise, the arm’s length organisation set up to guide the quality use of medicines (QUM), will lose its funding at the end of the year.
 
In a move revealed in the detail of last week’s Federal Budget, the organisation’s QUM stewardship responsibilities will transfer to the Australian Commission on Safety and Quality in Health Care (ACSQHC).

An NPS MedicineWise spokesperson expressed ‘disappointment and concern’ with changes that signal a fundamental shift for the organisation, which has existed since 1998.
 
The spokesperson said that while the budget implications are still being clarified with the Department of Health (DoH), there are concerns over their potential impact.
 
‘The defunding of an independent agency that has the singular focus on [QUM] risks a dilution of focus,’ they told newsGP.
 
‘We are disappointed and concerned with what this means for Australia at a time when quality and safe use of medicines is listed as a national health priority.’
 
While NPS MedicineWise is run as an independent not-for-profit, it is reliant on federal funding, which has been reduced in recent years. The latest four-year funding agreement was announced in the 2018 budget.
 
The NPS spokesperson said the organisation’s work had allowed $1.1 billion in direct savings for the Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS).
 
‘More importantly, these programs have resulted in demonstrable improvements in patient care and health outcomes for Australians,’ they said.
 
The decision to remove funding came without prior warning to NPS MedicineWise, newsGP understands.
 
This week, the DoH confirmed that funding for the Quality Use of Diagnostics, Therapeutics and Pathology (QUDTP) Program would cease for NPS MedicineWise from 1 January 2023.  
 
‘After this time a redesigned program will fund the ACSQHC to deliver stewardship of quality use of medicines and therapeutics in the Australian healthcare system,’ a DoH spokesperson told newsGP in an emailed statement.
 
A comment piece published in the Journal of Pharmaceutical Policy and Practice said NPS MedicineWise had provided services to over 24,000 GPs and 8000 pharmacists in 2018, and interacted with over one million citizens.
 
NPS MedicineWise currently oversees the MedicineInsight quality improvement program and publishes Radar for health professionals, as well as the independent journal Australian Prescriber.
 
A commercial NPS MedicineWise subsidiary, VentureWise, was set up in 2014 then discontinued in 2020. Organisations including the RACGP expressed reservations about the potential for conflicts of interest.
 
A DoH review in late 2019 cited ‘almost universal acknowledgement that NPS MedicineWise produces high quality, valued resources in the delivery of its programs which support the Quality Use of Medicines and Diagnostics’.
 
However, it also published 37 recommendations that included criticisms of the organisation’s collaboration and transparency.
 
The DoH said this week that $3.9 million of funding would be provided to support the transition to the ACSQHC, and that the changes would ‘help improve access to vital information for clinicians and patients regarding medicines, diagnostic tests, and possible harmful medication interactions.’
 
Competitive grant processes for projects to deliver education to health professionals and patients to improve health literacy around the use of medicines and tests would also still run, the DoH said.
 
Professor Mark Morgan is a member of the NPS MedicineInsight GP Advisory Group and Chair of the RACGP Expert Committee – Quality Care, which plays a pivotal role in creating and endorsing clinical practice guidelines.
 
He told newsGP that change brings potential risks and should not be undertaken as a cost-cutting exercise.
 
‘I am concerned that years of experience and knowledge that is held by NPS will be lost in any transfer of roles to another organisation,’ Professor Morgan said.
 
‘QUM should not be about saving dollars.
 
‘It should be about ensuring the right care to the right person at the right time. It should be about high-value care and not about lower cost care.’
 
Providing resources and support for QUM should be continuously evaluated, according to Professor Morgan, and programs should not be about managing the performance of individual GPs.
 
He also warned against creating scenarios where doctors are uncertain about exercising careful clinical judgement.
 
‘QUM programs should leave room for patient-centred individualised approaches in specific circumstances,’ he said.
 
‘[They] should focus on providing supportive resources, assisting reflective practice and providing unbiased evidence-based information.’
 
Professor Morgan highlighted the need for general practice QUM programs to cater to an environment which includes ‘many patients with multimorbidity and interacting biopsychosocial factors’.
 
‘GPs who understand this need to be at the centre of QUM program design and implementation,’ he said.
 
The NPS MedicineWise spokesperson said the organisation remains involved in ongoing discussions with the DoH ‘to better understand the decision and implications.’
 
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