Widespread concerns flagged about NPS MedicineWise demise

Jolyon Attwooll

27/09/2022 4:51:11 PM

Many worry about the impact on the safe use of medicine, while the transfer of skills is another key issue with employees already leaving.

The full impact of changes to the oversight of the Quality Use of Medicines remain unclear.

More than three in four newsGP readers believe the closure of NPS MedicineWise will negatively impact the safe use of medicine in Australia, the results of a new poll suggest.  
The survey ran last week on the newsGP website, with 77% of the 1297 respondents stating their belief that the recent changes are likely to have a detrimental effect on medicine use, while 14% took the opposite stance. The remainder said they are unsure.
The poll follows the most significant developments to the oversight of the Quality Use of Medicine (QUM) since the inception of the National Prescribing Service – which later became NPS MedicineWise – in 1998.
The final budget before the May Federal election revealed that NPS MedicineWise will no longer receive uncontested funding, and that many of its functions and responsibilities will transfer to the Australian Commission on Safety and Quality in Health Care (ACSQHC).
A review of the decision has since been carried out by Deloitte at the direction of Federal Health and Aged Care Minister Mark Butler, with some hoping NPS MedicineWise could continue and contest for funding in the future.
However, the review’s authors stated they believe the budget decision is ‘appropriate’ for the Quality Use of Diagnostics, Therapeutics and Pathology (QUDTP) program. It has since been confirmed that NPS MedicineWise will cease operating at the end of this year.
It means one of the key issues is now the transition of NPS MedicineWise employees to the ACSQHC.
In its conclusion, the Deloitte report urged for a ‘particular focus on the retention of the NPS MedicineWise highly skilled workforce who will be critical to the ongoing success of the QUDTP program’.
However, one former NPS MedicineWise employee, who left after the budget announcement and did not wish to be named, has said ‘dozens’ of highly skilled people have already resigned from the organisation.
They also said that many of their former colleagues are likely to feel reticent at transferring over to ACSQHC.
‘Personally, I feel there is some bad blood there,’ they told newsGP.
‘Given how we got blindsided by the Government’s budget announcement, I’m not sure how many will actually want to go work for the Commission, which is effectively a part of the Health portfolio.’
The authors of Deloitte review acknowledge the issue, albeit in somewhat dryer terms, describing the relationship between NPS MedicineWise and the Department of Health’s QUM branch as ‘not conducive to optimal delivery of the QUDTP program’.
Deloitte referenced the number and frequency of recent NPS MedicineWise reviews, which they said had changed ‘the nature and focus of the relationship’ between the Department of Health (DoH) and NPS.
‘The response to these reviews has been perceived by NPS MedicineWise as a heightened focus on compliance with activities, KPIs and performance metrics, which may have de-prioritised opportunities for innovation and service delivery evolution and strained resources,’ the report states.
In one comment in the Deloitte report, the ACSQHC also noted the implications for staff and the retention of skills.
‘As the delay goes on, NPS MedicineWise people and their capabilities leave,’ it stated. ‘That’s a risk to us.’
While no numbers were provided to newsGP, an NPS MedicineWise spokesperson described its workforce as ‘relatively stable’, with the ‘vast majority’ of employees still within the organisation.
However, they also warned turnover is expected to increase now that Minister Butler has endorsed the review’s recommendation.
‘We have excellent people, with a broad range of skills and expertise who will no doubt be offered other opportunities,’ the spokesperson said.
‘This is a key risk to a successful transition and we will be working closely with the Commission and the Department of Health and Aged Care to manage this.’
No final decisions have yet been made on all the positions that will transfer to the ACSQHC, including for around 50 educational visitors.
The NPS MedicineWise spokesperson said the organisation is still working with the DoH ‘to get clarity on which functions will be transitioning to [ACSQHC] and which related staff will be offered positions’.
Other concerns
Several other areas of concern beyond staffing have been raised since the original budget decision was confirmed, including uncertainty over the future of the highly regarded Australian Prescriber publication and the untested market for providing educational activities.
Professor Mark Morgan, Chair of RACGP Expert Committee – Quality Care, also said the Deloitte report seems to focus on PBS savings as a metric for impact.
‘Is this reasonable?’ he told newsGP.
‘Where there is under-use of medication or investigations, increased PBS/MBS would represent success.
‘A more appropriate set of health outcomes would be the “quadruple bottom line” – clinical outcomes, cost of services, patient experience, provider experience.’
Professor Morgan also says the use of data is yet to be clarified, including from medical records created by GPs and maintained using software and hardware GPs have purchased.
He highlighted RACGP guidance about this data and its value for research, planning and continuous quality improvement.
‘GP data should not be released without understanding the purpose and motivations of the organisation requesting the data,’ Professor Morgan said.
‘NPS MedicineWise has data sharing agreements in place. The Commission does not yet have data sharing agreements in place.’
He said that GPs and the RACGP need to understand positive benefits for any data release.
‘Curated and analysed data from NPS MedicineWise was valued by many GPs and it was backed by a program of academic detailing,’ Professor Morgan said.
‘We do not yet know what the Commission intends to do with the data so we cannot yet advise practices whether or not to provide their data to the Commission.’

The DoH was approached for comment.

Update 28.09.2022
In a response sent after publication a DoH spokesperson said the changes will reduce ‘the current duplication in functions between ACSQHC and NPS MedicineWise’.
They also stated that NPS MedicineWise ‘has not advised the department of any personnel or skill shortages impacting delivery at the current time’.
‘It is envisaged that the redesign will have a positive impact on health professionals and consumers as it will open new avenues for competitive funding to be available, including to colleges, for education and supporting activities, as well as having the overall reach of the program expanded to all healthcare settings to support quality use of medicines,’ they said.

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