Guide to the National Support Materials

The NPC national support materials provide access to online and downloadable resources that address selected prescribing and medicines management priorities within the NHS.

The materials are intended to raise awareness of the important issues within each topic and provide support to individuals and organisations to make changes to current ways of working. They cover policy and guidance, therapeutics and implementation and monitoring at a local level.

Selection of topics is informed by national priority areas for prescribing and medicines management, highlighted by national bodies and NHS organisations

• Department of Health
• NHS Institute for Innovation and Improvement
• National Institute for Health and Clinical Excellence (NICE)
• National Patient Safety Agency
• Medicines and Healthcare Regulatory Agency (MHRA)
• National Audit Office
• Healthcare Commission

Each topic includes both therapeutics and implementation resources.

Implementing better practice in renin-angiotensin drugs

This is a complex area in which to optimize the use of medicines.

There are five main indications for these medicines (hypertension, heart failure, diabetes, post-MI, and chronic kidney disease), and at least five potential changes from currently prescribed medicines:-

• from an A2RA to an ACEi (often when a patient has been started on an A2RA without having first had a trial on an ACEi);
• from ACEi + A2RA to an ACEi (perhaps when on review it is discovered that dual therapy has been commenced outside national guidance for that indication and there are no obvious individual circumstances which would justify that approach);
• from an ACEi to an A2RA (for example because of cough);
• from an ACEi to an ACEi + A2RA (for a minority of patients with heart failure); and
• from an ACEi + A2RA to an A2RA (perhaps when cough is a problem and dual therapy has been commenced outside national guidance for that indication and there are no obvious individual circumstances which would justify that approach)

This is not therefore a simple switch programme. However, there are potential improvements in the quality of care which can be obtained by reviewing the use of these medicines and in others there are cost savings. Prescribing data shows wide variation the prescribing patterns for this group of medicines.

The NPC has collated a range of resources to support organisations and individuals that are undertaking their own local prescribing reviews.

Therapeutics Resources
The therapeutics materials point to existing NPCi materials and NICE guidance and cover the key points for the most commonly encountered conditions for which these medicines are prescribed. They include; workshops, quizzes, key slides and data focused commentaries.

Implementation resources
Materials to support implementation and facilitate change. Please note that some of the resources are provided as templates intended for local adaptation. The remainder are not intended to be changed. They can be found in the Implementation Resources room.

Acknowledgements
The National Prescribing Centre would like to acknowledge the support of all of the individuals and organisations that have shared their ideas, documents and other materials to enable us to create these resources.