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Mr. Burstow: That is one of my main concerns, and a key issue in the executive summary of both parts of the evaluation. At the heart of the problem is the fact that a clear working definition of a medication review was not in place when the QOF and the NSF were set. Without such a definition, it is difficult to know what one is measuring and thus be confident that progress is under way.

Mr. Byrne: May I write to the hon. Gentleman on that point, as it merits more consideration than I can provide this evening?

I have talked about the efforts to support PCTs in establishing medicine reviews. We have also ensured that through the new general medical services contract steps are in place to encourage medication reviews. Across the country, about 90 per cent. of GP practices reported that at least 80 per cent. of their patients who were prescribed four or more repeat medicines had had a medication review in the preceding 15 months recorded in their notes. Over four fifths of GP practices reported that at least 80 per cent. of their patients who were prescribed repeat medicines had had a medication review in the preceding 15 months, which is an achievement.

Alongside the role of PCTs and GPs, we should consider the role of local pharmacists. We have gone to some lengths to underpin the important contribution that pharmacists make through the new community pharmacy contract. In the first six months, pharmacy owners have focused on the delivery of essential services. Even so, by the end of October, more than 20,000 people had had the benefit of a face-to-face consultation with their pharmacist to discuss their medicines and resolve problems. It was clear from the national consultation that we undertook as we developed the health White Paper that the role of community pharmacists was
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considered important by local communities. We will reflect on that in the White Paper to be published at the turn of the year.

Mr. Burstow: Will the Minister ensure that further consideration is given to the need to make sure that, with patients' permission, pharmacists have access to patient records so that they can take their history into account when they look at medicines that are being prescribed?

Mr. Byrne: That may, or may not, appear in the White Paper—time will tell.

From the medicines partnership evaluation that was published yesterday we know that patients welcome medication reviews. To gain the full benefit, they say that they need to be better prepared for the review. We must ensure that there is shared understanding of the purpose of the review to create an environment in which patients are empowered to ask questions about their medicines. We have taken that on board by supporting the medicines partnership in producing a guide to medicine use reviews, which patients can use to prepare and identify the questions that they want to ask before they consult their pharmacist. Copies will be available by the end of the month.

We have also commissioned NICE, the National Institute for Health and Clinical Excellence, to develop a clinical guideline that sets out best practice in involving patients in decisions about prescribed medicines.

The hon. Gentleman highlighted the role of the Commission for Social Care Inspection in ensuring that medication reviews were carried out in care homes in accordance with statutory regulations and national minimum standards. Where inspections are uncovering instances of inappropriate or over-prescribing of medicines, enforcement action is being taken. I am aware that in the past the hon. Gentleman raised the specific issue of the inappropriate or over-prescribing of anti-psychotic medicines. These medicines have an important role to play in the management of a range of conditions and they have a good safety record, but it is vital that they are used with care and in appropriate clinical situations. The role of non-pharmacological therapies is considered where that is an appropriate course of action.

CSCI inspectors routinely check records to ensure that medicines are properly controlled and correctly administered. Where the CSCI finds evidence of over-
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prescribing or inappropriate administration of medicines, such evidence is reported to the police and the professional bodies of those involved in such activities. The CSCI also employs pharmacist inspectors who can be called on for advice.

Furthermore, I understand that a report that focuses specifically on the management and administration of medication in care homes and in children's homes is expected to be published by the CSCI early in the new year. That report will be important because it will help to identify in much greater detail how care homes are performing against medication national minimum standards. It will also incorporate an analysis of complaints about medicines that the commission has received from care homes. I know that that will be of great interest to the hon. Gentleman.

In summary, the milestone in the national service framework for older people raised the profile of the importance of effective medicine-taking, and in particular the benefit of regular medication review. Significant action has been taken by primary care trusts and others to put in place the infrastructure to deliver those medication reviews. From the first year of the new general medical services contract, we can see and celebrate the progress that has been made, with the vast majority of people taking regular medicines.

Mr. Burstow: The Minister has been generous with his time. Will he undertake to consider the requests that I made at the end of my remarks, particularly the issue of the clarity of medication reviews, which was identified by the medicines partnership in the report that has been available only since yesterday?

Mr. Byrne: I shall look into that. There are different types of medication review, and it is for the clinician to determine which is the most appropriate for an individual patient. Sometimes that will involve a face-to-face consultation, but that will not necessarily be the right solution for many patients. I will happily come back to the hon. Gentleman with more detail on that.

We have seen a great deal of progress since the advent of the older people's national service framework. It is part of a broad package of improved care for older people that we have seen unfold over the past seven years. That is a reform programme that we intend to continue.

Question put and agreed to.

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