Integrating NHS Pharmacy and Medicines Optimisation into ... · • Nationally coordinated with AHSNs, Getting It Right First Time, NHS Right Care and NHS Clinical Commissioners •

6th November 2018

Integrating NHS Pharmacy and Medicines Optimisation into the new NHS landscape Richard Seal, Regional Pharmacist

Midlands and East

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The need for change 5-Year Forward View

Voluntary Sector

Hospital

Care Homes

Domiciliary Care

Mental Health

services

Primary care

Nursing Homes

NHS 111

Patient

• Service provision is fragmented in multiple different types of organisations

• Too often, these services don’t communicate effectively with each other

• The totality of patients’ needs are not always understood by those serving them

• Care is not always delivered in a person-centred way

System leadership for pharmacy and medicines optimisation

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System leadership and integration

1. A cultural shift towards systems leadership

2. Create the right environment and incentives to support the integration of services

3. Develop sustainable and autonomous systems, that can make the decisions required to improve care in their area within their share of the budget

1. Work together to address systemic challenges

2. Collaboratively develop a care model that more proactively manages need and gets upstream to prevent illness

3. Makes the necessary decisions to improve services in their area, within their share of the budget

In time, mature local

systems will…

STPs will provide the

opportunity for…


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Integrated Care Systems


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Primary Care Networks (PCN)

Informed and enabled patients

Practices as teams of teams

Personalisation and improved

outcomes

Integrated primary care

service

Digitally enabled working

Growing motivated and enabled staff

Aligned incentives

Primary care networks are small enough to give a sense of local ownership, but big enough to have impact across a 30-50K population.

They will comprise groupings of 100-150 clinicians and wider staff sharing a vision for how to improve the care of their population and will serve as service delivery units and a unifying platform across the country.


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NHS Long Term Plan


14 working groups to develop the next plan for the NHS, due to

be published Nov/Dec 2018:

Life course programmes:

Prevention, Personal Responsibility and

Health Inequalities

Healthy Childhood and Maternal Health

Integrated and Personalised Care for People

with Long Term Conditions and Older

People with Frailty, including Dementia

Clinical priorities:

Cancer

Cardiovascular and respiratory Learning

Disability and Autism

Mental Health

Enablers:

Workforce, Training and Leadership

Digital and Technology

Primary Care

Research and Innovation

Clinical Review of Standards

System Architecture

Engagement

From December 2018 to March 2019, staff, patients, the public

and other stakeholders will have the opportunity to help local

health and care organisations determine what the plan means for

their local area

Efficiency still a major priority given funding

challenges

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Whole Systems Leadership

• The NHS has taken a ‘whole system approach’ to delivering the

Medicines Value programme

• NHS England, NHS Improvement, NHS Digital, Health Education England

• Regional offices link with STPs, ICSs, CCGs, and providers

• Nationally coordinated with AHSNs, Getting It Right First Time, NHS Right Care

and NHS Clinical Commissioners

• Working together to explore the requirements for system leaders at

local level to deliver system wide medicines optimisation across the

whole health economy

• Working closely with the ICS and New Care Model teams to develop a

framework for a local pharmacy system

• Survey to understand how pharmacy leaders are working together

across the country


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Pharmacy Integration Fund


• The NHS has taken a ‘whole system approach’ to delivering the

Medicines Value programme

• NHS England, NHS Improvement, NHS Digital, Health Education England

• Regional offices link with STPs, ICSs, CCGs, and providers

• Nationally coordinated with AHSNs, Getting It Right First Time, NHS Right Care

and NHS Clinical Commissioners

• Working together to explore the requirements for system leaders at

local level to deliver system wide medicines optimisation across the

whole health economy

• Working closely with the ICS and New Care Model teams to develop a

framework for a local pharmacy system

• Survey to understand how pharmacy leaders are working together

across the country

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• Senior pharmacy leaders suggested issues, barriers, and solutions for pharmacy and medicines system leadership across STPs and ICSs

• The following themes were identified:

1. A need for joined-up working

2. A need for cultural change

3. Improving current ways of working

4. Lack of capacity

Survey feedback


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A project to establish a leader who is

accountable for and the governance

structure for decision-making about

NHS pharmacy and medicines

optimisation across an STP/ICS for

the benefit of patients

IPMO Governance


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Choosing the 7 Pilot Sites

• Performance for delivering against the Hospital

Pharmacy Transformation Plans

• Aggregate Single Oversight Framework scores for

acute trusts within the relevant footprint

• Existing involvement with PhIF programmes (GP

Clinical Pharmacists, IUC/NHS 111 Pharmacists,

Medicines Optimisation in Care homes)

• STP/ICS leadership maturity

• STP/ICS overall progress

• Other factors • existing leadership in pharmacy and medicines

optimisation

• pharmacy and medicines workstreams in the STP/ICS

plans

• STPs/ICSs which feature new models of care that may

alter pharmaceutical service delivery in the future


Black Country STP (Midlands)

Cumbria and North East STP (North East)

Dorset ICS (South West)

Hertfordshire & West Essex STP (Central & East)

Lancashire & South Cumbria ICS (North West)

South East London STP (London)

Surrey Heartlands ICS (South East)

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• Identify a dedicated senior NHS pharmacy and

medicines optimisation programme manager

(minimum 0.8 WTE)

• Establish a NHS pharmacy and medicines

leadership group (with appropriate protected

time and resource) that reports into the

STP/ICS structure and has board level

sponsorship

• Demonstrate the process for identifying a

STP/ICS Lead for Pharmacy and Medicines

Optimisation

• Develop and implement a NHS Pharmacy and

Medicines Optimisation Transformation plan

addressing key national and local priorities

ensuring it is fully integrated into wider

STP/ICS plans

• Involve regional stakeholders through a

regional engagement event

What sites need to do

• A description/organogram demonstrating the wider structure of

the STP/ICS and how pharmacy interacts with each part of the

system

• An organogram describing a pharmacy leadership structure,

lines of accountability and job descriptions for new roles that

enable this

• A “plan on a page” for delivery of national priorities related to

pharmacy and medicines optimisation (e.g. medicines value

programme and medicines safety programme) and contribution

to STP/ICS priorities and workstreams over the next two years

• A “plan on a page” for developing a flexible clinical pharmacy

workforce over the next two years

• A stakeholder engagement plan

• The above outputs should be developed through close links with

pharmacy leaders within the STP/ICS, STP/ICS Leads, and the

regional NHS England/NHS Improvement leadership team

(Including the regional directors, regional medical directors and

regional pharmacists)


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What might this look like?

The Northumberland Vanguard Model: stratifying patients according to need

https://www.pharmaceutical-journal.com/research/perspective-article/impact-of-an-integrated-pharmacy-service-on-hospital-admission-costs/20204550.article


























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• Nationally

• All pilot STPs are at different stages of development and maturity

• Some have existing medicines optimisation workstreams

• System leadership development not restricted to pilot sites

• Black Country STP

• Steering Group established – Chief Pharmacists of local trusts, CCG Medicines Optimisation leads, LPC and LPN

• Draft job description for project manager agreed

• Project planning day – 15th November

• Hertfordshire & West Essex STP

• Planning the way forward for the Herts and West Essex STP with a core group of senior leads

• Agreeing how to communicate this widely

• Exploring how the ownership for delivery will sit with the STP medicines optimisation workstream

• Governance mechanism for the funding arrangements of the £150k allocated to the STP for the programme

• Developing reporting functions and relationship with colleagues external to the STP

Progress to date


Documents

Integrating NHS Pharmacy and Medicines Optimisation into ... · • Nationally coordinated with AHSNs, Getting It Right First Time, NHS Right Care and NHS Clinical Commissioners •