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The future service framework for community pharmacy
NICPLD Regional ProgrammeSeptember-December 2019
Aim
To provide an overview of the key components of the new contract framework, highlighting the services to be provided by community pharmacies in N. Ireland in the short and medium term.
Intended outcomes• Understand the direction of travel in relation to the
development of community pharmacy services• Appreciate the range of core and additional services
that may/will be provided across the community pharmacy network
• Promote the role of community pharmacy in the delivery of consistent health promotion messages
• Enhance collaboration with GP practices and secondary care to promote effective care and safe practice
• Access appropriate education and training resources to develop yourself and staff in preparation for the introduction of the contract framework
CPD: ReflectionIdentify your learning need
Policy context Partnership working
Working collaboratively to translate policy to service provision
2
Fully connected
Integral part of primary care and
the wider HSC Broad range of clinical services
Independent prescribing as part of
some services
Patient registration
model
Contract framework
Service development:Process (1)
Service development:Process (2)
Review evidence
Develop draftAgree evaluation
frameworkPilot
Publish evaluationCommissioning
decision
Contract framework
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Practice quality system• Clinical governance
framework– Clinical audit 19/20
– Quality improvement– Business continuity
• Infrastructure– IT– Security
• Living Well
Practice quality system:Clinical governance framework
Clinical audit:• Community pharmacists can
demonstrate enhanced patient medication safety within pharmacy services
• Identify areas where improvements can support better patient care
Audit topic 19/20: Overuse of short acting bronchodilator (SABA) inhalers for the treatment of asthma. Identification of patients using more than 6 SABAs in the previous 6 months without an inhaled corticosteroid.
ELECTRONIC TRANSMISSION OF PRESCRIPTIONS (ETP)
ENHANCED SERVICES
ENHANCED COMMUNICATIONS
INFRASTRUCTURE
Prescriptions will be sent electronically from GP surgeries to nominated pharmacies where they are dispensed. Financial Claims sent from the system to the FPPS. ETP application integrates with PMRs.
The delivery of additional applications, running on the same infrastructure platform as ETP. In scope: Minor Ailments and Medicines Adherence.
• Email to facilitate secure communications to and from pharmacies, GPs and Department of Health.
• Access to NIECR
An enduring infrastructure solution that enables and supports Community Pharmacy modernisation first and foremost; but is also scalable to accommodate modernisation.
Practice quality system:Infrastructure: IT Practice quality system:
Living Well• Targeted health promotion
campaigns• Each campaign will run
for 2 months across all pharmacies
• 5 campaigns this year (19/20)
• Window displays, HP materials, Brief Intervention, sign posting to other services
Practice quality system:Living Well
Practice quality system:Living Well - Resources
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Practice quality system:Living Well – Choose to Live Better
Practice quality system: Support available from CPNI
www.communitypharmacyni.co.uk
Practice quality system: Support available from CPNI
www.communitypharmacyni.co.ukContract framework
Core services
• Dispensing • Repeat dispensing
• Adherence
Core services:Adherence
11,356 4,01630,872
MDS (21,225)Other (9,647) Data source: compliance register 16/17
Cohort 1Patients with potential for
abuse/misuse with
prescribed medicines
Cohort 2Community pharmacist assesses need and
provides an appropriate
solution
Cohort 3Assessment
is carried out by Trust and solution is provided
by the community pharmacist
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Adherence - Cohort 1: Patients with potential for abuse / misuse with
prescribed medicines
• Instalment dispensing would be available to patients prescribed certain medicines if required to reduce the risk of patient harm
• The Drug Tariff would be amended to define both the medicines which could be prescribed in this way and the fee payable for dispensing in instalments
Adherence - Cohort 2: Community pharmacist assesses need and
provides an appropriate solution
Assessment Adherence solution
Stock solutione.g. reusable compliance aid, eye drop applicator
Personalised solution
e.g. Medicines reminder card, MAR chart, compliance aid
Personalised solution
Eg. Medicines reminder card, MAR chart, compliance aid
Assessment by Trust
Provision of solution by community pharmacist
Maintenance / review of solution
Adherence - Cohort 3: Managed by community pharmacist following
Trust assessment
Contract framework
Additional services
• Medicines use reviews (MURs)
• Minor ailments– Pharmacy First
• Care home services• Smoking cessation• Out of hours(OOH)
emergency supply
Additional services:MURs
Patient feedback from postal questionnaire:ü 86% satisfied or very
satisfied with the service
ü 90%would recommend the service to another family member
Re spir at ory D iabet es
Bo th un known
Number of MURs April 18 - March 19
6
Additional services:Minor ailments
Acne 2,228 Haemorrhoids 3,783
Scabies 1,517 Verruca 2,780
Activity data: Feb – May 2019
Additional services:Pharmacy first
Advice and information
Supply medication Refer to GP
Patient registration
Additional services:Pharmacy first
Additional services:Pharmacy first – winter pressures
Stakeholder engagement
Review of consultation
formsPatient
experience
>96% of patients
very satisfied
>92%of patients more
confident to manage similar
symptoms
0ver 21,000
consultations
19% bought
additional OTC
77% of CPs thought the service was
beneficial to their patients
> 64% of GPs reported that service had
beneficial impact on workload
Additional services:Care home services
• Current low level service focusing on medicines supply advice
• New clinically focused service currently at scoping stage
• Pilot in 2020
Additional services:Smoking cessation
• In 2018/19, approximately 430 pharmacies actively delivering stop smoking services across NI
• 70% of all clients enrolled in stop smoking services across all providers, enrolled in community pharmacy
• Community pharmacy continue to provide favourable 4 week quit rate of 55%
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Additional services:Smoking cessation
Additional services:OOH emergency supply
Additional services:OOH emergency supply:
NIECR pilot
• 7 pharmacies• 27 community
pharmacists• Used on 40 occasions• No issues reported
Additional services: Support available from CPNI
www.communitypharmacyni.co.uk
Query – can we get a screen shot of CPNI’s members’ area with MUR support documents?
Contract framework Locally required services
• Palliative care• Opiate substitution• Needle and syringe
exchange service (NSES)
• Oxygen• Carers support
service
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Locally required services:Palliative care Locally required services:
Opiate substitution
• New OST guidelines for community pharmacists
• Pilot of patient registrationmodel
Locally required services:Needle and syringe
exchange service
• 21 pharmacies• 30,065 visits in
17/18• 3% increase
from 16/17• Patient charter
Locally required services:Carers support service
• Hidden carers service
• Started as a pilot in SE LCG
I have made three referrals into the Hidden Carers Service. Two in particular found it very beneficial as they had almost got to crisis point and didn’t know where to turn to get help. All three referrals were for dementia patients. The carers got the extra support that they needed and felt that they had a point of contact if their situation deteriorated.
Informing the contract framework:Pilots
• Acute care at home• Brief intervention• Hypertension • Point of care testing• Flu vaccination
• Future pilot areas
Pilots:Acute care at home
Pilot
Publish evaluation
Commissioning decision
Aim: to provide timely access to medicines for ACAH patients, by establishing a network of 8 community pharmacies in the Belfast area
Evaluation report published March 2018
Dependent on policy change by DoH
Future model:Locally required service: A small number of pharmacies to hold a small agreed list of injectable medicines, including antimicrobials that would not be routinely available from community pharmacies.
Policy change:All community pharmacies to be able to dispense routine prescription items required for ACAH patients.
Pilot conclusion: community pharmacists are well placed to support ACAH patients by providing a timely supply of medicines, thus ensuring the effective delivery of the ACAH service.
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Pilots:Brief interventions
• Pilot service delivered in the Belfast area• Aim of the service was to raise awareness of health
problems caused by drinking and provide advice in relation to reducing alcohol intake
• Participants completed an Alcohol ‘MOT’ to gauge alcohol intake
• Pharmacist and/or health and well-being adviser offered help and support to people to make changes to their drinking habits
• Variety of resources available to help pharmacies deliver the service
• Those identified as having dependency issues could be referred to specialist addiction services
Pilots:Brief interventions
Pilots:Hypertension
• Pilot to determine if community pharmacy can assist with the detection of undiagnosed hypertension
• Around 60 pharmacies contracted inSELCG area
• Pilot running from July 19for 6 months
• Evaluation to be undertakenby PHA
Pilots:Point of care testing
• Introduce CRP testing, in keeping with NICE recommendation for the assessment of non-pneumonic LRTIs
• Evaluate patient and pharmacist feedback on experiences of POC CRP testing in community pharmacy
Review evidence:
Develop draft:
Agree evaluation framework:
Pilot:
Publish evaluation:
NICE guidance
Service specification, guidance, training etc
MOIC
A number of pharmacies and GP practices in Northern and Western LCGs
Summer 2020
Pilots:Flu vaccination
• Value of community pharmacy based flu vaccination services recognised by DH
• Potential pilot for 2019/20 currently being scoped
Contract framework: Support available from CPNI
www.communitypharmacyni.co.uk
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Contract framework:Support available from CPNI
Katherine Kidd Head of Pharmacy [email protected]
Kerry Grimes Clinical Governance and Service Support [email protected]
CPNI phone number: 028 90 690 444
Contract framework:Conclusion
• Challenging work plan for 19/20
• Increase the clinical services in community pharmacy
• Improve integration within primary care and across the interface
• Enhance patient care
Contract framework Intended outcomes• Understand the direction of travel in relation to the
development of community pharmacy services• Appreciate the range of core and additional services
that may/will be provided across the community pharmacy network
• Promote the role of community pharmacy in the delivery of consistent health promotion messages
• Enhance collaboration with GP practices and secondary care to promote effective care and safe practice
• Access appropriate education and training resources to develop yourself and staff in preparation for the introduction of the contract framework.
CPD:Evaluation