NHS England Update Community Health Services Pharmacy Meeting

Presented by: Dr Jill Loader, Regional Pharmacist (South)

NHS England

3rd June 2014

Putting Patients First: Business Plan 2014-

15 to 2016-17

2 Sir Malcolm Grant

“Our contribution to a sustainable NHS is to

radically transform Pharmacy to be recognised

as the clinical experts who help people make

healthy living choices and achieve the most

benefit from their medicines every time”.

Keith Ridge Chief Pharmaceutical Officer (DH, NHS England & HEE)

Medicines and Pharmacy Leadership Team

Professional leadership, global anitmicrobial resistance, Pharmaceutical Price Regulation Scheme (PPRS)

Clare Howard Deputy Chief Pharmaceutical Officer (NHS England)

Medicines optimisation and community pharmacy strategy. Safe use of controlled drugs. Medicines Optimisation Clinical Reference Group

Bruce Warner Deputy Director Patient Safety (NHS England)

Patient safety improvement, advice and guidance. Safety alerts, cause for concern, patient safety collaboratives antimicrobial resistance, international work of the Patient Safety domain

David Cousins Senior Head for Safe Medication Practice and Medical Devices (NHS England)

Minimising harms arising from the unsafe use of medicines and devices, improving reporting and learning, identifying and communicating important risks, promoting safer practice, introducing safety officer networks

Malcolm Qualie Pharmacy Lead Specialised Services (NHS England)

Medicines optimisation strategy in specialised services, PPRS, national procurement of medicines, commissioning through evaluation of new medicines, commissioning policies

Alison Hemsworth Senior Programme Manager Community Pharmacy Contractual Framework (NHS England)

Developing pharmaceutical services in ways that support continuous improvements in quality and outcomes ,negotiations on community pharmacy service developments, Community Pharmacy Call to Action & Urgent and Emergency Care review

Professional leadership and clinical advice Urgent and Emergency Care review, Community pharmacy- helping with winter pressures, safer aseptic preparation in hospitals, LPNs

Jill Loader Regional Pharmacist (NHS England - South)

Michele Cossey Strategic (NHS England - North)

Professional leadership & clinical advice, cross sector strategic partnerships, enhancing the use of medicines & pharmacy services, role of pharmacy & medicines as part of transforming primary care & urgent &emergency care.

David Webb Regional Pharmacist (NHS England - London)

Richard Seal Chief Pharmacist (NHS Trust Development Authority)

Professional leadership and clinical advice on medicines optimisation and pharmaceutical services in NHS Trusts. Medicines optimisation strategy in NHS Trusts, medication safety, governance and assurance, antimicrobial stewardship, models of professional and service development

Professional leadership and clinical advice, emergency planning and resilience, specialist pharmacy services.

Justine Scanlan Director, Pharmacy Practice Unit & Specialist Pharmacy Services Lead, NHS England -North

Management of the Pharmacy Practice Unit, Liverpool and Specialist Pharmacy Services, providing information and support & metrics to demonstrate safe prescribing and service delivery

Bridget Sampson Director of Commissioning Devon, Cornwall and Isles of Scilly Area Team (NHS England)

Commissioning of Primary Care Services across Devon, Cornwall and Isles of Scilly (DCIOS) Member of the NHS Employers Pharmacy Negotiating Team Chair of NHS England Operations Pharmacy Reference Group Controlled Drugs Accountable Officer for Devon and Cornwall

PPRS & Statutory Scheme

• Q&As

• http://www.england.nhs.uk/wp-content/uploads/2014/05/pharm-price-reg-qa.pdf

• Statutory Scheme

• www.gov.uk/government/publications/statutory-scheme

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Antimicrobial Resistance

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https://www.gov.uk/government/pu

blications/uk-5-year-antimicrobial-

resistance-strategy-2013-to-2018

Pharmacy stewardship role

SPS

• Review published • http://www.england.nhs.uk/wp-content/uploads/2014/05/sps-final-rep-28-05-14.pdf.

• NHS England to commission for 3 years

• Engage with CCGs re commissioning of services from 2017

• SPS National Management Board and Implementation Group

• Head of SPS, Assistant Head of SPS (Medicines Preparation) and Assistant Head of SPS (Medicines Safety)

• Nominated leads Medicines Information and Medicines Assurance

6

Past year specialised commissioning

• Medicines Optimisation CRG

• Publication of principles around gain share

• Update and publication of medicines list for specialised services

• First wave of national tenders through CMU

• Appointment of 28 pharmacists to clinical CRGs

• Appointment of 19 embedded pharmacist

• CDF

• CPAG

• EAMS

• PPRS

7

Specialised Commissioning Review

Paul Watson Director of Turnaround- Specialised Commissioning

• Business as Usual

• Strategy - scope of spec comm, sustainability

• Clinically driven change

• Operational leadership

• Technical and contract delivery

• Financial sustainability

8

Chemotherapy

CRG

Draft algorithms policy

Draft algorithms

• multiple myeloma

• metastatic breast cancer

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Clinical Commissioning Policy:

Chemotherapy Algorithms for

Adults and Children

January 2013

Reference: NHS England XXX/X/X

Innovation scorecard - Heat Maps • http://www.england.nhs.uk/ourwork/innovation/inn

ovation-scorecard/

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http://www.england.nhs.uk/ourwork/innovation/innovation-scorecard/http://www.england.nhs.uk/ourwork/innovation/innovation-scorecard/http://www.england.nhs.uk/ourwork/innovation/innovation-scorecard/http://www.england.nhs.uk/ourwork/innovation/innovation-scorecard/http://www.england.nhs.uk/ourwork/innovation/innovation-scorecard/

Now or never? • Urgent and Emergency Care review

• Winter pressures, Earlier the Better

• Self Care

• Don Berwick/Francis/Keogh Safety collaboratives/ MSOs

• A Call to Action

• RPS Now or Never

• Rebalancing

• Financial challenge

• Frail elderly Better Care Fund

• Quality Premium

11

Pharmacy Call to Action

• 780 responses through website

• 100 written responses

• External company to analyse responses.

• Engagement with patients and the public.

Inform NHS England Primary Care Strategy and

Medicines Optimisation Strategy

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National CtA Event • Clear national standards for key services

• Access to shared patient record

• Improve relationships with GPs

• Shift balance from community pharmacy to role of community pharmacist in the community

• Incentives and contractual structure better aligned

• CCGs should engage community pharmacy from the start

• Raise awareness of potential of community pharmacy

• Improve national commissioning

13

SCR National Rollout

March 2014 KEY

PIP Commenced

Record Creation Commenced

Over 60% Records Created

Over 80% Records Created

Transforming Primary Care

• Pharmacist

• •Multidisciplinary team working

• •Preventing admissions

• •Prescribing

• •Supporting GPs on medicines optimisation

• •Supporting older people

• •Repeat dispensing [in community pharmacy}

• •Minor aliments, self care, healthy lifestyles

• Pharmacy (community)

• •Call to action

• •Accessibility and scale of usage

• •Current contract: Essential services etc 15

Consultation skills for pharmacy practice

16

Cross organisation project

Wide range of skill set

throughout the profession

Phase 1 launched 18th

March 2014

HWB/Local Authorities

Clinical Commissioning Groups

Strategy, policy, contract, procedure and assurance of achievement of outcomes

Implementation and development plans to reflect local circumstances

Local intelligence, clinical expertise, innovation and development of integrated care pathways

Peer support, peer review and benchmarking

Maximising performance

LPN Assembly

NHS England regional/

central

Area Teams

Local professional

networks

Informing needs, demand, supply in primary, community and secondary care

Aggregation of need and assurance of performance

HEE/LETBs

LPNs working as an integral part of NHS England Area Teams, developing close local working relationships

Local Professional Networks for Pharmacy

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Clinically-led commissioning ensuring a coherent offer for

public from multiple commissioners of services from

community pharmacy informed by patient and public

engagement

Quality improvement support continuous improvement in

quality of pharmaceutical services provision locally.

Pharmaceutical Needs Assessment advise H&W Boards in

producing a robust local PNA

Outcomes Framework contribute to every domain through

effective joined up work on medicines optimisation and

support for healthy living through community pharmacy –

CCGs, NHS England, Local Authorities, Public Health

England, Health Education England

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Stakeholder engagement-

co-production/testing/learning

2011/12

Securing Excellence in

Commissioning Primary Care,

June 2012 http://www.england.nhs.uk/wp-content/uploads/2012/06/ex-comm-pc.pdf

LPNs Single Operating

Framework, June 2013 http://www.england.nhs.uk/wp-content/uploads/2013/07/lpn-

sing-op-fram.pdf

LPN Website

http://www.england.nhs.uk/ourwork/d-com/primary-care-

comm/lpn/

http://www.england.nhs.uk/wp-content/uploads/2012/06/ex-comm-pc.pdfhttp://www.england.nhs.uk/wp-content/uploads/2012/06/ex-comm-pc.pdfhttp://www.england.nhs.uk/wp-content/uploads/2012/06/ex-comm-pc.pdfhttp://www.england.nhs.uk/wp-content/uploads/2012/06/ex-comm-pc.pdfhttp://www.england.nhs.uk/wp-content/uploads/2012/06/ex-comm-pc.pdfhttp://www.england.nhs.uk/wp-content/uploads/2012/06/ex-comm-pc.pdfhttp://www.england.nhs.uk/wp-content/uploads/2012/06/ex-comm-pc.pdfhttp://www.england.nhs.uk/wp-content/uploads/2013/07/lpn-sing-op-fram.pdfhttp://www.england.nhs.uk/wp-content/uploads/2013/07/lpn-sing-op-fram.pdfhttp://www.england.nhs.uk/wp-content/uploads/2013/07/lpn-sing-op-fram.pdfhttp://www.england.nhs.uk/wp-content/uploads/2013/07/lpn-sing-op-fram.pdfhttp://www.england.nhs.uk/wp-content/uploads/2013/07/lpn-sing-op-fram.pdfhttp://www.england.nhs.uk/wp-content/uploads/2013/07/lpn-sing-op-fram.pdfhttp://www.england.nhs.uk/wp-content/uploads/2013/07/lpn-sing-op-fram.pdfhttp://www.england.nhs.uk/wp-content/uploads/2013/07/lpn-sing-op-fram.pdfhttp://www.england.nhs.uk/wp-content/uploads/2013/07/lpn-sing-op-fram.pdfhttp://www.england.nhs.uk/wp-content/uploads/2013/07/lpn-sing-op-fram.pdfhttp://www.england.nhs.uk/ourwork/d-com/primary-care-comm/lpn/http://www.england.nhs.uk/ourwork/d-com/primary-care-comm/lpn/http://www.england.nhs.uk/ourwork/d-com/primary-care-comm/lpn/http://www.england.nhs.uk/ourwork/d-com/primary-care-comm/lpn/http://www.england.nhs.uk/ourwork/d-com/primary-care-comm/lpn/http://www.england.nhs.uk/ourwork/d-com/primary-care-comm/lpn/http://www.england.nhs.uk/ourwork/d-com/primary-care-comm/lpn/

NHS | Presentation to [XXXX Company] | [Type Date] 20

LPN Assembly and Steering Group

• Good group of LPN chairs, most recruited

• All will form Pharmacy Steering Group initially

• Important for linking commissioners and cross sector working

• Clinically-led commissioning

• Medicines optimisation around the patient and across boundaries of care

• Important that secondary care and others engage

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Getting medicines right at discharge

• Integrated care around the patient

• Cross sector working- NMS, tMURs

• Improve safety, reduce readmissions

• Effective communication

• On-going monitoring

• Understanding which medicines have stopped and started and why

• Support for medicines taking

• Joint decision making – plan when to take, when to stop, when monitoring needed, when to review, outcomes, side effects

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NHS Outcomes Framework

Senates

[12]

Strategic

Clinical

Networks

Local

Professional

Networks

Operational

Delivery

Networks

Other

Local

Networks

“The

conscious

and guiding

intelligence”

“Engines for

change and

improvement

across complex

care systems”

“Gathering

frontline

knowledge and

expertise”

“Mapping patient

pathways to ensure

access to specialist

support”

“15 AHSNs: Masters

of science and

evidence based

practice”

Multi-

professional

i.e. Cancer; CVD;

Maternity and

Children’s; Mental

Health / Dementia

/ Neurological

Conditions

i.e. Pharmacy;

Eye health; Dental

e.g. Adult Critical

Care; Neonatal

Intensive Care;

Trauma; Burns;

Paediatric NM;

Paediatric IC

e.g. Academic Health

Science Networks,

Research Networks

NHSCB Network Support Teams (AT-based)

Annual national priorities from the NHSCB Medical and Nursing Directorates

All supported by Improvement Body and Leadership Academy

Different Types of Network

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Model for Improvement

• Implementation without proof of concept in a segment is foolhardy

• Implementation of an idea without frontline input will likely be poorly accepted

• Reliable process must come before implementation and spread

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Patient Safety Collaboratives

• Through AHSNs

• Medicines Safety Thermometer part of change package

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Non-acute

Medication Safety thermometer

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Non-acute

Urgent and Emergency Care Review • The Review will develop a national framework and

associated guidance for CCGs in 2015/16 to help them commission consistent, high-quality and safe urgent and emergency care services across the country within the resources available.

Professor Keith Willett, Domain 3 Director, Acute Episodes of Care,

Medical Directorate, NHS England

Jonathan Benger, National Clinical Director, Urgent Care

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Community Pharmacy – helping with

winter pressures

http://www.england.nhs.uk/wp-

content/uploads/2013/12/comm-pharmacy-winter-

pressures.pdf

Toolkit, flu vaccination, repeat medicines, minor ailments

http://www.england.nhs.uk/wp-

content/uploads/2013/12/winter-press-com-pharm-serv.pdf

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http://www.england.nhs.uk/wp-content/uploads/2013/12/comm-pharmacy-winter-pressures.pdfhttp://www.england.nhs.uk/wp-content/uploads/2013/12/comm-pharmacy-winter-pressures.pdfhttp://www.england.nhs.uk/wp-content/uploads/2013/12/comm-pharmacy-winter-pressures.pdfhttp://www.england.nhs.uk/wp-content/uploads/2013/12/comm-pharmacy-winter-pressures.pdfhttp://www.england.nhs.uk/wp-content/uploads/2013/12/comm-pharmacy-winter-pressures.pdfhttp://www.england.nhs.uk/wp-content/uploads/2013/12/comm-pharmacy-winter-pressures.pdfhttp://www.england.nhs.uk/wp-content/uploads/2013/12/comm-pharmacy-winter-pressures.pdfhttp://www.england.nhs.uk/wp-content/uploads/2013/12/comm-pharmacy-winter-pressures.pdfhttp://www.england.nhs.uk/wp-content/uploads/2013/12/comm-pharmacy-winter-pressures.pdfhttp://www.england.nhs.uk/wp-content/uploads/2013/12/comm-pharmacy-winter-pressures.pdfhttp://www.england.nhs.uk/wp-content/uploads/2013/12/comm-pharmacy-winter-pressures.pdfhttp://www.england.nhs.uk/wp-content/uploads/2013/12/comm-pharmacy-winter-pressures.pdf

Process prior to Phase 1 Report

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• Evidence base - collected published and consulted upon http://www.england.nhs.uk/wp-content/uploads/2013/06/urg-emerg-care-ev-bse.pdf

• Online engagement tool - 680 responses

Most common comments

• Urgent and emergency care workforce (21 per cent)

• Telephone care (18 per cent)

• 999 services and A&E departments (18 per cent)

• Face to face care (18 per cent)

• Engagement events with clinicians and patients and

public.

• Emerging Principles

• Clinical Models

Emerging Principles

• Provides consistently high quality and safe care, across all seven days of the week.

• Is simple and guides good choices by patients and clinicians

• Provides the right care in the right place, by those with the right skills, the first time

• Is efficient in the delivery of care and services

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http://www.england.nhs.uk/wp-content/uploads/2013/06/uec-emerg-princ.pdf

Detail under each one, for statements visit

UECR Delivery Group

1. Better support for self care

support for self care, advance care planning

2. Right advice, right place, first time

Integrate pharmacy into UEC system, clinical advice, referral NHS 111

3. Highly responsive out of hospital services

Access to primary & community care, more services from pharmacy

4. Specialist centres to maximise recovery

Designate major centres, manage patient flow

5. Connecting services so the system is more than the sum of its parts

Payment system, quality measurement, cross boundaries 31

Early thinking: Community Pharmacy

32

• The pharmacy-based minor ailments system should be

strengthened.

• Directory of services should be clear on hours, services, etc.

• Re-direct through 111, but also allow walk-in access.

• Consulting rooms should be available

• Pharmacies and 3rd sector partners should be more actively

involved in education, drug reviews, medicines collection

and adherence.

• The issue of payment for items that would be free on

prescription needs to be resolved to encourage utilisation,

particularly amongst deprived groups.

• A consistent menu of urgent care services should be offered

by all pharmacies.

Medicines Optimisation Prototype Dashboard

Trial indicators e.g.

• PINCER

• QIPP prescribing indicators

• Medicines Usage Reviews (MUR):

% of pharmacies in AT conducting MUR

No. of MUR per 1,000 population (by AT)

• Medicines Reconciliation: % of patients receiving Med Rec within 24 hours

• Repeat Dispensing:

% of repeat dispensing items by CCG

% of electronic prescriptions dispensed as repeats

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Launching

this week

Involve patients

“We have really good data that show when you take patients and you really inform them about their choices, patients make more frugal choices. They pick more efficient choices than the health care system does.”

Donald Berwick, IHI

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