Area Team update – Local Professional Network

Samantha Travis, Clinical Leadership Adviser

Derbyshire / Nottinghamshire Area Team

Derbyshire / Nottinghamshire

2

• Population just under 2 million patients• 10 CCGs• 4 local authorities• 433 community pharmacies

Area team functions• 2 key functions• Direct commissioning – GPs / Pharmacies/

Optometrists and dentists• CCG Assurance

NHS | Presentation to [XXXX Company] | [Type Date]3

Key contacts – Pharmacy Contract (Notts)• Liz Gundel Ph: 01138 255461

• Kerrie Woods Ph: 01138 255456

• Mark Yates Ph: 01138 255466

• Jayne Bouch Ph: 01138 255447

• Richard Hobbs Ph: 01138 255472

• Chris Kerry Ph: 01138 255427 (enhanced services only)

All contracting queries relating to contract monitoring / essential / advanced services and roster / emergency supply / Pharmacy First & Palliative care

NHS | Presentation to [XXXX Company] | [Type Date]4

My role• Clinical Leadership Adviser – lead for establishing

and developing 3 local professional networks• Clinical pharmacist advice to Area Team• Controlled drugs Accountable Officer• Email all controlled drugs queries / errors/

discrepancies to samantha.travis@nhs.net• Ph: 01138 255474

NHS | Presentation to [XXXX Company] | [Type Date]5

Local professional networks – pharmacy functions

NHS | DCAF Presentation | November 20136

• Hosted by Area Teams since 1st April 2014

• Support local authorities on the development of the Pharmaceutical Needs Assessment which NHS England will use in commissioning pharmaceutical services

• Support the development of programmes of work to promote self-care and improve long term conditions management

• Work with CCGs to develop and implement the primary care strategy

• Work with patients and other health care professionals to develop a comprehensive programme of work aimed at ensuring medicines optimisation

• Share learning from medication incidents and Serious Incidents Requiring Investigation (SIRIs)

• Provide leadership to ensure robust commissioning of all locally enhanced services

Local Professional Network – What have we done so far?

• Established network – includes 2 LPCs, CCGs, local authority representatives, Acute Trust Chief pharmacists, contracts managers, Academia, LPF member, patient reps

• Meets every 6 weeks – guest speakers • LPN executive – 3 LPN Chairs, Medical Director

and Director of Commissioning• Opportunity to review progress and to discuss

challenges / barriers• Developed work plan – signed off by the Medical

Director

7

LPN hosted events / training• Training for pharmacists (CCG funded)

- Dementia Friends (CPPE)

- Health coaching

- Diabetes

- Mental health

- Leadership

Call to Action – 5 events – hosted and facilitated by LPN members and primary care contracting team members

8

Community Pharmacy Strategy• Strategy written in January 2014• Useful tool when talking to LPCs, CCGs / LA

about pharmacy• Key themes threaded through area teams wider

primary care strategy

]9

Community Pharmacy Strategy themes• Promoting the wider role of community pharmacy

to the public, GPs• Joint working with GPs & CCGs• Medicines optimisation• Medicines safety initiatives• Public health & community pharmacy• Urgent & out of hours care• Call to Action – Community Pharmacy

10

Promoting the wider role pharmacytopublic, GPs• Local ‘Think Pharmacy Campaign’ for winter ailments - December

• National campaign ‘The earlier, The better’ from Jan 2014

• Aims to increase public understanding of and confidence in community pharmacy services.

• Increase the number of people accessing self-care information and advice on NHS Choices when they have a minor ailment.

• Increase the number of people accessing community pharmacy services when they have a minor ailment.

• Target audience over 45s, over 60s via their friends, family and carers and carers 45-64 years

11

Urgent & emergency careThe Urgent and Emergency Care Review recognised that; ‘Community pharmacies are an under-used resource: many are now open 100 hours a week with a qualified pharmacist on hand to advise on minor illness, medication queries and other problems. We can capitalise on the untapped potential, and convenience, that greater utilisation of the pharmacy workforce can offer.’

12

Urgent & emergency care• Area team commissioning Pharmacy First / Palliative Care

Drug Stockist and Roster from April 2014

• Commissioned emergency supply of medicines service for 2 weeks over Christmas / New Year 13/14.

• 200 calls/day at weekends / Bank Holidays from patients who have run out of repeat medicines (DHU)

• Very popular with OOH services and CCGs – AT has commissioned in OOH period for whole of 2014/15.

13

Medicines Optimisation

• Pharmacists generally considered as experts on medicines – Liberating the NHS 2010

• LPN looking at various initiatives – secondary / primary care

• Opportunity to work jointly with CCGs to scope and explore the possibilities to provide medicines optimisation and ensure patients get the best outcomes from their medicines

14

Medicines Optimisation• Patient centred approach. • Focuses on gaining the most benefit for patients

from their medicines. It is all about making patients part of the decision in relation to their medicines.

• Understanding the patient’s goals and aspirations, which may be different from the outcomes the NHS would like to see, listening to their concerns and beliefs about medicines

• Stopping or reducing medicines as well as starting new ones.

15

Medicines Optimisation – the problem• 30 – 50% of patients do not take their medicines as

intended by the prescriber

• 6.5% of hospital admissions are due to adverse drug reactions, 70% of these are avoidable.

• 70% of care home residents have a problem with their medicines at any one time

• 22% of the population now take more than 5 medicines and 5.8% are on ten or more medications a day, rising to 16.3% in those over 65 years of age.

• Waste medicines in England cost approximately £300 million annually

16

Medicines Optimisation workstream1. Asthma / COPD inhaler technique business case

2. Developing a case for a service to help polypharmacy patients to get best outcomes from their medicines

3. EPS – Notts - one third GP practices are live. Working with Healthwatch to agree some key messages for patients who are reporting confusion with the service (non recurrent AT funding)

4. Care homes – reviewing services with 5 Notts CCGs

17

Public health role of community pharmacy• Community pharmacy can play an important role in improving the health of

the population in England.

• PHE has recently expressed keenness to explore:

• The role of the HLP

• Health marketing

• NHS Health Checks

• Blood pressure checks

• Vaccination

• Smoking Cessation

and have highlighted community pharmacy’s excellent track record in delivering these services]18

Public health role of community pharmacy• Healthy Living Pharmacy – excellent evaluation

from elsewhere• First step is to train Healthy Living Champions• Funding obtained from Notts LETB to train 85

pharmacy staff members• Distance learning package – accredited by the

Royal Faculty of Public Health• 80+ in training currently across Notts

19

Primary care transformation GP services are at capacity – opportunity for pharmacists?

• Management of minor ailments (local audit 45% of those presenting at GP surgery could have been managed by other HCP)

• May be opportunities for pharmacists to take on some of the case management of patients with long term conditions

• Independent prescribing – challenging in the past for community pharmacists to use skills – business case submitted to realise this potential

• Currently working up a pilot with a local CCG to explore how we could use trained community pharmacists to work alongside GP practices using prescribing skills- business case submitted to realise this poten

20

Work streams – Medicines safety • Established medicines safety work stream – 2

Acute Trusts, community providers, CCGs • Hoping to expand to include 4 Trusts• Help for Harry – discharge MURs / NMS• Common assessment process for patients

requiring compliance aids• Agreeing common messages for patients around

medicines

21

Call to Action• 110 pharmacists and stakeholders gave us their

views on future of pharmacy• Strong call for national service specifications for

enhanced services• National campaigns promoting pharmacy• Improved technology needed – patient records• Output from NHSE expected Autumn

22

Coming soon………• Working with School of Pharmacy– University of

Nottingham working up an audit / survey of patients visiting community pharmacies to look atr the range and quality of self care advice given to patients and patients perception of the service offered

• Forming links with HEEM

23

Pharmacy First

Samantha Travis, Clinical Leadership Adviser

Derbyshire / Nottinghamshire Area Team

Pharmacy First - refresher• Still commissioned if you were signed up and active last

year!

• Accreditation requirements – CPPE Minor Ailments pack

• Actively promote the service to anyone registered with a GP in Notts who is exempt from prescription charges

• Resource materials available tonight – will be updated over next few months

• Working with CCG to see if we can fund pharmacies who aren’t signed up

]25

Pharmacy First - Ailments• Pharmacists can currently provide advice and treatment for the following

ailments on the Pharmacy First scheme:

• Head LiceVaginal Thrush

• Sore ThroatConstipation

• ToothacheInsect Bites & Stings

• FeverWarts & Verrucas

• EaracheFever

• Bacterial Conjunctivitis Athlete’s Foot

• DiarrhoeaHaemorrhoids

• ThreadwormHayfever

Patients can also be referred to their GP if necessary.

26

Pharmacy First• Follow specification

• Refer patients with red flag symptoms / contraindications

• Provide only formulary products

• Recent audit of GP appointments – 40% could have been dealt with by a pharmacist – important urgent care role

• Need to build on the scheme – its not perfect - but must start by ensuring eligible patients are signed up in those pharmacies offering the service

• Contact me if you need specifications etc

• Point of contact for those not signed up who would like to

27

What are we trying to achieve?• To encourage patients to use the pharmacy, when

appropriate for advice and treatment of minor ailments.

• To increase the capacity of the available GP appointment schedules to provide a better service to patients with more severe or urgent conditions.

• To give patients more choice in how they access health services

• To expand the role of the Community Pharmacist and enhance relationships between health professionals

]28

Contact• Samantha Travis, LPN Chair / CDAO, Derbys /

Notts Area team• Samantha.travis@nhs.net• Ph: 01138 255474• Thanks for listening!

]29