www.england.nhs.uk

NHS Long Term Plan

14th May 2019

Sejal Parekh for

Jill Loader, Deputy Director of Pharmacy

Commissioning (England)

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NHS Politics

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Long Term Plan – an overview

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The NHS Long term Plan published

on 7 January 2019 marks the NHS

70th anniversary.

National debate has centred on three

big truths.

These concerned:

1. funding,

2. staffing,

3. increasing inequalities and

pressures from a growing and

ageing population.

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Long Term Plan – an overview

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This Plan sets out how 3 main concerns will be tackled

by:

• secure and improved funding path for the NHS,

averaging 3.4% a year over the next five years,

(cf 2.2% over the past five years)

• wide consensus about the changes now needed.

(confirmed by patients’ groups, professional bodies

and frontline NHS leaders who have helped shape

this plan)

• work that kicked-off after the NHS Five Year

Forward View is now beginning to bear fruit,

providing practical experience of how to bring about

the changes set out in this Plan. Almost everything in

this Plan is already being implemented successfully

somewhere in the NHS.

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The NHS Long term Plan focuses on two main

issues:

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• Connectivity

The first is how we intend to improve the connectivity of services to patients, which touches on issues such as integration of care, of access to care, and of developing new channels including digital solutions.

• Outcomes

The second is how the health system will deliver improved outcomes in the areas that are most responsible for ill health, including cancer, mental health, cardio vascular disease, and through prevention.

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Major practical changes over next 5 years

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Boost out of hospital care

Redesign and reduce pressure on urgent care

Digitally enabled primary and Out-Patient (OP) care

Focus on population health through Integrated Care System (ICS)

Personalised care

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• Comprehensive Model of Personalised Care published January 2019

• At least one in five appointments with GPs are about issues that aren’t purely medical

• Social prescribing is offered alongside other medical treatment options for people who

have physical or mental health conditions

• Social prescribing link workers work in close partnership with pharmacy, social care,

community health and other health and care professionals

NHS LTP cross-cutting priority: Personalised care

Six evidenced-based interventions so personalised care can be implemented

at scale across the health system. Each defined by a standard set of

practices:

1. Shared decision making

2. Personalised care and support planning

3. Enabling choice, including legal rights to choice

4. Social prescribing and community-based support

5. Supported self-management

6. Personal health budgets and integrated personal budgets

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• Everyone who has to stay overnight in hospital is provided with help to stop

smoking

• Every pregnant woman is offered face-to-face support to help her stop smoking

• Help people using outpatient services for conditions that are made worse by

smoking to quit smoking

• More people able to access support to help control their diabetes

• More people to attend weight management services, especially those who are

obese and have another condition such as high blood pressure

• People admitted to hospital with alcohol related problems can be cared for by

specialist Alcohol Care Teams

• Continue to use antibiotics sensibly so that they are still available for future

generations

• Provide digital tools such as smartphone apps to enable more people to access

online NHS services and support self-management

LTP cross-cutting priority: Prevention of ill-health

New evidence-based NHS prevention programmes will be developed that

focus on reducing smoking, obesity and alcohol intake:

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Through Integrated Care

Systems, commissioners will

make shared decisions with

providers on

• population health,

• service redesign

implementation

Triple integration of the NHS Long Term Plan

1.Primary and specialist

care

3. Health and social

care

2. Physical and mental

health

NHS Long

Term Plan

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Community Services and Long Term Plan

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• Digital consultations

• Integrated teams of GPs, community health and social care staff.

• Expanded CHS teams to provide fast support to people in their own homes as an alternative to hospitalisation/ ramp up NHS support for people living in care homes.

• More NHS community and intermediate health care packages to support timely crisis care, to free up >one million hospital bed days.

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Pharmacy and Long Term Plan

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The NHS Long Term Plan establishes an ambition to better utilise the skill set of pharmacy

• PCN clinical pharmacists in GP and care homes

• to deliver more services to help people stay well in the community and relieve pressure on other parts of the system.

• It also sets out an ambition for more joined-up and coordinated care

• support the overall transformation of pharmacy, through service initiatives funded by the Pharmacy integration Fund.

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LTP pharmacy ambitions

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Urgent Care – pharmacy connection schemes

Referral to pharmacy from NHS 111 (DMIRs)

NHS Urgent Medicines Supply Advanced Service (NUMSAS)

Development of referral of minor illness from

• GP to pharmacy

• 111 online referral to pharmacy

• Urgent care to pharmacy

Underpinned by digital integration 111 DoS, NHS.net, SCR, WES, NHS mail

Prevention • Healthy Living Pharmacies,

• Public Health campaigns,

• Vaccination

• Case finding

• Early diagnosis

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LTP pharmacy ambitions

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Medicines optimisation and safety

NSAIDS

prevention of asthma deaths

medicines safety report

risk and mitigations

LASA errors

Transfers of care around medicines (TCAM)

Medicines Safety Programme and QOF

Workforce development

Clinical pharmacists in GP and care homes

Prescribing

Accredited checking technicians

Leadership skills

IPMO

Quality Payments Scheme

Pharmacy

Integration Fund

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Pharmacy Integration

Fund NHS RightCare

Programme and AHSNs

Digital Medicines

Programme at NHS Digital

2,000 new clinical

pharmacist MO roles in GP practices

Workforce developme

nt in collaboration with HEE

Developing new care

models – for urgent care

and care homes

Quality Payments Scheme

Pharmacy Integration

Fund set up to enable

pharmacist and

pharmacy technician

integration in primary

care as part of new multi-

disciplinary healthcare

teams, making the most

of their clinical skills

To support system wide medicines optimisation, NHS England is enabling the

transformation of pharmacy practice to improve the quality and efficiency of services for the

public

The drivers for pharmacy integration

Up to 5% of fund used to

evaluate each project

Evaluation looks at

scalability and

sustainability

Pharmacy integration to support medicines

optimisation

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Proposed vision for the integrated clinical pharmacy team

• Clinical pharmacists and pharmacy technicians a central part of

multi-professional teams in PCNs

• Community pharmacy teams deliver consistent, high-quality minor

illness care and support the public to live healthier lives

• Community pharmacists have capacity to deliver more clinical

care

• Support and encourage pharmacy technicians to practise at

the top of their licence as new technologies transform

medicines dispensing and supply processes

• Hospital and mental health pharmacists continue to be part of

specialist teams and extend their practice into primary care,

including providing consultant pharmacist support

• CCG pharmacy teams leading on population health

• Consistent delivery of these goals will require clinical and

professional leadership across the health and care system, by

Regional Chief Pharmacists and proposed Clinical Directors of

Pharmacy and Medicines in each ICS

Next steps for 2019/20:

• Publish IPMO

framework

• Develop proposed

governance framework

for pharmacy and

medicines across an

ICS

• System wide metrics

for use of data

developed and

benchmarked

• Continue to be led by

Regional Chief

Pharmacists

• PCN recruitment of

clinical pharmacists

from July 2019

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Resources for

primary medical and

community services

will increase by over

£4.5 billion by

2023/24

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• Published in January 2019 by NHS

England and the BMA General

Practitioners Committee in England

• Five year framework: 2019/20 GMS

Contract changes and joint proposals

for the four subsequent years

• The Framework sets direction for

primary care and seeks to address the

core challenges facing general

practice.

A five year framework for the GP

services contract Summary of agreement

• Addresses workload issues

• Brings a permanent solution to indemnity

costs and coverage

• Improves the Quality and Outcomes

Framework

• Introduces a new Network Contract DES

(DIRECTED ENHANCED CARE)

• Helps join-up urgent care services

• Enables practices and patients to benefit

from digital technologies

• Delivers new services to achieve NHS

Long Term Plan commitments

• Gives five-year funding clarity and

certainty for practices

• Tests future contract changes prior to

introduction

• QOF review (published July 2018)

15 indicators will be added or amended including blood

pressure, diabetes, mental health, COPD and cervical

screening

• QI modules – safer prescribing of NSAIDs, valproate, lithium

and other high risk medicines

• Reducing medicines harm using PINCER and other similar tools.

• Test beds

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GP contract: Quality and Outcomes

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Primary Care Networks (PCNs): service delivery

units

• Small enough to give a sense of local ownership

• Big enough to have impact across a 30-50K population

• Groupings of clinicians and wider staff working together to improve the care of their population

• Service delivery units and a unifying platform across the country.

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Domiciliary

Care

Person

Primary

care

Mental

Health

services

Nursing

Homes

Voluntary

Sector

Hospital

Care

Homes NHS 111

Informed and

enabled people

Practices as teams of teams

Personalisation and improved

outcomes

Integrated primary care

service

Digitally enabled working

Growing motivated and enabled staff

Aligned incentives

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• GP practices working together as the core of a PCN, partnered with other local

providers to deliver a more integrated service.

• Investment to reimburse 20,000 + staff as part of the new network contract

• Up to 6 WTE clinical pharmacists in post in PCN community multidisciplinary

teams by 2024 (also physios, physician assistants, social prescribing workers,

paramedics)

• New GP QOF covering prescribing safety in 2019/20

• Clinical pharmacists in PCNs will provide a focal point for collaborative working

across the different pharmacy sectors including hospital, mental health and

community pharmacy.

• Collaboration with non-GP providers, such as pharmacies, will be a

requirement for networks from 2020.

PCNs and pharmacy

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• In 2017, the World Health Organisation (WHO) launched

its third Global Patient Safety Challenge ‘Medication

Without Harm’, which aims to reduce the global burden

of severe and avoidable medication-related harm by

50% over five years.

• Research identified there are an estimated 237

million ‘medication errors’ per year in the NHS in

England,

• 66 million potentially clinically significant AND

‘definitely avoidable’ adverse drug reactions

• collectively costing £98.5 million annually,

• are directly responsible for, approximately 700

deaths per year

The National Medicines Safety Programme

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Medication Without Harm

WHO Global Patient Safety Challenge

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• The National Medicine Safety Programme (MSP) addresses the most

important priorities through three lenses:

• high risk drugs

• high risk parts of the medicines use process

• patients with the highest vulnerabilities

• All aspects of medication use will be considered:

- safe packaging and labelling design;

- safer prescribing methods, including electronic prescribing;

- understanding of human-factor error;

- the use of metrics to drive a reduction in the risk of harm;

- changes to administration protocols.

The National Medicines Safety Programme

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www.england.nhs.uk

UK 5-year AMR Strategy 2013-18:

Seven key areas for action

DH – UK High Level Steering Group

NHSE/NHSI/PHE

Human health DEFRA

Animal health DH

1) Better access to and use of surveillance data

2) Programme 1 - Improving infection prevention and control (SRO

Ruth May)

3) Programme 2 - Optimising prescribing practice (SRO Keith Ridge)

4) Programme 3 - Improved use of diagnostic tests (SRO Sue Hill)

5) Programme 4 – Improved use of antimicrobials, in animals,

agriculture and the environment (SRO Pete Borreillo)

6) Improving professional education, training and public engagement

7) Improving the evidence

base through research

8) Developing new drugs,

vaccines and other

diagnostics and

treatments

9) Strengthening UK and

international collaboration

UK AMR Portfolio Board

AMR NHS Agencies

Coordinating Group

Various working groups

2016 target: 50% reduction in

the number of inappropriate

antibiotic prescriptions by

2020

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• National Overprescribing Review Opening Symposium 15 May

2019

• 150 attendees across medicine, nursing and pharmacy, plus

representation from patients and charities, commissioners and

ALBs

• Over 60 submissions received of work going on nationally in

reducing overprescribing

• First event, but there will be opportunities for all to input as the

review continues

• Setting the vision for overprescribing and identifying the key

areas for further investigation alongside an in depth review of the

available evidence

• From the symposium a SLWG will take forward the themes

identified

• Polypharmacy recommendations for the Secretary of State

National Overprescribing Review

and polypharmacy

NHS England and NHS

Improvement

• Short Life Working

Group appointed

and will meet

during 2019

• NIHR review of

research

• Report published in

2020

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Summary

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• Increased funding for Community

Health Services and Primary care

• Utilising the skills/services of CHS

pharmacists

• Next 5 years – more integrated

roles with other healthcare

providers

• Focus on care of the elderly,

TCAM, health prevention, health

and wellbeing,

• Community based and integrated

health care approach

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What’s the national approach?

‘The frail Elderly’ ‘An Older Person

living with frailty’ A long-term condition

Hospital-based

episodic care

Disruptive & disjointed

Late

Crisis presentation

Fall, delirium, immobility

Timely identification

preventative, proactive care

supported self management

& personalised care

planning

Community based

person centred &

coordinated Health + Social

+Voluntary+ Mental Health

+ Community assets

FROM THIS TO THIS

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Any questions?