All District Health Boards. Delivering on the Pharmacy Action Plan next steps

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1 1 All District Health Boards Delivering on the Pharmacy Action Plan next steps

2 Objectives for today 2 Share with you what we heard during the consultation Continue the conversations we have started with you about the future of pharmacy Discuss how we can keep the conversation going - the next steps

3 Pharmacy Action Plan focus areas 3 Population and personal health Minor ailments and referral Tools for change Leadership Smart systems Workforce Regulation Medicines management services Dispensing and supply services equity working together

4 4 Consultation Started 5 March and closed 10 April 850+ people attended DHB meetings - Sector agents also held regional meetings Over 1150 completed written submissions received

5 Respondents 5 CHANNEL Online Questionaires RESPONDENTS CATEGORY Community pharmacy contract holder 41% RESPONSE TYPE s Organisations Individualised, 921 s Individuals Registered pharmacist 42% All Other 6% Other healthcare provider 2% Pharmacy Technician 3% Pharmacist professional body 3% Member of the Public 3% Pro forma, 220

6 Policy / funding relationship 6

7 Themes Evergreen contract Schedules 1 and 2 Contract structure Governance 7 Local commissioning Neither option supported

8 Time to reflect 8 do not support the IPSCA proposal or the option for a 12-month extension as drafted by DHBs Current CPSA12 contract expires on 30 June Consultation outcomes need time to be fully considered Pharmacy contract-holders need certainty DHBs will extend the current contract for three months to allow time for conversations with the sector and confirmation of funding, and time for contract-holders to consider the offer

9 Integrated Pharmacist in the Community Agreement Process 2018 May June July August May 9 Today 3 Month Extension Announced Contract Drafting Stakeholder Discussions Extension of Current Agreement Notified to all contract holders Three month variation letter sent September No change to services or funding $4.1M continues Integrated Pharmacists in the Community Agreement OFFER October November December January February March April Go live new contract Integrated Pharmacist in the Community Agreement IN PLACE Evergreen with annual review Local Commissioning (for some services only) Enable innovative practice Professional Advice Funding $4.1 Million New Funding 1 9 May Month Agreement OFFER 12 Month Agreement 12 Month Term will not be renewed CPSA 12 Based agreement Providers not eligible for additional services or funding Da

10 10 Evergreen Comments Not opposed in principle but not in its present form In an evergreen arrangement clarity of how fees are to be adjusted is essential Opportunities Tighten change process and review process Look at ARRC and PSAAP processes Review consultation provisions Delineate national review process from local processes

11 Governance 11 Comments The contract replicates the Contract Group as the vehicle for managing changes This is folly Opportunities Re-write relationship clauses after considering ARRC / PSAAP examples Clear governance arrangements will provide the sector with greater certainty and confidence

12 Contract structure review and change processes 12 Comments The process for adjusting over time is not defined over time will require greatly strengthened provisions dealing with procurement arrangements and standards across 20 DHBs Opportunities Include more specificity (similar to PSAAP and/or ARRC annual review process) Cost pressure New service specification funding arrangements Consider more specificity, for example: Change control process Sector representation Consultation.

13 Schedules 1 & 2 Comments incredulous that it had been proposed at all. It is emphatically rejected It is clear the split is the pivot on which the whole strategy turns necessity allows pharmacists to free up time The proposed split poses a fully avoidable patient safety risk and increases the risk to pharmacists professional practice Opportunities Keep Schedules 1 & 2 linked in the offer Include a process clause noting that Schedules 1 & 2 service model will be offered together until work is done on patient safety, regulation, funding and IT. Explicitly put funding back together and add a new line for additional funding for professional advice Establish standalone payment schedules that separate the fees/funding paid from the service specifications for: o Schedules 1, 2, 3A (nationally consistent); and o Schedules 3B, 3C (can be locally commissioned plus individual schedules) Review terminology 13

14 DHB local commissioning Comments DHB inaction or unwillingness to fund new services leading to cynicism amongst communities and professionals The proposed changes are essentially a way of breaking up the log jam that inhibits the development of integrated services Opportunities 14 DHBs will follow appropriate procurement processes for local commissioning Describe information that will be made available by DHBs Illustrate reinvestment processes

15 Standardised LTC service level variation by DHB 15

16 Funding Comments The proposed new model constitutes a fundamental change to the structure of community pharmacy funding and contracting the projected contract split under the proposal for 2018/19 suggest approximately 33% of funding would be commissioned locally Opportunities 16 DHBs commission services to improve health outcomes for their communities. There is no change to how services are funded and delivered under the new agreement The new agreement provides a framework for local conversations within a nationally agreed structure Underlying funding growth is projected to continue DHBs are proposing additional funding in the new contract

17 Funding 17 Schedule 3A 4% Schedule 3B Dispensing 11% Schedule 3B Local 21% Schedule 2 42% + Professional services fee Schedule 1 21% Schedule 3C local 1% + $4.1M

18 Other considerations 18 Comments (National Pharmacist Service Framework) these tools should be used in the development of future services Facilitate the uptake of alliance contracting across all DHBs building on the success of this approach Opportunities DHBs recommend utilising the national pharmacist framework developed by the Pharmaceutical Society as a template Include Pharmaceutical Society in governance Alliancing

19 Where to from here What Consultation analysis Ongoing Stake-holder discussions Finalise contract wording Three-month extension Contract available for offer Completed by: May 2018 May/June 2018 Wednesday, 27 June 2018 Thursday, 7 June 2018 Wednesday, 25 July

20 20 All District Health Boards Keeping the conversation going