1 SERVICE LEVEL AGREEMENT

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1 1 SERVICE LEVEL AGREEMENT This Service Level Agreement (SLA) stipulates the contractual terms applied to the relationship between: NHS Commissioning Board (The Commissioner, NHS England) and The Community Pharmacy included in the Pharmaceutical Provider List (The Provider) pertaining to the provision of Discharge Referral and Medicines Reconciliation Service as a Local Enhanced Service (LES) (The Service) during the period 1 st July st December 2016 with possible extension to 31 st March 2017 No part of this Local Enhanced Service specification, by omission or implication, defines or redefines essential or advanced services.

2 2 OVERVIEW 2.1 BACKGROUND We know when patients move between care settings there are often unintended discrepancies in patients medicines after discharge from hospital affecting up to 87% of patients. Both the new medicine service (NMS) and post-discharge medicines use reviews (MURs) can be used to provide a seamless care pathway for patients who transfer from hospital to the community setting. Community pharmacists can play a much bigger role in supporting patients with their medicines if they have the right information to work with. Hospital referral to community pharmacy guide, published in December Heidi Wright, RPS practice and policy lead for England, says: The transfer of information from hospital to community pharmacies about a patient s medicines, particularly where changes have occurred, will help support patients to get the most from their medicines. Non-compliance is a major cause of hospitalisation among patients with chronic diseases and around a fifth of patients discharged from hospital experience adverse drug events. In the Tees project, pharmacists at the Freeman Hospital and the Royal Victoria Infirmary use a newly designed module in the PharmOutcomes web application to refer discharged patients to a local community pharmacy. Patient information including date of birth, postcode, NHS number, GP details and the discharge medicines list is sent electronically. The pharmacy contacts a patient within three days to arrange a medicine use review or new medicine service consultation on the premises. 2.2 STRATEGIC AIM To improve the post-discharge support for patients by facilitating early medicine reconciliation thereby reducing re-admissions / ED attendances. Reduce errors on medication prescribed and supplied in the community following changes instigated in hospital. 2.3 OBJECTIVES Improved care across the secondary primary care interface. Linking acute, community and practice based pharmacists. Reduced re-admissions due to drug related issues Medicines Optimisation improved compliance and outcomes Improve patient experience and care Support integrated approach and clinical skills through community pharmacy Cement use of Summary Care Records in Worcestershire 2.4 ENABLERS Close working across pharmacy sectors in Acute Trust, GP Practices and Community Pharmacy. PharmOutcomes to record data, provide reports, measure KPIs, facilitate secure transfer of data and support invoicing / payments. Access to view for Project Manager.

3 Copies of discharge medication sheets to be given to patients for onwards transfer to their regular Community Pharmacist. To work towards automated transfer and gathering consent while still in hospital Early access to SCR for Community Pharmacists Stationery design pre-printed envelopes for copies of discharge medication sheet; business card with MI helpline manned by WRH pharmacist and patient leaflet. 2.5 PILOT OUTLINE Period - Six months following engagement and training event. Based on DMR scheme in Wales, Red envelope service in Gloucestershire and incorporating the Refer to Pharmacy scheme in the North East. 2.6 KEY PARTNERS Worcestershire LPC Fiona Lowe (Chief Officer) and Project Manager for pilot fionalowe@nhs.net ( ) Worcestershire Acute Hospital Trust Rachael Montgomery (Deputy Chief Pharmacist) Worcestershire CCGs Jane Freeguard (Head of Commissioning) South Worcestershire Healthcare Marianne Tucker Martin (Lead Pharmacist) NHSE LPN Satyan Kotecha (Chair) NHSE Michelle Deenah (Senior Primary Care Contracts Manager) NHSE Gurjinder Samara CSU team PharmOutcomes support, reports and invoicing gurjinder.samra@nhs.net england.pharmacypaymentswm@nhs.net 2.7 PILOT TERM 1 ST JULY 31 ST DECEMBER 2016 Launch evening event to be held on the 21 st June 2016 at Charles Hastings Education Centre at Worcester Royal Hospital at 6.45 for 7.15pm. 1 st July 2016 Service Start 1 st July Phase one paper referral and access to dedicated medicines information help line for two wards at Worcester Royal Hospital Phase two tbc incorporate ED new anticoagulation patients for counselling on new medication and interactions (all treatments) and extend to other wards Phase three tbc incorporate links to frailty audits / referrals Reviews at months 1, 3, 5 and 6 Any extensions would be subject to funding and success of the pilot

4 3 SERVICE DETAILS 3.1 REFERRAL Worcester Royal Hospital will refer patients on discharge to participating Worcestershire Community Pharmacies. This will be via the patient in this first instance. A copy of the discharge medication summary will be provided including a list of medicines stopped or changed. It will in due course switch to using a newly designed module in the PharmOutcomes web application to refer discharged patients to a local community pharmacy. Patient information including date of birth, postcode, NHS number, GP details and the discharge medicines list sent electronically. Initially, while the paper transfer in in place the community pharmacist records and payment mechanism aspects only will be used on PharmOutcomes. The receipt of the discharge summary triggers the participating pharmacy team to provide a discharge MUR or NMS as appropriate and claim for these services through the normal mechanism. The pharmacy contacts a patient within three days to arrange a consultation on the premises. For this service a telephone MUR may be allowed for housebound patients, subject to approval by NHSE. An example of the discharge medication summary will be provided at the launch event. Where this is sent via the patient the green envelope will have the following wording on the outside: This is an additional copy of the list of the medicines you have been discharged on for your Community Pharmacist. Please give this to your Community Pharmacist asap and before your next repeat prescription is due This will ensure that your Pharmacist is informed about any medicine changes made 3.2 INTERVENTION Participating pharmacies on receipt of the discharge medication summary should retain it until the patient orders their next supply of medication from the GP. A MUR or NMS should be arranged as soon as possible along with any other support required. The hospital will provide a background information sheet as well as the discharge summary. This sheet will include any recommendations or concerns that they have. When the FP10 is received is must

5 be compared with the discharge information. Any discrepancies must be investigated using information from the hospital information, Summary Care Records and reference to the hospital helpline and the surgery contacting the Practice Pharmacist in the first instance. All interventions and actions including MURs should be recorded on the PharmOutcomes system, which will trigger payments for the interventions. MUR and NMS must be claimed separately in the usual way under advanced services regulations. You may also request to undertake a domiciliary MUR or in exceptional cases a telephone MUR by applying to NHSE via england.pharmacypaymentswm@nhs.net. Please include in the request that it relates to a Discharge Service patient. Any queries should be raised with the GP or Practice Pharmacist and where necessary with the hospital via the dedicated helpline This help line can also be used to obtain a copy of the discharge information should this not be provided by the patient. In order to meet the information governance requirements, the pharmacy will need to quote their OSC code (i.e. F code that use for NHSBSA) and confirm patient details as set out below: Discharge Medicines Helpline For advice and information relating to Patients Medicines after their in-patient stay at either The Worcestershire Royal Hospital, or The Alexandra Hospital, Redditch Please phone our Medicines discharge helpline on between the hours of 9-5pm Mondays Fridays Please note for us to be able to answer your query, callers will need to be able to identify the patient s full name, their date of birth and NHS number Community Pharmacists will need to have obtained patient consent before calling The hospital pharmacy medicine information team will man the dedicated discharge helpline and support with any query resolution in relation to changes made to medication while the patient was at the hospital. All interventions made must be recorded within 1 working day on PharmOutcomes. A secure referral can be sent to GP Surgery via PharmOutcomes, where concerns remain. The PharmOutcomes form must be completed in full for the intervention. Payment will be generated from this completion. Intervention includes anything undertaken proactively or reactively to support medicine reconciliation following discharge from hospital: Contacting helpline Contacting surgery Counselling patient Query resolution

6 Supporting ordering the repeat medication from GP referring to discharge summary Arranging for changes to FP10 following discussions with GP / hospital Compliance Support Review of Summary Care Record (SCR) Please also confirm whether a MUR or NMS has been completed. A copy of the PharmOutcomes Forms will be supplied at the launch evening along with screen shots. The PharmOutcomes data will be used to categorise the significance of the interventions in relation to reducing re-admissions. The community pharmacists review aims to improve patients awareness of changes to medicines during the hospital stay, and educate them on how and when to take their medicines and any side effects. The community pharmacist can also refer patients to public health services or call the referring hospital pharmacist to discuss a patient s care. 3.3 FOLLOW UP SUPPORT FOR VULNERABLE FRAIL PATIENTS For vulnerable, housebound patients, in their own home and where the Pharmacist considers that there is significant risk to patient safety, a domiciliary visit can be requested. This is expected to be a small number of patients, equating to less than 5% of referrals. The specialist frailty pharmacist at WRH Tina will be available during normal working hours for consultation on bleep 639 as well as support from the helpline. It may also be appropriate to contact the practice based pharmacist. The Pharmacist should contact Fiona Lowe on or by on fionalowe@nhs.net for authority for a pharmacist or technician / dispenser to visit the patient. This visit would be to provide medication counselling, compliance support, check the patient s medication supplies, agree any arrangements to remove any discontinued medicines and signpost to any other relevant services. All required DBS and safeguarding principles will apply. If confident to do so a level one falls assessment can be completed. Any concerns following the visit should be referred to the patients GP. A secure copy of the visit outcomes can be sent to GP Surgery via the referral form on PharmOutcomes. The visit and outcomes must be recorded on PharmOutcomes within 1 working day. This will be linked to the additional payment for this part of the service.

7 3.4 DISCHARGE & INTERVENTION SERVICE REFERRAL FLOW CHART No Yes Helpline at WRH who can provide information about changes made during inpatient stay and supply a copy of discharge information if patient forgets to give it to pharmacy Practice Pharmacists (or GP) can support with information wrt changes made FP10s Yes No Permission to undertake Domiciliary Visit contact Fiona Lowe, following speaking to WRH Frailty Lead Tina and / or practice pharmacist. GP Referral

8 3.5 IN AND OUT OF SCOPE In Scope: Patients discharged during normal hours from WRH on Laurel Floor, ED NOAC patients and any subsequent additional wards as agreed and shared with Community Pharmacies. Out of Scope: Patients discharged to Intermediary Care setting (e.g. community hospitals) Patients not referred by WRH pharmacy team. Note the helpline can still be utilised for any patient discharged from a Worcestershire Acute Hospital and MURs and NMS can be undertaken as usual for other discharge patients. The intervention service is only available for those referred either through PharmOutcomes or the Patient envelope. 3.6 SERVICE PROVIDER DUTIES Staff Each provider must ensure that any personnel involved in providing any aspect of care under this agreement must have the necessary training and skills and a member of the team attends the launch evening on 21 st June (6.45 for 7.15 pm) at Charles Hastings Education Centre. If it is not possible to attend the launch event, suitable alternative arrangements must be discussed with Fiona Lowe ( ) The Provider must: Identify a lead (Pharmacist or Technician) within the pharmacy team who would be the point of contact for the service and takes responsibility for informing/updating all team members. The contact details (name, , phone number) of this lead will be shared with the commissioner. Any changes to this lead will be communicated to the commissioner via the available routes. Ensure that pharmacists and staff involved in the provision of the Service are aware of, and operate within, local protocols and legal requirements. Ensure that all DBS and safeguarding is in place. Existing and new pharmacy staff not directly involved with the provision of the service should be adequately trained to be aware of the service and the obligations of this agreement Premises The service must be provided from premises currently on the General Pharmaceutical Council s Register of Premises and the appropriate Health and Wellbeing Board Pharmaceutical list. Premises must have a consultation room for MURs and NMS reviews Access The service must be available at the Provider location throughout the whole Core and Supplementary Hours.

9 3.6.4 Service The Provider must be satisfactorily complying with its obligation under Schedule 1 of the Pharmaceutical Services regulations to provide Essential Services and have an acceptable system of Clinical Governance. The Provider must ensure that this service is performed in accordance with current national standards and guidelines including the Misuse of Drugs Act 1971, Misuse of Drugs Regulations 1985, and RPSGB/GPhC Standards of Good Practice Measurement and Audit The Provider will complete consultation details on the on line IT platform for any service provision event related to this scheme. The Provider will update any relevant Standard Operating Procedures to cover provision of the service. All relevant staff must sign a record to show that they have read and understood the SOP Duties of Individuals Performing the Service The Service must be performed by a Pharmacist registered with the General Pharmaceutical Council Additional Training Any individuals performing the Service are actively encouraged to attend NHS England training day(s), which will be held at least once a year. Any new staff must receive advice/training Other Requirements It is the responsibility of the individual performing the Service to ensure that all professional activities undertaken by them, or under their control, are covered by appropriate professional indemnity arrangements Record Keeping All documentation must be retained for a minimum of 12 months. 4 REMUNERATION NMS and MUR to be claimed in the normal way through NHSBSA Each intervention recorded on PharmOutcomes for a referred patient will receive a fee of 5 Each approved domiciliary visit documented on PharmOutcomes will receive a fee of 25

10 4 AGREEMENT This document constitutes agreement between the parties detailed below regarding the provision of the specified Local Enhanced Service. Name Service: Location Service: of of Discharge Referral and Medicines Reconciliation Service Worcestershire for all patients with a GP in Worcestershire Period Agreement of Commissioner Lead Contact Local Lead for Provider: 1 st July st December 2016 (with possible extension to 31 st March 2017) Yasmin Akhtar - yasminakhtar3@nhs.net Mobile Fiona Lowe fionalowe@nhs.net Mobile (fax ) Telephone: Authorised Signatories: Name: Organisation: Address: For the Commissioner: Brian Wallis NHS England West Midlands For the Provider: N/A Signature: Date: 14 th June 2016 Position: Department: Primary Care Contracts Manager Primary Care

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