Urgent and Emergency Care Review and a commissioning perspective

Transcription

1 Urgent and Emergency Care Review and a commissioning perspective Anne Joshua NHS 111 Pharmacy Lead, NHS England 26 th March 2015

2 National vision for urgent and emergency care: Whole system transformation For those people with urgent but nonlife threatening needs: Provision of highly responsive, effective and personalised services outside of hospital, and Care delivered in or as close to people s homes as possible, minimising disruption and inconvenience for patients and their families For those people with more serious or life threatening emergency needs: Ensuring they are treated in centres with the very best expertise and facilities in order to maximise their chances of survival and a good recovery 2

3 5 principles of Urgent and Emergency Care Review 1. Supporting self-care; 2. Helping people with urgent care needs to get the right advice or treatment in the right place, first time, always and everywhere; 3. Providing a highly responsive urgent care service outside of hospital so people feel they have options beyond A&E; 4. Ensuring that those people with more serious or life threatening emergency needs receive treatment in centres with the right facilities and expertise; 5. Connecting the whole urgent and emergency care system together through networks. 3

4 Published guidance for local SRGs & commissioners..

5 Uptake Flu and pneumococcal vaccination Urgent repeat medicines Self care for deprived communities/common ailments NHS 111

6 Issues IT compatibility Communication/referral/nhs.net NHS 111 staff understanding DoS Reporting activity Pharmacists willing to take part Distances for patients Community pharmacy culture to be part of UEC. HEKSS pilot development programme to develop role

7 Urgent Care Blog NHS Choices, 21 January 2015 The vital role for pharmacists on the front line. or

8 Feeling under the weather? Extended Feeling under the weather campaign from 13th January until 31st March Initial results showing selfreported behaviour change.

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10 Pharmacists in ED Expressions of interest for national pilot Letter for national LETB Pharmacy Leads and Chief Pharmacists Medicines focused clinician, focused on minor injury and minor illness, independent prescriber. Build on West Midlands work (HEWM and regional partners) 400 presentations, over 5 weeks training week + 4 weeks observation, 3 days a week 65 trusts across 13 LETBs commencing March 2015

11 Pharmacist in the NHS 111 contact centre Yorkshire Ambulance service Lead pharmacist and bank of 10 pharmacists working shifts weekends and evenings Integrated Care 24 (IC24) Seven pharmacist prescribers working across 111 and GPOOHs Care UK (Dorking) Independent pharmacists (4) working across 111 and GPOOHs Local Care West (LCW) London Urgent Care Community pharmacists (5) working weekends handling calls via IVR routing across all 111 providers 11

12 Role of pharmacist Handling medicines enquiries, e.g. administration and dosage problems, interactions, pain relief advice Advising call handlers Advising NHS 111 clinicians: paramedics, nurses, dental nurses Managing repeat prescription request referrals Providing self-care advice to patients/callers for common minor illness Prescribing? In GPOOHs/ NHS

13 NHS 111 Pharmacy programme Technical development DoS: mobile access for pharmacists/pharmacies DoS: common minor illness template DoS: flexible searching for pharmacy services, e.g. enabling visibility of services that are offered within timeframes that are different from opening hours. Referral to pharmacy messaging SCR within contact centre EPS visibility e.g. EPS tracker Digital 111 via NHS Choices 13

14 NHS 111 Pharmacy programme (contd) Operational development NHS 111 Workforce programme : link to wider pharmacy developments within UEC Referral to pharmacy: repeat prescriptions Referral to pharmacy: common minor illness Medicines and poisons training for NHS 111 clinicians Learning and development Phase 2 pilots with evaluation partner Newcastle University, North East CSU and South and South East CSU: 5 pharmacy specific Pharmacy reference group 14

15 NHS 111 Phase 2 Pilots Title Area NHS 111 provider Partners Improving utilisation of community pharmacies Improving utilisation of community pharmacies To enhance the use of pharmacist and pharmacy support staff skills both within the NHS 111 call centres and as a referral end point Aylesbury vale Oxfordshire Yorkshire and Humber South Central Ambulance Service South Central Ambulance Service Yorkshire Ambulance Service Bucks LPC Central Southern CSU Bucks CCGs Berks and Oxford LPC Central Southern CSU Oxfordshire CCG Greater Huddersfield CCG Community Pharmacy West Yorkshire (LPCs) Enhance and expand the clinical skill mix of NHS 111 West Midlands Pharmacy integration North and S Essex & Gt Yarmouth and Waveney Sandwell CCG IC24 West Midlands Ambulance Service N/A Arden and Worcester LPC Celesio Pan-London Pharmacy Hub within an NHS 111 contact centre, and Dental Triage Hubs external to NHS 111. Referral of urgent repeat medication to community pharmacies London region London Ambulance service Care UK Partnership of East London Co-operatives London and Central West Unscheduled Care Collaborative (Lead) Care UK (Smile -dental) Kings Healthcare dental service Barts dental service Pharmacy London (LPCs)

16 Pharmacist in GP Practices RPS and RCGPs joint statement: They [pharmacists] would work closely with GPs and other colleagues to resolve day to day medicine issues, particularly for patients with long term conditions and who are taking a number of different medications. They would also liaise with hospitals, community pharmacists and care homes to ensure seamless care for patients. 16

17 Pharmacist in GP OOHs Pharmacist as prescribers Minor illness Repeat prescription management Medication advice GP OOHs NAO review integration with rest of the urgent and emergency care system and ensure quality of care 17

18 UECR Delivery Group planned publications Transforming Urgent and Emergency Care services in England: Advice for SRGs- Establishing Urgent Care and Emergency Care Networks Clinical Models for Ambulance Services Improving referral pathways between urgent and emergency services in England Guidance for local health and social care communities

19 Commissioning Urgent and Emergency Care

20 OACP: NHS England new regional structures (showing sub-regions)

21 Referring to the new structures We now have four regional teams and these will operate on a single level. The new 12 sub regions are now integrated into these new regional teams. We should no longer to refer to area teams. A central team replaces the National Support Centre. Transition to new structure from January 2015 to 31 March New structure fully functional by 1st April 2015.

22 Five Year Forward View Need for greater emphasis on prevention; supported self-care for minor illnesses and long term conditions and greater availability of personalised health information. Recognised the important role of pharmacists in strengthening primary and out of hospital care and recognised the need to build the public s understanding that pharmacies and on-line resources can help them deal with minor ailments without the need for a GP appointment or A&E visit.

23 Five year forward View into action: Planning guidance The proposed new care models highlighted the need for pharmacists to be integral to Multi-specialty Community Providers, the need for far greater use of pharmacists as part of the urgent care system and the importance of medication reviews to enhance health in care homes. Recognised that there is a need for national and regional expertise to implement care model change rapidly and at scale.

24 Planning Guidance Primary care is not just about general practice. During 2014, we heard hundreds of views about how community pharmacy, dentistry and aspects of eye healthcare could develop to support better outcomes. Early in 2015 we will set out our response, taking account of the best ideas in how we implement new models of care.

25 Activities: role of each commissioning level for U&EC CCGs: Stakeholder engagement, commissioning and quality assurance of deliverables SPGs: CCGs collaborating to agree, lead implementation and monitor system-wide commissioning and intentions that support local delivery SRGs: Development of programme deliverables to support consistent delivery of high quality care National: Guidance and toolkits to support commissioning and to inform the membership of networks and to define quality indicators UEC networks to define strategy at local and regional level 25