Report of the Launch Event Wednesday 27th April 2016

Report of the Launch Event Wednesday 27th April 2016 All Nations Centre CARDIFF

Opening Pharmacisits arrived and networked with all delegates at the All Nations centre before taking a seat. Delegates were welcomed by Andrew Evans, Principal Pharmacist, Welsh Government. Mr Evans started providing background to why everyone has been invited and touching on the story of the origins of the Community of Practice (CoP). He then introduced Paul Gimson, the lead for improvement in Primary care & Matt Wyatt, Improvement Advisor at 1000 Lives Wales. What s a Community of Practice? Matt Wyatt provided a plenary presentation on the concepts and methods that underpin the development of a community of practice. He described the origin of the concept, the defining features and how a CoP can do things that other types of group can t. Matt outlined the participatory and organic development of the relationships; highlighting the experiences that participants could expect. It has to be immersive, to understand it; you have to be surrounded by the experience.

The right focus for a Community of Practice? Paul Gimson gave a presentation exploring what the focus of the CoP should be. He covered the primary care plan, discussed what the role of a cluster pharmacist is and asked delegates to consider their experiences across clusters, their integration, services and planning. He asked what we need to do as a CoP to make these experiences better? He concluded the presentation with a closing remark that it s up to the CoP to decide which, if not all, are the right focuses for this CoP. Mind mapping Matt asked the participants in groups of 2-3 to mind map the influences on the role of the cluster pharmacist. This issue caused fantastic discussion on the tables which is necessary for a CoP. The mind maps expanded to capture all thoughts and opinions around cluster pharmacy. There was a huge volume of feedback, some are displayed on the next few pages, the others are found in the appendix.

Mind Maps

What are cluster pharmacists dealing with? The level of feedback from this session suggests that this topic could form the basis of a more detailed and dedicated session within a future meeting of the CoP. It was noted that several areas amongst the mind maps were repeated numerous times which may require further exploration of service and development needs. It was evident that sharing common experiences from pharmacists could be a powerful and integral component to shaping the future of the profession. Some of the themes are below. The mind maps themselves still supply of a wealth of information Development needs CPD, role extension, training needs. Recognition identity, clinical expertise. Communication feedback, networking, isolation. Support admin tasks. Time Work life balance. Pressure to report drug switches, cost savings, activity spreadsheets. Scope of practice utility, current skill sets. Quality of care variation within a cluster. Resources IT A pharmacist operating in unknown territory Paul introduced Rob Liddington, a pharmacist formerly of the British Army discussed some of the challenges he has faced when trying to improve medicines optimisation in difficult circumstances with limited resource. These included snake bites, methanol poisoning and difficult decision making.his most poignant message to fellow pharmacists were to be inventive and adventurous.

Delights and Dilemma s Working on their tables, participants were asked to create two lists. These Wordles illustrate the feedback with the largest words appearing most often. List 1: Things that annoyed you in your work, this week: List 2: Things that annoy you in your work, permanently:

Participants were then asked to consider what made work meaningful for them, what aspect of their work, provided them personally with a sense of delight. The room then self-organised into complementary groups based on the themes that arose. The delights are in the wordle below. The groups were then provided with a challenge: 1. To add up the total years experience on a table. 2. To list every initiative, programme or event they had come across in their professional career. 3. In their groups to then write a list to capture work the CoP could do in the future. They were encouraged to discuss some of the issues and problems that have arisen throughout the day. The result: 1. The total experience of the 75 attendees in the room was 1234 years. 2. The list of events are below, a total of 68 different pieces of work. List of programmes, initiatives and policies 111 Mid staffs 1000 Lives Minor Ailments scheme Agenda for change MMIS AWMSG 2003 MUR Blacklist MURs 2004 Clusters NHS direct Common Ailments 2013 NICE (late 90's) CPD NWIS Community pharmacy contract 2005 Pathlinks Degree course (up 3 to 4) 1997 PGDs Devolution 2001 Pharmacist mandatory CPD 2207/8 Different health ministers Polypharmacy

List of programmes, initiatives and policies DMEs 3010 POM's to Ps DMR Post grad diplomas Electronic prescriptions Pre reg exams 1992 Emails Prescribing data Enhanced services Prudent Healthcare 2014/2015 Facility Pharmacists QoF Fallow year 2001 Registered / Checking technicians Fund holding 90's Responsible Pharmacist GMS 2004 contract Robotic dispensing GP contract 2008 RPS / GPHC HA to Trusts to UHBS 2010 NHS reorganisation RPSGB to GPHC 2010/11 Healthcare inspectorate Wales Schools of pharmacy 2010 Improving Health 2014 Setting the direction Independant / Supplementary Prescribers Shipman Internet - patient googling Smoking cessation / banned indoors Just in case boxes Spoonful of sugar Kings Fund Supplementary Independant prescribing 2004 LHB reorganisations 2009 & others Together for Health 2000's LHG to LHB 2000 / 2001 Trusted to care, Berwick report MECC TTC 2002 Medicines act WCCG 2012 Medicines Reconciliation WES - hosted computers 3. The work we could do in the future was sorted by themes which are: Improving Relationships Training and Development Sharing Best Practice Measurement Finance Governance At the risk of being lists of tables, the idea is so that the whole CoP has a record of what was recorded. They are included to create discussion at future events. Duplication has been removed or combined. Improving relationships Advice forum - in between meetings - share resource for problem solving Communication Decrease the isolation Directory of COP Educate colleagues i.e. GP Education of healthcare team Education of patients Education required for GP's to explain purpose of role - clarify different pharmacist roles

Improving relationships Email list Embedded in practice Encourage GP attendance (funding / locum cover) Engagement Engagement with GPs and rest of team Expectations and clarification of the role (Pharmacists, GPs, practice, HB and WG) Feedback from surgery's - how getting along Forum Good to have more practice managers involved GP expectations integration into GP team Greater influence in primary care Integration - community pharmacy its role integrating into the cluster world Minor ailment training Multidisciplinary working Networking PR ( improving relationships) Professional networking - blogs, email, electronic forum Promote pharmacists resource i.e. What we can do for patient Promotion of role Public awareness - patient opinion, patient education Public Health / health promotion - empowering patients Publication of role Regular contact Relationship with team Support Sustaining role of cluster practice pharmacists Time for COP to shine while GP community decline Understanding of others about the role USP of a cluster pharmacist Visibility in practice Training / Development Medication review - tools available to help? Cluster tech's Adopt additional skills? - phlebotomy, foot assessments, monitoring conditions Advocacy / mental capacity e.g. In care homes (Shine) Chronic disease management Clinical element and teaching - monitoring i.e. Bloods etc, introduction, clinically identity areas go Clinical systems training (master classes) Consultation skills Education - skills - what and how? Standardised? Education and training - patient assessment, consultation skills, deprescribing, TA relevant, Expert speakers - 1 hour clinical session added to COP Getting the most of a cluster pharmacist Importance of IP qualification Induction checklist / plan for cluster pharmacist (based on experience of pharmacist) Interpreting bloods (in context of CDM) Interpreting test results

Training / Development IT training IT/ colleague roles Optional training Peer review / Mentoring / Hot review / Clinical Supervision Professional development - maintenance / building competency Protective time Research / Evaluation Specific cluster pharmacist tasks, applicable across all surgeries. Training (specific) Training needs, support needs and resources of pharmacists Training on GPs and how they operate - funding, QoF, GMS contract. Training package Undergraduate - incorporate into course. Pre reg - split between primary and secondary care Sharing best practice Benefits of cluster pharmacists to practice & patient England - 3 year postgrad qualification (facility + ipek (sic?) is this better Glossary of best practice examples Inhaler technique (AW note - Powys project) Learning from good model of practice Polypharmacy / de prescribing Prescribing Process Quick wins - care homes, polypharmacy, enteral nutrition, asthmatics (inhalers), gaining confidence, relationships with GPs/ DN's. Reorganisation - delivering value Share and evaluate best practice - GP one. Sharing good idea / practice Sharing ideas across cluster practices Sharing of skills / expertise / learning / case studies Sustaining GP Practices Measurement? Increase number of pharmacists per surgery rather than cluster Impact of pharmacists on improving patient care Improve DNA rates Increase number of pharmacists i.e. One per surgery Meaningful data Repeat dispensing Showing 'value', outcome measures - quality, quantity time saved, financial save Waste / batch prescribing Finance Batch prescribing - savings vs safety Business cases writing

Finance Financial return to practices / LHB - value to struggling partnerships and LHB Funding / Business cases MUR funding - Clusters instead for COP Potential threats to general practice business from community pharmacy e.g. Dispensing, flu, drums, asthma checks etc - these sayings will not attract new GP partners Governance Antibiotic governance Centralised uniform evaluation Clear direction to be set by - Cluster? LHB? WAG? Patients? GPs? Clinical coding (contribution to QoF / LES) RGD ( Service evaluation - Pincer study) - KPI, outcomes, IT support Evaluation This programme of work is being evaluated by Cardiff University (supported by a grant from the Health Foundation). Alison Bullock introduced the research team and the evaluative element of the programme. She outlined what the evaluation would entail and the contributions of those involved. Three things will happen to support the production of a final evaluation report in 2017: Observation of the CoP meetings Focus group discussion and individual interviews Your reports about your QI practice (submitted on a short structured online form) Short structured online reports about your QI practice. Purpose To learn about how a Community of Practice might help you use your quality improvement skills (Bronze IQT training) for better service outcomes. Does a CoP support the habits of an improver and develop technical, soft and learning skills?

Closing Keynote The closing keynote was presented by Dr. Richard Lewis, the National Professional Lead for Primary Care in Wales. He shared his early reflections of being in post. He recognised the formidable challenges facing GPs, and primary care in Wales and across the UK. He was pleased to have encountered unexpected levels of enthusiasm, examples of innovation and novel ways of trying to overcome what are difficult times for health services. He advocated that primary care can offer the means of a solution to the challenges currently facing health systems the world over and that the National Primary Care Plan for Wales is an unequivocal commitment to put primary care front and centre. He promoted that new approaches have to be found if we are to maintain sustainable health and social care services. He covered the significant evidence of initiatives involving the valuable use of health professionals in practice and in the community across all specialities and more through cluster working in Wales. There is evidence emerging on their impact from all these areas on increasing capacity and helping to manage workload. He put questions to the group and there was light discussion over what problems are being faced and the way forward within a CoP. Richard closed the keynote with a message to the CoP we can predict clusters should make waves of change once they are having a measurable impact, I think clusters too have the potential to change everything.

Forming the Community of Practice Margaret Allan, Director of WCPPE closed the first Community of Practice for Cluster Pharmacists. Margaret recapped on the day s events and reiterated that the CoP is what the group wants out of it, and that it can only truly form if we keep the momentum going. She thanked everyone for their time and commitment, contributing to the mind maps, dilemmas and discussions. She hoped that others felt the sense of purpose created in the room and that this was an opportunity for ongoing networking and communication for the pharmacists in the community. On behalf of 1000 Lives Wales, Paul Gimson and Matt Wyatt quickly thanked everyone for their attendance and reminded them of the upcoming meetings, overleaf.

Next Time Tuesday 12 th July 2016 Thursday 13 th October 2016 Wednesday 25 th January 2017 For further information contact: Paul Gimson Public Health Wales Mail: Innovations House, Llanharan CF72 9RP Email: paul.gimson@wales.nhs.uk Phone: 01443 233233

APPENDIX Attendee list First name Last name Job title Organisation Margaret Allan Director-WCPPE Cardiff University Mark Allen Clinical Pharmacist Cardiff & Vale UHB K Louise Victoria Claire Thomas Allen Allum Arthur Banning Policy and planning manager, Wales North Wales Regional Coordinator Pharmacist prescribing advisor Practice Support Pharmacist Company Chemists Association Wales Centre for Pharmacy Professional Education Abertawe Bro Morgannwg UHB Brecon Medical Group Practice Carl Barrett Cluster Pharmacist Cwm Taf UHB Rachel Beckett Practice Based Pharmacist - Monmouthshire South Aneurin Bevan UHB Ian Bevan Practice Manager - Bridgend North Network Lead Abertawe Bro Morgannwg UHB Sarah Bevan Cluster pharmacist Hywel Dda UHB Ann Brown Practice Manager General Practice (The Health Centre Abercynon) Alison Bullock Professor Cardiff University Sarah Bush Prescribing Adviser Taf Ely Cluster Cwm Taf UHB Mike Curson Senior Primary Care Pharmacist Aneurin Bevan UHB Manjinder Dahel Prescribing advisor Abertawe Bro Morgannwg UHB Lowri Davies Frailty and Chronic Conditions Cluster Pharmacist Hywel Dda UHB Ian Dodd Practice Manager Cwm Taf UHB Allan Donnithorne Cluster Pharmacist Cardiff & Vale UHB Rowena Duffield Practice Based Clinical Pharmacist Bethan Edwards Cluster Pharmacist Consultant in Pharmaceutical Public Sian Evans Health Head of Pharmacy Samantha Fisher Affairs, Lloyds Pharmacy Programme Manager for Paul Gimson Primary Care Aneurin Bevan UHB Abertawe Bro Morgannwg UHB Public Health Wales Community Pharmacy Wales 1000 Lives Improvement Service

First name Last name Job title Organisation Anthony Hall Practice pharmacist Aneurin Bevan UHB Lloyd Hambridge Practice Based Clinical Pharmacist Caerphilly East Neighbourhood Care Network Aneurin Bevan UHB Paul Daniel Harris Hay Healthcare Partnerships Manager Taff Ely cluster pharmacist Boots UK Cwm Taf UHB Jamie Hayes Dirctor Cardiff and Vale Lucy Higgins Practice Based Pharmacist- Monmouthshire North NCN Aneurin Bevan UHB Claire Hill Practice-Based Clinical Pharmacist, Newport North NCN Aneurin Bevan UHB Charlotte Hill GP cluster Pharmacist Cwm Taf UHB Kath Gareth Hodgson Holyfield head of programme delivery Principal Pharmacist in Public Health Wales Centre for Pharmacy Professional Education Public Health Wales Caroline James pharmacist Cwm Taf UHB Kirsty James Receptionist Cwm Taf UHB Tracey James GP, DSMP for IP pharmacist at Newport Aneurin Bevan UHB Hayley James neightbour care network pharmacist Aneurin Bevan UHB Kate Jenkins Cluster Pharmacist Cardiff & Vale UHB Marian Jones Cluster Pharmacist Cardiff & Vale UHB Viv Kent Practice Manager Aneurin Bevan UHB Non Lewis Prescribing Advisor Advanced Pharmacist Cwm Taf UHB Christina Lewis GP Cluster Pharmacist Abertawe Bro Morgannwg UHB Robert Liddington Pharmacist Specialist Care quality commission Sarah Long cluster pharmacist Abertawe Bro Morgannwg UHB Paul Mayberry Community Pharmacy Lead Aneurin Bevan UHB Haydn Mayo Community Director Cardiff & Vale UHB Ruth Mitchell Pharmacist Boots Moira Moore Practice Business Manager Ashgrove Surgery Sarah Moore Practice manager Parc Canol group practice practice based Melissa Morgan pharmacist Aneurin Bevan UHB

First name Last name Job title Organisation Gethin Morgan Cluster Pharmacist Cardiff & Vale UHB Kirsty Morris Prescribing advisor Advanced Practice Vanessa Morton Pharmacist Cluster Pharmacists - Rachel Murphy West Network Bridgend Abertawe Bro Morgannwg UHB Abertawe Bro Morgannwg UHB Abertawe Bro Morgannwg UHB Emma Nurse Cluster Pharmacist Hywel Dda UHB Practice based clinical Carl Peacock pharmacist Aneurin Bevan UHB Lorna Phillips Respiratory Pharmacist Cwm Taf UHB Lia Popa Pharmacist Betsi Cadwaladr UHB Lisa Pottenger practice based pharmacist Carolyn Poulter Regional Co-ordinator Aneurin Bevan UHB Wales Centre for Pharmacy Professional Education Nerys Rees Practice Nurse Cwm Taf UHB Lisa Riley Pharmacist Aneurin Bevan UHB Debra Roberts Head of Programme Development Wales Centre for Pharmacy Professional Education Elaine Russ Research Centre Manager Cardiff University Has Shah GP Cwm Taf UHB Kate Spittle Practice Pharmacist Cwm Taf UHB Senior Primary Care Anne Sprackling Pharmacist Aneurin Bevan UHB Neil Jayne Sugden Taylor-Lloyd Pharmacist Prescribing Adviser Practice business manager Abertawe Bro Morgannwg UHB Cwm Taf UHB Elly Thomas Practice Pharmacist Ashgrove Surgery Helen Thomas Pharmacist Davies Chemist Ltd Jane Thomas Senior Primary Care Pharmacist Aneurin Bevan UHB Avril Tucker Primary Care Antimicrobial Pharmacist Abertawe Bro Morgannwg UHB Christine Vining Primary Care/Practice Pharmacist GP practices in Cwm Taf and Cwm Taf UHB Sheree Vyas pharmacist Wales Centre for Pharmacy Professional Education Jonathan Walker Locality Pharmacist Betsi Cadwaladr UHB Service Improvement and 1000 Lives Improvement Andrew Ware Development Manager Service Katie Webb Researcher Cardiff University James Wermig practice pharmacist Aneurin Bevan UHB

First name Last name Job title Organisation Helen Wigley Cluster Pharmacist Cardiff & Vale UHB Don Wilkes Practice Pharmacist Argyle Medical Group Rory Wilkinson Locality Lead Pharmacist Betsi Cadwaladr UHB Anna Williams Prescribing Support Pharmacist Hywel Dda UHB Nerys Williams locum practice pharmacist Parc Canol surgery Michael Williams Practice Pharmacist Aman Tawe Partnership Medical Practice Ivana Wong cluster pharmacist Cardiff & Vale UHB Bev Woods Pharmacist Team Leader - Primary Care Cwm Taf UHB

Mind Maps

01/05/2016 09:30 Registration & Refreshments Pharmacists in Practice All Wales Community of Practice 10:00 How did we get here? Andrew Evans 10:20 What s a Community of Practice Matt Wyatt 11:00 The Right Focus For a COP Paul Gimson 12:00 A Pharmacist in Unknown Territory Rob Liddington 12:30 Lunch & Networking 13:30 Delights and Dilemmas Matt & Paul 14:30 Evaluation Alison Bullock 14:45 Closing Keynote Richard Lewis 15:00 Forming the Community of Practice Margaret Allan 15:30 Close Andrew Evans HOW DID WE GET HERE? Matt Wyatt WHAT IS A COP? Apologising Improvement Advisor at Public Health Wales Why am I here? Complex Need Creating Space Apologising Mechanistic Answer Best Practice Rational Risk Averse Deductive Structure Targets Projects Facts Unilateral End Points Instructed Planned Taught Delivered To Supervised Manufactured Consultation Process Universal Standardised Similarity Supply Designed Information Organised Teams Intelligence Inform Regulated Negotiated Probable Show Invent Leadership Organic Context Good Practice Holistic Risk Wise Political Network Outcomes Experiments Ideas Together Connections Advocated Responded Learned Achieved With Accountable Grown Participation People Individual Tailored Diversity Equip Evolved Communication Understood Groups Wisdom Discuss Appreciated Mediated Possible Guide Innovate Relationship 1

01/05/2016 TQM BPE CIC PDSA L6σ & PBMA End Step 2 Step 1 Start The Process Fallacy Processes are defined by a very highly specified, predetermined end point and they are very, very useful. Things that are not processes: Retrospective Coherence Lists drawn into shapes It must be your fault... Extravert v Introvert Sensing v Intuition Thinking v Feeling Judgement v Perception Leadershippers on tour... Culture Vision Values Strategies Objectives Missions Champions Frontlines Processes (again) Integrated Modernisation Pathway Seamless Linkage Facility Proactive Context Pyramid Optimal Resource Framework Stable Client Model Inclusive Downsizing Market Special Polynomial Network Focused Consensus Vision Strategic Engagement Transformation Instinctive Fallback Solution Virtual Empowerment Mechanism Mutual Appreciative Flow Elemental Scoping Principal Established Cartesian Exercise Participative Tertiary Approach Innovative Learning Forum Organic Stakeholder Cascade Evolutionary Leadership Cycle Narrative Pooling Inquiry Robust Re-engineering Tree Collaborative Centred Challenge Eclectic Regional Partnership 2

01/05/2016 www.inc.com 1 13 4 Altogether in practice Your trained in a silo, employed in a silo and then someone says, now all go and work together it ll be fine! Communities of Practice... 1991: Institute for Research on Learning in Palo Alto, California - Etienne Wenger and Jean Lave coined the term Community of Practice The term was first used in their study of apprenticeship and has since been applied to government, education, social service providers, and various professional organizations. A lot has happened since! A community of practice is a network of people who share a specific area of knowledge and are willing to work and learn together over a period of time to develop and share that knowledge a shared domain of interest a membership who meet to share their experience and a common practice The basics it is recognised that some of the most creative and sustainable work comes from facilitating passionate and committed practitioners to share experiences and knowledge, in order to bring about change in their own practice. Fluffy bunnies 3

01/05/2016 Over the last 10 years... Care Planning Unified Assessment Chronic Conditions Passing the Baton Discharge Nurses Intermediate Care Challenging Behaviour Falls Collaborative Complex Care Forum PMLD Pharmacists in Practice Practice in Practice It s a living thing not a machine, it lives & dies! Groundwork, a few rules & a sense of direction Fine tuning the rhythm & wisdom of the crowd Enthusiasts, the six hour rule & a tipping point Participative, fun and intellectually stimulating A shift in perspective... How to create the conditions that enable people to feel good, have space to think, get together, take a risk, do a couple of experiments and nurture their intrinsic motivations... all at the same time? The Fundamental Attribution Error 24 www.thesun.co.uk 4

01/05/2016 Leveraging the Diversity... Unconditional Positive Regard static.panoramio.com 25 Crowd Error = Average Error Diversity Paul Gimson THE RIGHT FOCUS 5

01/05/2016 Current roles within the pharmacy team Practice Based Pharmacist Primary Care Pharmacist Prescribing Advisor Community Pharmacist Intermediate Care Pharmacist Hospital Pharmacist Prescribing Pharmacist etc Cluster Pharmacists... Follow the money... Primary Care Plan A primary care service made up of a wide range of professionals working as a coordinated and integrated team of GPs, nurses, pharmacists, midwives, health visitors, dentists, optometrists, physiotherapists, podiatrists, healthcare support workers, social workers and others. Will become the mainstay of the NHS: tackling the root causes of ill health, preventing people from being admitted to hospital unnecessarily, helping those who have been admitted to get home quickly with the right support; motivating and supporting people with chronic conditions and long-term illnesses to manage their health at home. The new primary care service for Wales will help to reshape the NHS, developing and increasing the primary care workforce to provide the majority of care close to people s homes, accelerating the transfer of services from the hospital to the community and improving the way people can access services. Primary Care Plan Primary Care Plan A primary care service made up of a wide range of professionals working as a coordinated and integrated team of GPs, nurses, pharmacists, midwives, health visitors, dentists, optometrists, physiotherapists, podiatrists, healthcare support workers, social workers and others. Will become the mainstay of the NHS: tackling the root causes of ill health, preventing people from being admitted to hospital unnecessarily, helping those who have been admitted to get home quickly with the right support; motivating and supporting people with chronic conditions and long-term illnesses to manage their health at home. The new primary care service for Wales will help to reshape the NHS, developing and increasing the primary care workforce to provide the majority of care close to people s homes, accelerating the transfer of services from the hospital to the community and improving the way people can access services. PRINCIPLES UNDERPINNING THE PLAN Prevention Co-ordinated care Co-Production Planning services at a community level of 25,000-100,000 people Primary Care Clusters Prudent healthcare. No GP should routinely be undertaking any activity which could, just as appropriately be, undertaken by an advanced nurse, a clinical pharmacist or an advanced practioner paramedic 6

01/05/2016 So what...?...is your experience? Of working ACROSS the cluster? Of INTEGRATION with the wider primary care team? Of the provision of CLINICAL PHARMACY SERVICES Of PLANNING services on a population level...do we need to do? To improve working ACROSS the cluster? To INTEGRATE the role of cluster pharmacist with the rest of the primary care team To deliver CLINICAL PHARMACY SERVICES based on the identified NEEDS of your local population Pick a subject you think is important Rob Liddington UNKNOWN TERRITORY mind-mapping.co.uk Lunch & Networking RECONVENE @ 13:30 Matt & Paul DELIGHTS AND DILEMMAS 7

Conceptual Real World Conceptual 01/05/2016 Dilemmas... Delights... Create list with dates, of all the policies, strategies, projects reorganisations and big ideas that you ve been involved in (or subjected to) throughout your career, that have effected how you practice. www.despair.com Discovering any potential assets Exapting assets to a new greater utility Adapting assets with continuous feedback Optimising assets by moving them around Milking the assets you ve already got Stretch participants to explore opportunities and innovate in unpredictable environments Participative method, creative facilitation and immersive exercises Some Participants will feel more comfortable in exploration others in analysis: the model is a synthesis to leverage the collective diversity Time scale is fractal over a session, a day and the life of the programme Time Learning sessions begin and end by reflecting on the participants own experience of life back in the real world Expert led case study, measurable precedent and working tools Stretch participants to analyse problems and embed evidence in predictable environments 8

01/05/2016 Evaluation Alison Bullock EVALUATION Helping GP practice-based pharmacists to implement their improvement skills: Assessing the value of a community of practice model Working in collaboration with Margaret Allan Andrew Evans Matt Wyatt Paul Gimson Purpose To learn about how a Community of Practice might help you use your quality improvement skills (Bronze IQT training) for better service outcomes. Does a CoP support the habits of an improver and develop technical, soft and learning skills? Guinea pigs.. Our approach 1.Develop an official theory (logic model) to describe the conditions or context (C) under which the mechanisms (M) operate to produce desired outcomes (O). 2.Undertake a CoP case study, observing meetings, interviewing participants 3.Present a real theory which describes the features required for optimising the contribution of a CoP and implementation of QI skills. 9

01/05/2016 What will happen? You participate in CoP meetings which we observe Focus group discussion and individual interviews Short structured online reports about your QI practice. This project has been reviewed and approved by a research ethics committee at Cardiff University. Thank you for listening bullockad@cardiff.ac.uk 02920 875403 www.cardiff.ac.uk/curemede Richard Lewis KEYNOTE Corporate slide master With guidelines for corporate presentations Pharmacists in Practice 27 April 2016 All Nations Centre, Cardiff Dr. Richard Lewis National Professional Lead for Primary Care in Wales NHS Wales/Welsh Government 10

01/05/2016 The Primary Care Plan 1978 Primary Care Front and Centre Planning care locally Improving access and quality Equitable access A skilled local workforce Strong leadership. Alma Ata 1978 Alma Mata Declaration 1978 Government Commitment Clusters Public Health Initiatives (PHW & Legislation) Community Referral Personal Responsibility Integrated Whole System Approach/Planned & Unscheduled Care, OOH, Social Care Multidisciplinary Primary Health Care Teams Real Challenges Real Needs OECD Report An ageing population High levels of chronic disease Health inequalities Lifestyle choices and other 11

01/05/2016 Primary and Community Care Teams Re-Inventing the Primary Healthcare Team Clinical pharmacists Improving access to Community Pharmacy Improving access to optometry Improving access to audiology Improving access to dentistry Extended practice nurse role Advanced & specialist nurse practitioners Physiotherapists Paramedic practitioners Occupational therapists Physicians Associates Let s Journey Together Margaret Allan FORMING THE COP 12