Implications of the Carter report for MI, what we can learn from colleagues in Scotland? Yvonne Semple Lead Pharmacist, MI Services NHS GGC UKMi PDS Tuesday 27 th September 2016
What can we learn from Scottish Colleagues?
What can we learn from Scottish Colleagues?
What can we learn from Scottish Colleagues?
What can we learn from Scottish Colleagues? Views of Chris Ham CEO The Kings Fund (blog entry 21/6/16) Patient Safety Healthcare Improvement Scotland Clinical Care National clinical strategy CMO s Realistic Medicine Integration of Care Auditor general challenges NHS Scotland to realise benefits of integrated working
Carter Report (Feb 2016) Optimising resources Set of benchmarks and indicators to enable comparison Variances in use of medical staff job planning and deployment of Allied Health Professionals In hospital pharmacy we know that the more time pharmacists spend on clinical services rather than infrastructure or back-office services, the more likely medicines use is optimised Quality, efficiency & performance Challenges with wider system issues; barriers to greater collaboration, cooperation and economies of scale
Carter Report (Feb 2016) Recommendation 3 Trusts should, through a Hospital Pharmacy Transformation Programme, develop plans by April 2017 to ensure hospital pharmacies achieve their benchmarks such as increasing pharmacist prescribers, e-prescribing and administration, accurate cost coding of medicines and consolidating stock-holding by April 2020, in agreement with NHS Improvement and NHS England so that their pharmacists and clinical pharmacy technicians spend more time on patient-facing medicines optimisation activities;
Carter Report (Feb 2016) Recommendation 3 Trusts should, through a Hospital Pharmacy Transformation Programme, develop plans by April 2017 to ensure hospital pharmacies achieve their benchmarks such as increasing pharmacist prescribers, e-prescribing and administration, accurate cost coding of medicines and consolidating stock-holding by April 2020, in agreement with NHS Improvement and NHS England so that their pharmacists and clinical pharmacy technicians spend more time on patient-facing medicines optimisation activities;
Carter Report (Feb 2016) Hospital pharmacy and medicines optimisation The primary functions of the hospital pharmacy team are to work closely with patients, doctors and nursing staff to choose, prescribe and monitor clinical outcomes of medicines to meet clinical needs and to support their optimal use. Simply put, the NHS needs to focus the pharmacy workforce to drive optimal value and outcomes from the 6.7bn it spends on medicines. Trusts should therefore ensure more clinical pharmacy staff are deployed. To deliver optimal use of medicines, make informed medicines choices, secure better value and drive better patient outcomes.
The service has two broad functions: to support medicines management within NHS organisations to support healthcare professionals optimise use of medicines for individual patients
Quality, efficiency & performance Challenges with wider system issues; barriers to greater collaboration, cooperation and economies of scale Medicines Information Services within Scotland
5 million people 12 billion 14 health boards 8 support boards Integrated delivery Health and Social Care
No NHS Board MI Service 1 NHS Ayrshire and Arran Yes 2 NHS Borders No clinical pharmacy cover only 3 NHS Dumfries & Galloway No clinical pharmacy cover only 4 NHS Western Isles Supported by NHS Highland 5 NHS Fife Supported by NHS Tayside 6 NHS Forth Valley Supported by NHS Lanarkshire 7 NHS Grampian Yes 8 NHS Greater Glasgow & Clyde Yes 9 NHS Highland Yes 10 NHS Lanarkshire Yes 11 NHS Lothian Yes 12 NHS Orkney Supported by NHS Grampian 13 NHS Shetland Supported by NHS Grampian 14 NHS Tayside Yes
Collaboration and Teamwork
The 3Ps of teamwork Purpose Why, What, When People Who? Process How?
Team synergy A team produces a better result than the sum of the individual results of its members A team improves even its best member s result 1 + 1 > 2
Four Regional Centres NHS Grampian (Aberdeen) NHS Greater Glasgow & Clyde (Glasgow) NHS Lothian (Edinburgh) NHS Tayside (Dundee) All MI centres are based within acute care hospital sites All 14 health boards represented at ASMIP
Meet every 3 months Audit of smaller non-regional centres Peer review on regional basis Link with UKMi Executive Members of UKMi working groups education / CG Provide peer support
Share resource bulletins / memos Share Formulary work briefings for non-formulary medicine requests Annual report to Directors of Pharmacy Group Scottish Medicines Consortium Horizon Scanning Yellow Card Scotland
Centralisation in Scotland
Centralisation in Scotland
Centralisation in Scotland
Collaboration in Scotland
Future collaborative work programme BNF educational tool Supply problems On-call resources Education packages Possible support for 7/7 working nationally as a MI team
Centralisation - personal experience Single MI pharmacist in small hospital Area MI centre Learn more better at what I do Share workload, training don t feel isolated Don t know everyone, faces = lost visibility. Some colleagues are wary of approaching MI don t know who they will speak to
Centralisation - personal experience Part of team in process of centralisation Lead on centralisation Emotional for staff.. Get all stakeholders involved Service Level Agreement Consider issues in advance information governance Practicalities who are the key players?
Service Level Agreements Legal contract between board areas Enable service provision across Boards Finance Service specification Information governance Review
What do Hospital Pharmacists think about the MI Service? Questionnaire & Focus Group High level of satisfaction Centralisation has not affected majority Impact on sites where service has moved Impact on MI resources available at sites without physical MI centre
Set up of MI Services in GGC Population of 1.2 million Centralised MI service SLA with one HB Core functions Enquiry answering Formulary / Handbook Clinical Effectiveness projects Clinical pharmacy
Set up of MI Services in GGC Enquiry Answering Team Virtual team Shared database and enquiry workload Specialist services cross cover Close links with clinical teams across GGC
Set up of MI Services in GGC Clinical Effectiveness Team Real world data New medicines / established therapies Appropriateness / Safety Examples Biologics Parkinson s VTE LMWH and DOACs Omalizumab Oncology Cancer Medicines Outcomes Programme (CMOP)
Set up of MI Services in GGC www.ggcmedicines.org.uk
Set up of MI Services in GGC www.ggcprescribing.org.uk