Introducing the NTDA Medicines Optimisation and Pharmaceutical Services Richard Seal Chief Pharmacist NHS Trust Development Authority
What are the basic functions of the NHS TDA? Functions previously held by.. now held by the NHS TDA DH SHAs Appointments Commission Assurance of clinical quality, governance and risk in NHS trusts Performance management of NHS trusts Management of the FT pipeline Appointments to NHS trusts of chairs and non-executive members and trustees for NHS charities, where the Secretary of State has a power to appoint
What are we setting out to achieve? Our ambition is to deliver high quality, sustainable services in every part of the NHS The Government has set a target to ensure that all providers become Foundation Trusts We provide oversight, support and performance management for all remaining NHS Trusts Quality is at the heart of the organisation the clinical directorate has around 50 staff dedicated to supporting NHS organisations to improve quality The vast majority of organisations are expected to be able to reach FT status although a small minority may be unviable
What s the scale of the challenge? One aspiration: to deliver sustainable, high quality services in every part of the NHS NHS Trusts Some that are close to achieving FT status Some require support to ensure they progress along the pipeline Some need significant support or intervention to be able to succeed One national operating model that has quality improvement at the heart of what we do
Where are they based? North - 19 Mids & East - 37 Of the 102 NHS Trusts the split is: 62 Acute 14 Mental Health 7 Ambulance 19 Community Of the 62 Acute Trusts: South - 24 London - 22 20 Large (> 400m) (turnover) 29 Medium (200m 400m) 13 Small (<200m)
The support NHS Trusts can expect from the NTDA One clear ambition To ensure that every NHS Trust can deliver high quality, sustainable services for the communities they serve What support the quality and clinical team is able to offer Named teams to support trusts locally One-to-one support and advice for MDs and NDs Links with high performing Trusts Peer review Mentorship support for new directors On-site expertise on key issues
Clinical team to support NHS Trusts improve quality Patient Experience Julia Holding Director of Nursing Peter Blythin One voice on quality Medical Director Dr Kathy McLean Workforce Intelligence Chief assurance & & insight Pharmacist Richard Wilson surveillance Richard Seal Fabian Henderson With a set of functions which will help create the conditions to succeed HCIA 4 x clinical leads Clinical Quality Directors Heads of Quality Quality Managers With a local presence to support and work alongside NHS Trusts to help them to improve the quality of care they provide
NTDA Approach
Planning guidance The planning guidance is to enable trusts to confirm that they meet key requirements for : Quality Workforce Performance Finance Quality, Innovation, Productivity and Prevention (QIPP) Innovation, Health and Wealth NHS Foundation Trust Pipeline
Accountability Framework Describes how expectations will be delivered, sets out how the NHS TDA will work with Trusts on a day-to-day basis, how progress will be assessed and how development support will be provided
Medicines and the NHS TDA Medicines Optimisation... describes the way we will deliver the quality use of medicines to improve outcomes for patients Outcomes and effectiveness Safety Patient experience Safety Outcomes & Effectiveness Patient Experience
Medicines Optimisation Issues Medicines still most common therapeutic intervention 30 to 50% are not taken as intended Medication errors at unacceptable levels 2 to 14% of admitted patients (~ 300,000 to 2 million p.a.) Literature suggests 5 to 8% of hospital admissions due to preventable adverse effects of medicines ~ 19,000 p.a. in West Midlands Medicines waste ( 300m in primary care, unknown in secondary care) Patients report poor experience with medicines (Picker Institute) Not enough information or support (CQC Outcome 9) Relatively little effort towards understanding clinical effectiveness of medicines in real practice The more common a problem, the less likely it has been that energy and resources would be expended in tackling it Robert Francis QC
The legacy of Mid Staffs Hospital Francis Report Failure to put the patient first Acceptance of poor standards Lack of consideration of risks Defensiveness and secrecy Inwards-looking Misplaced assumptions of trust Challenges for Chief Pharmacists - Do you know what business you are in? - Pharmacy or medicines optimisation service? - Lack of engagement - Professional isolation - Target-driven - Over reliance on external assessments - Failing to see what others do - Focus on process rather than outcomes - Changes in delivery models - Lack of innovation - Workforce & skill mix - Lack of resource
Drivers for medicines optimisation Safe use of Medicines Medicines are used safely and patients are protected from avoidable harm Clear lines of responsibility and accountability for safe and secure use of medicines Optimal outcomes through informed implementation of NICE and other national guidance Medicines Optimisation Effectiveness and value Access to senior advice (Chief Pharmacist or equivalent) on the legal, safe and secure handling of medicines Effective systems for ensuring cost-effective use of medicines and budget management eg. formularies Effective relationships between commissioners and providers are in place Patient experience and outcomes Decisions about medicines are made jointly between patients and healthcare professionals Patients and carers are supported along care pathways and across all care interfaces to make the best possible use of medicines Decision-making process about availability and funding of medicines are robust, transparent and in accordance with NHS constitution commitments
NTDA Approach Baseline Assessment Available data CQC, SIs, workforce Legislative & Regulatory Requirements NTDA framework Self-assessment and benchmarking Clinical Academy Faculty of expert practitioners Links with high performing trusts Multidisciplinary approach Identifying and addressing development needs Peer review, appreciative enquiry Identifying and sharing exemplar practice Collaboration and buddying On-site support and intervention Assurance How will your trust board be assured that medicines optimisation is in place? NTDA sign off
NTDA Framework for medicines optimisation and pharmaceutical services Sources - RPS Hospital pharmacy standards - Relevant legislation and Regulations - CQC Outcomes 9 - NHS Constitution - DH performance framework - Controls assurance framework - Spoonful of sugar - RPS principles for medicines optimisation Provide a means by which NHS trusts can assess their own current position and enable NTDA to establish a baseline Identify areas of existing good practice and areas for development Peer review and buddying Co-operation and collaboration on issues of mutual interest Focus for delivery of Master classes Assurance during transition to Foundation status
Areas of specific interest Safety Integrated governance Medicines reconciliation Medication errors Antimicrobial stewardship and AMR Safe and secure handling of medicines HARMs Patient Experience Access to advice on medicines Interfaces of care Risk assessment & pharmaceutical care planning Adherence support Friends and family test Effectiveness and outcomes NHS Outcomes framework NICE implementation incl. formularies QIPP, CRES, CIPs incl. homecare Workforce, skill mix, education & training Benchmarking and KPIs, peer review
NTDA Priorities HCAI, antimicrobial stewardship and antimicrobial resistance benchmarking and implementation of CMO recommendations Standards for education and training (multidisciplinary) Support for management of long term conditions making every contact count Transfers of care discharge planning and pharmaceutical care Areas of high risk VTE, omitted doses, higher risk medicines, SUIs and Never Events Models of delivery for pharmaceutical services incl. workforce, leadership and contract specifications
In summary Our ambition is to deliver high quality, sustainable services in every part of the NHS Medicines Optimisation... describes the way we will deliver the quality use of medicines to improve outcomes for patients Outcomes and effectiveness Safety Patient experience