Health and high quality for all, now and for future generations GP Community Pharmacy Transformation Programme Update February 2016
What is the GP Community Pharmacy Transformation Programme? The is locally funded by (NHS England, North Midlands) and is designed to maximise s health and wellbeing by making efficient use of the skills of both General Practitioners and Community Pharmacists. The aims to develop and evaluate new models of to test whether the quality can be improved by utilising community pharmacy independent prescribers (CPIP) in both a GP practice and/or a community pharmacy setting. CPIPs will be part of the wider General Practice team and co-manage s with long term conditions and urgent needs. Care for s in nursing s is also being tested. The project is hosted by Newark and Sherwood CCG. These models will be tested in 6 different locations across Derbyshire and Nottinghamshire over an 18 month period. Why is the important? NHS England s five year forward view (5YFV) of the NHS outlines the challenges from an aging population, increases in Long Term Conditions (LTC), demands from s acting as consumers,and the trend towards less healthy lifestyles. These challenges are characterised by three gaps, which will over time widen, if change does not occur within the NHS and society: 1) The health and wellbeing gap; 2) The and quality gap; 3) The funding and efficiency gap. The 5YFV is clear that there is a need to transform the way in which the NHS s for s, to promote multi-disciplinary teams, promote community based, and to promote self- of s. So, in summary there are increasing demands from s living longer, with more complex conditions, and wanting access quicker. There are pressures on recruitment and development of enough staff to cope with the increasing demands. There is an opportunity to use talented and highly trained pharmacists more effectively in Primary Care, to help to test whether we can start to bridge these gaps. We hope that the pharmacists will be able to help s and practices understand their medications better, conduct more comprehensive medication reviews, help to alleviate pressures in the general practice team by assisting with for s with long term conditions and urgent needs and add extra capacity to see s. BUXTON DERBYSHIRE Chesterfield Medical Partnership RIPLEY MANSFIELD RETFORD Abbey Medical Group NEWARK Well Spring Surgery DERBY NOTTINGHAM Giltbrook Surgery Lister House Surgery Swadlincote Surgery NOTTINGHAMSHIRE
What is the GP Community Pharmacy Transformation Programme? The Aims How is the being managed? We have a board made up of our sponsors NHS England, the project team, a, a GP, a clinical pharmacist, s from CCGs and Pharmacy organisations (LPCs and Pharmacy Voice) and we report on progress back to NHS England. How is the being evaluated? The project team closely monitors activity on a monthly basis but we are also working closely with the University of Nottingham, School of Pharmacy, to compile an independent evaluation of the activity at each of the pilot sites, services provided, outcomes for s, experiences, effects on practices and to look at how the model can be sustained into the future. What is contained in this update? We plan to issue the update every 2 months, and will feature the work of a different pilot site. The update is interactive, a bit like a web site, so you can click on buttons and look at information that is of interest to you. We plan to include examples of, and hope to include videos and pictures highlighting experiences and successes of the new services. We also will include pilot summaries on progress to date, and feature inputs from people contributing to the. In this update, there is a page on the involvement of our Citizen Representative, Mick White, who is part of our board. If you have any questions or would like further information please contact the manager Gerald Ellis, gerald.ellis@nhs.net This newsletter was produced by Sara Lewis at Newark and Sherwood CCG. If you have any comments or testimonials that you would like to include in future editions, please email sara.lewis@newarkandsherwoodccg.nhs.uk To maximise s health and well-being by making efficient use of the skills of GPs and CPIPs Develop and evaluate new models of to test whether the quality of can be improved by utilising CPIPs in partnership with GPs Develop medicines expertise in practice Help s to better understand their medicines Personal and clinicial development for pharmacists Improved help for s to manage their long-term conditions
Overview of Chesterfield Medical Partnership North Derbyshire CCG Rachel Smith. Clinical Pharmacist, Peak Kate Chilton - Practice Partner Dr Ami Kundu GP Supervisor Pilot commenced July 2015, 4 days per week - Hypertensive and AF reviews - DMARD reviews Abbey Medical Group Newark and Sherwood CCG Richard Harris. Clinical Pharmacist, Weldricks Rick Gooch Practice Manager Dr Ei Cheng Chui GP Supervisor Pilot commenced October 2015, 3 days per week - Nursing Home reviews Giltbrook Surgery Nottingham North and East CCG Jessica McMullen. Clinical Pharmacist, Manor Julie Wright - Practice Partner Dr Jacques Ransford GP Supervisor Pilot commenced October 2015, 2 days per week - Long terms conditions, CKD audit - Urgent Care - Nursing reviews Lister House Surgey Well Spring Surgery Swadlincote Surgery Southern Derbyshire CCG Nottingham City CCG Southern Derbyshire CCG John Gell. Clinical Pharmacist, NUH Steve Chapman Practice Manager Dr Andrew Brooks GP Supervisor Pilot commences April 2016, 3 days per week - Urgent Care Nitin Lakhani. Clinical Pharmacist, Jaysons Joanne Sherwood Practice Manager Dr Mark Swinscoe GP Supervisor Pilot commenced February 2016, 1 day per week - Home visits housebound s - Urgent Amardeep Nahal Clinical Pharmacist, Brennans Sarah Longland - Practice Manager Dr Ken Patton GP Supervisor Pilot commenced November 2015, 2 days per week - Urgent Care, triage
Kate Chilton, practice director at Chesterfield Medical Partnership has a wealth of experience in health, after spending 28 years in the NHS, during which time she has worked for the PCG, PCT, as a commissioner and provider, and as a practice manager. She now sits in a fairly unique position as practice director and feels very passionate about her role. The merger which formed Chesterfield MP came at a time when a lot of GPs were retiring, and recruiting new ones proving difficult, so the practice was was facing a problematic future, and had to look at new ways of working. Which is where Rachel Smith, and the GP community pharmacy transformation came in. Rachel has been working for Peak Pharmacy since 1998, and 8 years ago began at Chesterfield MP one day a week as a Prescribing Support Advisor. It was mainly as a cost saving initially, but developed into more clinical work, and that s how I became involved with the practice. For Kate, the fact that Rachel was already linked in with the practice and the staff was a huge bonus: Rachel was already working with the practice before the project, even before I joined 9 years ago, so there is confidence, there is trust; there is a really strong relationship. -Kate Chilton Since starting work on the pilot, Rachel says the biggest shift in her work has been that she is now interacting with s, rather than just combing through records on a computer. I ve also got my prescribing qualifications now, so i m issuing prescriptions as well. Kate Chilton - Practice Director Dr. Ami Kundu - GP Clinical Supervisor Rachel Smith - Independent Prescribing Pharmacist Chesterfield Medical Partnership is a merger of two well established Chesterfield GP Surgeries: Ashgate Medical Practice (formerly Avondale Road Surgery - which includes a branch site at Holme Hall) and Whittington Medical Centre. Registered s: 14,000 Chesterfield Medical Partnership Rachel Smith, Independent Prescribing Pharmacist www.medicalpartnership.co.uk In addition to providing Rachel with personal development opportunities, the pilot has had positive implications for s, GPs and the wider practice team. It s about finding the right skill mix for s, rather than just doing what s always been done -Kate Chilton Although saving money and increasing capicity may be the driver for much service redesign, the key is, of course, to do so whilst improving the quality of, which is precisely what has happened at Chesterfield, right through from the GPs to the admin staff. Receptionist, Hannah Coleman says: It s been great, because when people have a medication query and it s urgent for the day, we used to log it with the doctor on call, which meant their job would get a lot busier, whereas now we can log it for Rachel, and she can advise them. She also does a lot of medication reviews too, which frees up appointments, which makes our job a lot easier. I realise that now I ve got these new skills, I could go and take them elsewhere, but I don t want to do that. I feel very loyal to Peak, and to community pharmacy -Rachel Smith
What GPs and Patients at Chesterfield think pilot: Chesterfield Medical Partnership What s great about Rachel is she is able to focus the appointment on your medication, so the comes in with just one thing on their mind, all of the focus is on medication and leaves with every question answered. As GPs we are already pushed for time, and for available appointments. Having Rachel allows me more time to deal with s with more complex conditions. -GP -GP Since July Rachel has made over 1,400 contacts, which has created a lot of capacity for the practice. -GP Dr J. Ali, GP Partner This is the first time I have been able to properly discuss my medications with an expert. -Patient As a, having a comprehensive review of medications, having time to discuss what they are and to understand how they work, means that I understand why they are important and I am much more likely to take them. -Patient
Mick White - Citizen Representative How did you become involved in the project? MW: I originally put in for a role with the CCG and was unsuccessful in that particular interview, but then this role became available and the director at the time asked if I d be interested in taking part in this type of project, and it was exactly what I was looking for. And what was that? Because it is in an area that was going to be challenging for me, as I don t know a great deal NHS, but I was comfortable that I could bring something useful to the project as it gives me the opportunity to utilise the skillset I have from my time building and managing power stations, and as a senior manager. What do you think you have bought to the project? I think I ve bought some different ways of doing things. Not an NHS way. Coming from a private enterprise, our whole culture is about the customer client relationship- the customer being the, in this instance- so that is very much my focus, which I think gives me the opportunity to ask questions that maybe other people wouldn t ask, and bring some clarity in this area. I was also able to offer some strategic changes or advice to the project board way that the project was going in one or two other areas to help it arrive smoothly, and I think some of those were taken on board. What do you feel are the benefits of the project? Throughout my working er I ve always had the view that if you ve got highly skilled people, they should be working at their correct level, so when the idea of this project was put to me it was clear in my mind that you have some highly skilled people, the pharmacists, who may not have been working at their best level, which would contribute more to the NHS, and also themselves. This should then allievate some of the skills shortages you ve got. Mick is the rep for the GP Pharmacy transformation project. He comes to the NHS with over 40 years experience as a project manager building power stations all over the world. His experience in the private sector and his naturally strategic and analytical mind enables him to ask the important questions needed to drive the project forward with a strong the customer - our s. If you ve got highly skilled people, they should be working at their correct level And the main challenges? From a project point of view, it s a change management at it s highest level, so the biggest challenge is acceptance from both the GPs and the s that there is a different way of working. and to ensure that the s don t see it as undermining the quality of that s being offered at the moment, but actually keeping that quality, or enhancing, and that it is seen as being part of the NHS, and not a fragmentation process. Nationally, my biggest concern would be that there will not be enough CPIPs available to be able to carry out this type of work, because you ve got to have not just people with skills ie. qualifications, but they ve also got to want to do it. It s a change management at it s highest level What do you see as the future for the project? I see this as a true project, in the sense that the outcomes are not really clear.. I think the early signs are that it will make a difference, or it is making a difference. I can see it being the basis of a future in the NHS where you ve got CPIPs as a key function assisting the GPs who then should have hopefully more time to be able to deal with the more complex nature of the more complex cases.
An elderly stated that she was breathless using her GTN spray 3 x a week. After a review with the pharmacist, she had the dose increased. After 4 weeks the had less breathlessness and was able to reduce the spray to being used once a week Patient Care A was referred to the pharmacist following diagnosis of heart disease (AF). At the appointment the pharmacist was able to explain the options for treatment thoroughly. The felt reassured, involved in the decision and very happy with the explanations, thanking the pharmacist We looked at s in the practice with Chronic Kidney Disease, and were able to check that all of their test results were up to date or called them in to get them done. We were able to check their medications and enable s to have a comprehensive consultation with their GP. We could not have done this without the help from the pharmacist A diabetic felt that they had cold extremities and was feeling unwell. The pharmacist did a review and changed their medicines, which resulted in the taking fewer medicines and feeling better on the new ones A was reviewed that was taking over 20 medicines and the pharmacist found that a number were no longer appropriate and was able to remove them from future prescriptions A attended ENT hospital and was prescribed medicines for their condition from hospital. The pharmacist conducted a review and found that the dose was not high enough to be effective, and the medicines were also not being taken regularly. The Pharmacist explained how the medicines worked and why they were important. The now understands their medicines better and is able to take them as required and is getting the benefit intended from the medication A was taking antipsychotic medicines but had not had the recommended blood tests done, as the GP was unaware that this should be done. The blood tests were initiated in line with current guidelines
Patient Care Ken, a at Chesterfield Medical Partnership on his experience seeing Rachel Smith, the Community Pharmacist. Talking to Rachel is quite easy, she puts you at your ease I have told my daughter about seeing the Pharmacists, and she says it s good that I know what I am taking With Rachel she went over everything you can ask her questions if you don t understand and you don t feel like you are on the clock I have told my mates and they are astounded that there is someone that can explain everything Watch the full interview here: https://youtu.be/hggrjctvwjq
Contact Us If you have any comments about this update, or would like further information GP Community Pharmacy Transformation Project, please contact Gerald Ellis: gerald.ellis@nhs.net Our Programme Board Samantha Travis, Chair NHS England North Midlands Local professional Network Chair David Ainsworth Director of Primary Care Mid Notts CCGs Michael White Citizen Representative Elizabeth Wade Head of Policy, Pharmacy Voice Nick Hunter Chief Officer, Nottinghamshire LPC Dr Ian Matthews Assistant Medical Director, NHS England North Midlands Cathy Quinn Clinical Lead for Programme, Newark and Sherwood CCG Gerald Ellis Programme Manager, Newark and Sherwood CCG Joanne Stanney Head of Medicines Management, Southern Derbyshire CCG Gayle Wright Team Administrator, Newark and Sherwood CCG Ian McKenzie Derbyshire LPC