Health and high quality for all, now and for future generations GP Community Pharmacy Transformation Programme Update no. 2 April 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. CPIPs are still employed by their community pharmacy providers who are important strategic partners to the. These partners are Peak Pharmacy, Manor Pharmacy, Brennans, Jaysons, Weldricks and NUH. 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. This is a local for Derbyshire and Nottinghamshire and DIFFERS TO THE NATIONAL Clinical Pharmacists employed in general practices announced in September 2015 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: DERBYSHIRE 1) The health and wellbeing gap; 2) The and quality gap; 3) The funding and efficiency gap. BUXTON Chesterfield Medical Partnership RETFORD 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. MANSFIELD Abbey Medical Group RIPLEY NEWARK Well Spring Surgery DERBY NOTTINGHAM Giltbrook Surgery Lister House Surgery Swadlincote Surgery NOTTINGHAMSHIRE
What is the GP Community Pharmacy Transformation Programme? 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. How is the being managed? We have a board made up of our sponsors NHS England, the project team, a citizen representative, a GP, a clinical pharmacist, representatives 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 The Aims 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 chesterfield citizen representative
Overview of 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 375 Consultations to date (as at March 2016) - Long terms conditions, CKD audit - Urgent Care - Nursing reviews Chesterfield Medical Partnership - North Derbyshire CCG Rachel Smith. Clinical Pharmacist, Peak Kate Chilton - Practice Director Dr Ami Kundu GP Supervisor Pilot commenced July 2015, 4 days per week. 1941 consultations to date (as at March 2016) - Hypertensive and AF reviews - DMARD reviews - Hospital discharges 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 833 consultations to date (as at March 2016)
Overview of Lister House Surgery - 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 Well Spring Surgery - Nottingham City CCG Nitin Lakhani. Clinical Pharmacist, Jaysons Joanne Sherwood Practice Manager Dr Mark Swinscoe GP Supervisor Pilot commenced February 2016, 1 day per week 26 consultations to date (as at March 2016) - Home visits housebound s - Urgent Swadlincote Surgery - South Derbyshire CCG Amardeep Nahal Clinical Pharmacist, Brennans Sarah Longland - Practice Manager Dr Ken Patton GP Supervisor Pilot commenced November 2015, 2 days per week 458 consultations to date (as at March 2016) - Urgent Care, triage - Home visits housebound s
What difference has it made having a pharmacist as part of the General Practice team? It has made a big difference to all of the members of the team including doctors, nurses and the administrative team, as we now have a medicines expert. That brings us a different viewpoint to managing s. It feels as if we have a complete team now, it all works really well together, it has improved our communications and made us look in more depth at the s medication. What do s feel about seeing the pharmacist? The feedback to Dr Ransford, the GP partner, has been very positive, The s have been really impressed and happy. Patients are getting 20 minutes and a thorough review of their medications. Many of the s want to come back and see Jessica for follow ups. There have been 1 or 2 s saying that they want to see a GP, but they tend to dislike any change. We had the same thing when we introduced Nurse Practitioners a few years ago. But once s get to know Jessica they are really happy to come back and see her again. Giltbrook Surgery Jessica McMullen. Clinical Pharmacist, Manor Julie Wright - Practice Partner Dr Jacques Ransford GP Supervisor It feels as if we have a complete team now, it all works really well together www.surgery.nhs.uk What kind of work is the Pharmacist doing at the practice? Jessica started off with conducting medication reviews with s, just to get to know the practice, our ways of working, the systems, and for us to get to know her. Most of these reviews used to be tagged on at the end of a consultation with the GP, but now Jessica can do these really thoroughly, having more time to talk to the and get them to understand why they are talking the medications. Very soon she was helping us with other things including chronic disease management. She is really good with asthmatic s, conducting hypertension reviews and is also now seeing s and offering help with lifestyle changes too. Jessica has done some really good work on audits as well, which has enabled the practice to get up to date reviews for over 200 s with chronic kidney disease.
Giltbrook Surgery So, Jessica, how did you become involved in the project? The Operations Director at Manor asked me opportunity, to see if I would be interested. Because I am a prescriber, and I don t get much opportunity to use that qualification, except for things like travel clinics, I thought it would be really interesting, to get more involved in people s health and to do more clinical work. Plus it s helpful to know in detail how a GP surgery works. How does this work differ to what you do in community pharmacy? In community pharmacy there is a lot of contact but its brief and you don t have much time to influence the s. But having access to the record and being able to review issues with Dr Ransford, having specific appointments with enough time means that we can offer a comprehensive service to s. This also the kind of approach that the NICE guidelines recommend. So can you give us an example what you might do in a review? A might come in for say a blood pressure review, I would check that with them, but then also ask them ir medications and go through that thoroughly. We can go through the reasons why they are taking the medication, how it works and the importance of taking it regularly and at the right time. Sometimes we can help s by amending the dose, up or down, or even stop it altogether if it s no longer needed. I can also arrange for s to have 7 day readings at for things like blood pressure monitoring, which helps them to look after themselves better. In many cases s mention side effects, or the fact that the treatment is not working properly, which they often would not mention to the GP because of the time available. So how have found working in the project? Development wise it has been invaluable really because it s so much more involved with s. I do a lot of work with Jacques the GP to develop clinically, but also to check things that we are changing for s. Julie has been really supportive too, finding the right s that I can help. I really enjoy the that the project team has organised including the clinical skills and the leadership and personal development. It s been a great project to work on. Development wise it has been invaluable really because it s so much more involved with s
Training An Enhanced Clinical Skills Course for Pharmacists has been put together for the by James Pratt, an Advanced Nurse Practitioner Educator in and Course Director Frank Coffey who is the Associate Professor and Consultant in Emergency Medicine at Nottingham University Hospitals. Over the 6 days the Pharmacists are given guidance and structure to develop their skills in the following: History taking and cardiorespiratory examination The elements that make up medical consultations and history taking Clinical reasoning and red flags across the body systems Anatomy and physiology of the ENT and respiratory systems Examination of ENT system Cardinal symptoms of the ENT and respiratory systems and common presentations Cardinal symptoms of the cardiovascular system Putting it all together Macleod s clinical examination and Marieb s Anatomy and Physiology are key reference books for the delegates. The is a blend of background, theory, practical experience and knowledge, and the Pharmacists get the chance to put into practice what they are learning with specially trained Patient actors and actresses. This culminates in an assessment of each delegate using a combination of multiple choice examination covering anatomy, physiology and pathphysiology relevant to their learning modules. In addition there is an objective structured clinical examination (OSCE s) test which involves four 12-15 minute stations of history taking and physical examination skills that were taught in the sessions.
Training Pharmacist feedback on the course so far: Can you identify any changes that you have been able to put into practice after the first days? The way in which I record consultations on System One. Checking BP, and looking for more in-depth possibilities (changing mind set). Much more comprehensive history taking more detailed. My mentor said the records were much more meaningful. What was good about days 2 and 3 of the course? History taking in simulated s was invaluable as was the examination practice. Frank Coffey, Consultant in Emergency Medicine. Director (Department of Research and Education in Emergency Medicine, Acute Medicine, and Major Trauma) Hear Frank s thoughts on the by clicking on the link below: https://youtu.be/ycjdoykeday How do you think that you can use the skills and knowledge that you have acquired so far, and can you comment on how the course rates in giving you the confidence and skills to take histories and conduct examinations with s? My confidence with history taking has improved a lot after the 2nd session where we were able to practice and be given feedback. I have much clearer picture and structure in my mind of what I need to ask a and how I can present those findings. Do you have any additional comments that you would like to make? The course is better than many I have done before because it is practical hands on and realistic and there is excellent opportunity for one to one feedback and support from numerous health professionals.
Patient Care Here are some examples of how the pharmacists are making a difference to During a BP review I was able to manage the step down of treatment for a previously diagnosed with hypertension. He had recently lost a considerable amount of weight so it was possible that he was no longer hypertensive. His BP was at target so I stopped his BP medications and reviewed his BP at a later date where his BP was still at target and agreed with the that he no longer needed medication which he was very pleased about and we will continue to review. Another BP had high BP in clinic and was worried that he had white coat syndrome so I counselled him on how to take BP readings at and we were able to use his readings to guide treatment as if we had gone off the clinic readings alone he would have needed an increase in his medication but we were able to avoid that. 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. 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 Ian McKenzie Derbyshire LPC Update No.1 can be downloaded here: http://www.newarkandsherwood.nhs.uk/file_download/1643/gppt.pdf Q4 Update can be downloaded here: http://www.newarkandsherwood.nhs.uk/file_download/1749/160404+gp+pharmacy+transformation+q4++report_final.pdf