Community pharmacy flu vaccination services- preparing for 2014/15

Seasonal InfluenzaAn integrated approach to service delivery

• Kevin Noble MRPharmS – Partner, Pinnacle Health LLP

Content

INTRODUCTION AND CONTENT

•Background•NHS Service commissioning 2013/14• Service models • Uptake profile• Referral profile•Private influenza vaccination service outcomes•Barriers to service delivery•Competency & maintaining a skilled workforce

Targets

NHS TARGETS

2013 NHS aspirational targets: 1. To reach or exceed 75% uptake for people aged 65 years and over as

recommended by WHO2. To reach or exceed 75% uptake for people under 65 years with

clinical risk factors

2012/13 AchievementOver 65s: 73.4% Under 65s: 51.3%

Q. What can we do to improve uptake to achieve targets?

Analysis of NHS data from 3 Discrete Areas 2013/14 Season

COMMISSIONING MODELS APPLIED

Commissioning model applied. Patients were over 16 years in all areas

Area

(No of providers) Target groups Start date

Total Vaccinated

Area 1 (113) All risk groups* 1st October 2013 5260

Area 2 (146)

Under 65s with risk factors 15th October 2013 2043

Area 3 (208)

Under 65s with risk factors

1st November 2013 2613

*Excluded pregnant ladies

Data from three commissioning areas has been analysed to examine the impact on uptake of vaccination & engagement

Analysis of NHS data from 3 areas 2013/14

ENGAGEMENT AND UPTAKE

Uptake profile Numbers vaccinated

Area (No of providers)

Over 65 years Under 65 years with co-morbidity

First time vaccinated

Area 1(113) 3495 (66%) 1765 (34%) 488 (9%)

Area 2(146) 0 2043 (100%) 372 (18%)

Area 3(208) 0 2613 (100%) 606 (23%)

Area Average under-65 vaccinated per providerArea 1 15.6 vaccinations per provider (46.5 ave total

cohort)

Area 2 13.9 vaccinations per providerArea 3 12.5 vaccinations per provider

Applying a no restrictions to risk groups approach for those wishing to access pharmacy services produces higher numbers of vaccinations in all risk groups

Analysis of NHS data from 3 areas 2013/14

ENGAGEMENT AND UPTAKE

Uptake profile through life of service Month Area 1 (Oct 1st) Area 2 (Oct 15th) Area 3 (Nov 1st)

October 3609 745 0November 1268 922 1685

December 302 266 642

January 68 108 193February 12 2 92March 1 0 1

Barriers to service provisionArea 2 – Late preparation of service agreement for sign offArea 3 – LMC opposition to service caused service delay of 1 month

Uptake of vaccination is at its peak in October. Early commissioning of service is essential to maximise uptake

Analysis of NHS data from 3 areas 2013/14ENGAGEMENT AND UPTAKE

Days of the week attendance Month Area 1 (Oct 1st) Area 2 (Oct

15th)Area 3 (Nov 1st)

Sunday 50 26 29Monday 970 365 502Tuesday 893 347 504Wednesday 920 317 421Thursday 995 375 430Friday 1047 352 517Saturday 385 261 210

Uptake peaks Mon to Fri – pharmacy offers opportunistic service delivery without appointment. Attractive to those in full time employment as difficult to attend appointments, less likely to attend weekend clinicsConsideration – The retirement age is increasing. Many over 65s in this situation

Higher levels of service delivery are seen Monday to Friday. Pharmacies provide opportunistic access to vaccination without an appointment

Analysis of NHS data from 3 areas 2013/14ANALYSIS OF REASONS FOR ATTENDANCE

Reasons for Pharmacy attendance Reason for attendance Area 1 Area 2 Area 3

Did not attend GP becauseWork commitments 100 277 312Transport issues 81 15 22Other commitments 213 116 46Previous experience 40 28 17GP unable to provide service 96 107 120No GP clinic dates available 70 59 58Unable to attend Occ Health 0 6 0Prefer pharmacy 1330 197 151More convenient 3273 1134 1760Unwilling to say 14 20 18

In all three areas, significant numbers of patients reported a preference for pharmacy stating convenience as a major factor

Analysis of NHS data from 3 areas 2013/14Analysis of Referral into service

Area Self referral Pharmacy GP practice

Area 1 2718 2438 84 (1.6%)Area 2 1266 556 160 (7.8%)Area 3 1368 1074 114 (4.4%)

Collaborative working can improve uptake of vaccineReferrals from GP practice low in all areas as percentage of total

REFERRAL METHOD

A collaborative workforce will refer to other providers in periods when services are unavailable. Improved collaboration will improve uptake

Private influenza vaccination outcomesInformation gathered from 139 service providers

where both NHS and private service available

Patient profile Numbers

vaccinated

Over 65 years 301 (11%)Chronic heart disease 41 (1.5%)Chronic liver disease 3 (0.1%)Chronic renal disease 7 (0.3%)Chronic respiratory disease 130 (4.7%)Diabetes 64 (2.3%)Immunosuppressed 15 (0.5%)Neurological condition 15 (0.5%)Main carer 21 (0.8%)Private patient 2193 (79.9%)

PRIVATE FLU VACCINATION SERVICE OUTCOMES – PATIENT PROFILES

Significant numbers of NHS eligible patients access private services. These patients are not accounted for in DH returns via ImmForm

Private influenza vaccination outcomesReasons given by NHS eligible patients for Pharmacy attendance

Reason for attendance Numbers

Unable to attend GP - Work 57Unable to attend GP - Transport 19Unable to attend GP - Other commitments 14Unable to attend GP - previous experience 3Unable to attend Occ Health 1Prefer pharmacy 226More convenient 287GP unable to provide service 14Unwilling to say 6No GP clinic dates available 15

PRIVATE FLU VACCINATION OUTCOMES

Patients eligible for NHS vaccination pay to access vaccination services rather than engage with existing models of service delivery

Barriers to service provisionBARRIERS

• Chaotic approach to service commissioning• Limited access to service for certain risk groups• Opposition to commissioning decisions by other

Heath Care Professionals resulting in delayed implementation – October key month for uptake

• Unclear guidance for providers limits levels of provider engagement

Commissioning must be patient centred and offer choice if the main objective is to maximise

uptake

Commissioning intentions must be well planned and set out in a timely manner allowing providers to prepare to meet service quality criteria

Maintaining a Competent Workforce &

Sustainable services

COMPETENCY

Provider competency criteria set by NHS England 2013/141. Completion of recognised training course2. Annual basic life support and anaphylaxis update3. Evidence 40 patients vaccinated last season

Area 1 Area 2 Area 3Number of providers vaccinating more than 40 people

42/113 8/146 8/208

Allowing all risk groups to access service creates more sustainable services

Allowing all risk groups to access pharmacy services improves levels of engagement as a more confident workforce is produced. This in turn improves sustainability of services

Conclusion

Q. How can we make changes to service models to improve uptake of vaccination?

A. Improve provider choice and make services more accessibleHow can this be achieved?

Integrating community pharmacies as a service provider has:i. Met with high approval ratings from those accessing

vaccination services at these sitesii. The main reasons for use were more convenient or simply

preference as a provider.iii. Higher numbers of older people are now still in full time

employment passed the national retirement age. Limiting access to opportunistic services on the grounds of age will have a negative impact on uptake in this patient group.

iv. Area 1 service model demonstrates the maintenance of a competent workforce as higher numbers of patients are vaccinated at provider sites.

CONCLUSIONS

Pharmacy flu vaccination services receive high approval ratings from service users. Convenience of access is the most common reason given for using these services

Exemplar Business CaseBUILDING THE BUSINESS CASE

• Your starter for ten…

… but it needs localisation

Pinnacle Health developed this exemplar business case for use by LPCs and Area Teams to reduce the commissioning burden and allow timely service delivery

Exemplar Business CaseBUILDING THE BUSINESS CASE

• Key statistics prepared for you

… but they need to be used in the document

Pinnacle Health developed this exemplar business case for use by LPCs and Area Teams to reduce the commissioning burden and allow timely service delivery

Exemplar Business CaseBUILDING THE BUSINESS CASE

• Step 1 – The task ahead for the commissioners

… can be found in the Appendix

Pinnacle Health developed this exemplar business case for use by LPCs and Area Teams to reduce the commissioning burden and allow timely service delivery

Exemplar Business CaseBUILDING THE BUSINESS CASE

• Make it visual…

… by using historical data

Pinnacle Health developed this exemplar business case for use by LPCs and Area Teams to reduce the commissioning burden and allow timely service delivery

Exemplar Business Case for 2014BUILDING THE BUSINESS CASE

• Final figures not yet available from PHE• We will convert historical “PCT” to “AT” data• Refresh document with new intelligence

But don’t wait if you have the opportunity to engage

Pinnacle Health developed this exemplar business case for use by LPCs and Area Teams to reduce the commissioning burden and allow timely service delivery

The Difference We MadeTHE DIFFERENCE WE MADE

• Provisional figures to 31 January 2014

• Early Commissioning, Early Delivery & Full Cohort gets the best results for patients and populations

Pinnacle Health developed this exemplar business case for use by LPCs and Area Teams to reduce the commissioning burden and allow timely service delivery

Over 65s Under 65s

Area 1Early, Full Cohort 73.5% -> 73.9% 53.8% -> 56.9%

Area 2Middle, Under 65s 73.1% -> 73.0% 47.8% -> 49.2%

Area 3Late, Under 65s 75.4% -> 75.3% 56.0% -> 56.9%

Table discussion- making the case locally

Table discussion- how to overcome barriers once the service is

commissioned