D E R B Y S H I R E L P C A N D N H S S O U T H E R N D E R B Y S H I R E C C G W E D N E S D AY 1 S T M AY

DOMICILIARY RESPIRATORY SCHEME [PILOT] LAUNCH EVENT

WHY RESPIRATORY DISEASE?

•  Derby Hospitals Data – April 12 to Feb 13: •  3,138 admissions for respiratory problems •  403 readmissions equivalent to 12.8% •  £556,098 – readmission tariff value!

•  Hardwick CCG – asthma pilot •  Croydon Domiciliary Visiting Service in Croydon •  MURs in the home – not just for respiratory patients •  280 MURs completed •  174.1 emergency hospital admissions avoided •  £609,350 cost avoidance (£3,500/admission) •  LPC encouraging more contractors to sign-up to keep

momentum going

BACKGROUND TO PILOT

•  Southern Derbyshire CCG Prescribing Sub-group •  Respiratory disease and frail elderly •  £40,000 non-recurrent funding [Transformational Funding] •  Collaboration with LPC •  Build an evidence base for commissioning the service

•  Community Pharmacy •  Pharmacist-led interventions and support •  Improve domiciliary care of patients with respiratory disease •  Identify at-risk patients •  Improve patient outcomes •  Reduce the number of hospitalisations

AGENDA

•  7.10 pm Welcome and Introductions John Sargeant, LPC Chair

 

•  7.20 pm Frail Elderly Respiratory Pilot Briefing Andrea Smith, Pharmacist and LPC member

•  7.40 pm Respiratory Training Update Anna Murphy, Consultant Respiratory Pharmacist, Glenfield Hospital

•  8.55 pm Medicines Management Considerations Dr. Diane Harri, NHS Southern Derbyshire CCG

•  8.55 pm PharmPerform and Data Capture John Sargeant, LPC Chair

•  9.05 pm Next Steps and Expressions of Interest John Sargeant, LPC Chair

•  9.30 pm Close

TRANSFORMATIONAL

•  Level 1 services – NRT, Not Dispensed, MARs, etc •  Level 2 services – MURs and EHC •  Level 3 services – INR •  Domiciliary respiratory scheme: •  Must get this right and deliver a professional service •  An opportunity to get involved in patient care and work

with other healthcare professionals

•  Could be the start of something great, but get it wrong and: •  Pharmacy looses credibility •  Will be seen as a missed opportunity •  Might not be asked again…

DRS PILOT BRIEFING ANDREA SMITH, PHARMACIST

PILOT OVERVIEW

•  Community pharmacy teams & domiciliary support •  Repeat collection •  Delivery services •  Compliance aids

•  Domiciliary Respiratory Scheme [Pilot] •  £40k non-recurrent transformational funding •  Develop evidence base for respiratory interventions •  Show how pharmacists can make a difference

•  Community Pharmacists are ideally placed to: •  Review inhaler technique •  Provide advice and support to ensure that patients obtain the

maximum clinical benefit from their medicines (tMURs/NMS) •  Medicines optimisation

AIMS / OBJECTIVES

•  To support patients currently unable to benefit from regular face-to-face contact with their local pharmacist and improve… •  Knowledge of medication/condition •  Inhaler technique and symptom control

•  Improve communications between pharmacists, GPs and other healthcare providers •  Manage waste / reduce prescribing costs •  Opportunity to demonstrate the value of

community pharmacist interventions

SCOPE

•  Current diagnosis of asthma / COPD •  Housebound •  Patient must be registered with a GP practice in the

Southern Derbyshire CCG •  Patient’s GP should agree suitability for the pilot •  Patient must give informed written consent •  Pharmacist must have a recent (2 years) CRB check •  Pharmacist must be MUR accredited •  All data must be recorded on the PharmPerform©

database

DRS PATHWAY - ENROLMENT

1.  Suitable patient identified 2.  Service is explained to the patient (leaflet) 3.  Written consent is obtained 4.  GP ‘patient approval letter’ completed and sent

to the GP with a copy of the patient consent 5.  GP confirms patient eligibility. 6.  Pharmacy team contacts the patient:

1.  Agrees date and time for the initial visit 2.  Patient may wish carer/family to be present

7.  Register the patient on PharmPerform©

DRS PATHWAY – VISIT 1

1.  Pharmacist visits the patient as agreed. 2.  During the visit the MUR process is completed for

ALL MEDICINES 3.  Inhaler technique is checked using an In-check

Dial device 4.  ACT / CAT / MRC dyspnoea score is recorded 5.  Surplus / unwanted medicines are checked and

recorded/removed 6.  Discuss on-going support and agree next visit/

contact

DRS PATHWAY – POST VISIT 1

1.  Complete respiratory MUR form 2.  Complete Medication Care Plan 3.  Send a copy of both forms to the GP 4.  Supply the patient with a copy of the Medication

Care Plan 5.  Transpose all information onto the PharmPerform©

database (retain all paperwork in the pharmacy) 6.  Follow-up / liase with GP where appropriate

DRS PATHWAY – MONTHS 2-5

1.  Patient is contacted as often as is required (minimum of once per month)

2.  During the contact (home visit / telephone call) you will check: •  ACT/CAT/MRC score •  Discuss medication used •  Dispense and deliver medicines (as appropriate) •  Provide ongoing advice/support •  Up-date care plan where medication changes are made

3.  All patient contact must be recorded on PharmPerform©

DRS PATHWAY – FINAL VISIT

1.  Repeat of initial visit at month 6 – intervention MUR Post-visit: •  Complete paperwork and data entry •  Complete evaluation process (feedback form /

questionnaire)

FINANCE

Initial Visit: ~ 1 hour home visit by pharmacist Completion of MUR form + care plan + data entry

£80

(+£28 MUR fee)

Months 2-5 Minimum of once/month contact @ £20/month Care plan to be kept up-to-date Data entry at each stage

£80

Month 6: ~ 1 hour home visit by the pharmacist Completion of MUR form + care plan + data entry

£80

(+ £28 MUR fee)

Post pilot: Completion of patient satisfaction survey / feedback audit

KEY OUTCOMES

•  To ensure that housebound patients are better able to manage and understand their medicines (education/ support/ medication care plan)

•  To improve inhaler technique •  Maximum clinical benefit from their device •  Reduce the risk of respiratory related hospital admissions

•  To reduce waste/stockpiling •  To provide healthy living advice / stop smoking support •  To improve communications between healthcare

professionals •  To demonstrate the value of CP in domiciliary care.

RESPIRATORY TRAINING UPDATE

ANNA MURPHY, CONSULTANT PHARMACIST

MEDICINES MANAGEMENT CONSIDERATIONS

DR. D IANE HARRIS , SOUTHERN DERBYSHIRE CCG

PHARMPERFORM© JOHN SARGEANT, DERBYSHIRE LPC CHAIRMAN

NEXT STEPS

•  Expressions of interest •  Fax to LPC at 01246 431897 •  LPC to co-ordinate and countersign •  Liaise with NHS SD CCG Prescribing Sub-group •  Pilot funding restrictions (numbers)

•  Pharmacist •  Supporting documents •  Identify respiratory patients who would benefit •  Liaise with patient’s GP as needed

•  LPC Website •  www.derbyshirelpc.org