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The future service framework for community pharmacy

NICPLD Regional ProgrammeSeptember-December 2019

Aim

To provide an overview of the key components of the new contract framework, highlighting the services to be provided by community pharmacies in N. Ireland in the short and medium term.

Intended outcomes• Understand the direction of travel in relation to the

development of community pharmacy services• Appreciate the range of core and additional services

that may/will be provided across the community pharmacy network

• Promote the role of community pharmacy in the delivery of consistent health promotion messages

• Enhance collaboration with GP practices and secondary care to promote effective care and safe practice

• Access appropriate education and training resources to develop yourself and staff in preparation for the introduction of the contract framework

CPD: ReflectionIdentify your learning need

Policy context Partnership working

Working collaboratively to translate policy to service provision

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Fully connected

Integral part of primary care and

the wider HSC Broad range of clinical services

Independent prescribing as part of

some services

Patient registration

model

Contract framework

Service development:Process (1)

Service development:Process (2)

Review evidence

Develop draftAgree evaluation

frameworkPilot

Publish evaluationCommissioning

decision

Contract framework

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Practice quality system• Clinical governance

framework– Clinical audit 19/20

– Quality improvement– Business continuity

• Infrastructure– IT– Security

• Living Well

Practice quality system:Clinical governance framework

Clinical audit:• Community pharmacists can

demonstrate enhanced patient medication safety within pharmacy services

• Identify areas where improvements can support better patient care

Audit topic 19/20: Overuse of short acting bronchodilator (SABA) inhalers for the treatment of asthma. Identification of patients using more than 6 SABAs in the previous 6 months without an inhaled corticosteroid.

ELECTRONIC TRANSMISSION OF PRESCRIPTIONS (ETP)

ENHANCED SERVICES

ENHANCED COMMUNICATIONS

INFRASTRUCTURE

Prescriptions will be sent electronically from GP surgeries to nominated pharmacies where they are dispensed. Financial Claims sent from the system to the FPPS. ETP application integrates with PMRs.

The delivery of additional applications, running on the same infrastructure platform as ETP. In scope: Minor Ailments and Medicines Adherence.

• Email to facilitate secure communications to and from pharmacies, GPs and Department of Health.

• Access to NIECR

An enduring infrastructure solution that enables and supports Community Pharmacy modernisation first and foremost; but is also scalable to accommodate modernisation.

Practice quality system:Infrastructure: IT Practice quality system:

Living Well• Targeted health promotion

campaigns• Each campaign will run

for 2 months across all pharmacies

• 5 campaigns this year (19/20)

• Window displays, HP materials, Brief Intervention, sign posting to other services

Practice quality system:Living Well

Practice quality system:Living Well - Resources

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Practice quality system:Living Well – Choose to Live Better

Practice quality system: Support available from CPNI

www.communitypharmacyni.co.uk

Practice quality system: Support available from CPNI

www.communitypharmacyni.co.ukContract framework

Core services

• Dispensing • Repeat dispensing

• Adherence

Core services:Adherence

11,356 4,01630,872

MDS (21,225)Other (9,647) Data source: compliance register 16/17

Cohort 1Patients with potential for

abuse/misuse with

prescribed medicines

Cohort 2Community pharmacist assesses need and

provides an appropriate

solution

Cohort 3Assessment

is carried out by Trust and solution is provided

by the community pharmacist

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Adherence - Cohort 1: Patients with potential for abuse / misuse with

prescribed medicines

• Instalment dispensing would be available to patients prescribed certain medicines if required to reduce the risk of patient harm

• The Drug Tariff would be amended to define both the medicines which could be prescribed in this way and the fee payable for dispensing in instalments

Adherence - Cohort 2: Community pharmacist assesses need and

provides an appropriate solution

Assessment Adherence solution

Stock solutione.g. reusable compliance aid, eye drop applicator

Personalised solution

e.g. Medicines reminder card, MAR chart, compliance aid

Personalised solution

Eg. Medicines reminder card, MAR chart, compliance aid

Assessment by Trust

Provision of solution by community pharmacist

Maintenance / review of solution

Adherence - Cohort 3: Managed by community pharmacist following

Trust assessment

Contract framework

Additional services

• Medicines use reviews (MURs)

• Minor ailments– Pharmacy First

• Care home services• Smoking cessation• Out of hours(OOH)

emergency supply

Additional services:MURs

Patient feedback from postal questionnaire:ü 86% satisfied or very

satisfied with the service

ü 90%would recommend the service to another family member

Re spir at ory D iabet es

Bo th un known

Number of MURs April 18 - March 19

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Additional services:Minor ailments

Acne 2,228 Haemorrhoids 3,783

Scabies 1,517 Verruca 2,780

Activity data: Feb – May 2019

Additional services:Pharmacy first

Advice and information

Supply medication Refer to GP

Patient registration

Additional services:Pharmacy first

Additional services:Pharmacy first – winter pressures

Stakeholder engagement

Review of consultation

formsPatient

experience

>96% of patients

very satisfied

>92%of patients more

confident to manage similar

symptoms

0ver 21,000

consultations

19% bought

additional OTC

77% of CPs thought the service was

beneficial to their patients

> 64% of GPs reported that service had

beneficial impact on workload

Additional services:Care home services

• Current low level service focusing on medicines supply advice

• New clinically focused service currently at scoping stage

• Pilot in 2020

Additional services:Smoking cessation

• In 2018/19, approximately 430 pharmacies actively delivering stop smoking services across NI

• 70% of all clients enrolled in stop smoking services across all providers, enrolled in community pharmacy

• Community pharmacy continue to provide favourable 4 week quit rate of 55%

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Additional services:Smoking cessation

Additional services:OOH emergency supply

Additional services:OOH emergency supply:

NIECR pilot

• 7 pharmacies• 27 community

pharmacists• Used on 40 occasions• No issues reported

Additional services: Support available from CPNI

www.communitypharmacyni.co.uk

Query – can we get a screen shot of CPNI’s members’ area with MUR support documents?

Contract framework Locally required services

• Palliative care• Opiate substitution• Needle and syringe

exchange service (NSES)

• Oxygen• Carers support

service

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Locally required services:Palliative care Locally required services:

Opiate substitution

• New OST guidelines for community pharmacists

• Pilot of patient registrationmodel

Locally required services:Needle and syringe

exchange service

• 21 pharmacies• 30,065 visits in

17/18• 3% increase

from 16/17• Patient charter

Locally required services:Carers support service

• Hidden carers service

• Started as a pilot in SE LCG

I have made three referrals into the Hidden Carers Service. Two in particular found it very beneficial as they had almost got to crisis point and didn’t know where to turn to get help. All three referrals were for dementia patients. The carers got the extra support that they needed and felt that they had a point of contact if their situation deteriorated.

Informing the contract framework:Pilots

• Acute care at home• Brief intervention• Hypertension • Point of care testing• Flu vaccination

• Future pilot areas

Pilots:Acute care at home

Pilot

Publish evaluation

Commissioning decision

Aim: to provide timely access to medicines for ACAH patients, by establishing a network of 8 community pharmacies in the Belfast area

Evaluation report published March 2018

Dependent on policy change by DoH

Future model:Locally required service: A small number of pharmacies to hold a small agreed list of injectable medicines, including antimicrobials that would not be routinely available from community pharmacies.

Policy change:All community pharmacies to be able to dispense routine prescription items required for ACAH patients.

Pilot conclusion: community pharmacists are well placed to support ACAH patients by providing a timely supply of medicines, thus ensuring the effective delivery of the ACAH service.

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Pilots:Brief interventions

• Pilot service delivered in the Belfast area• Aim of the service was to raise awareness of health

problems caused by drinking and provide advice in relation to reducing alcohol intake

• Participants completed an Alcohol ‘MOT’ to gauge alcohol intake

• Pharmacist and/or health and well-being adviser offered help and support to people to make changes to their drinking habits

• Variety of resources available to help pharmacies deliver the service

• Those identified as having dependency issues could be referred to specialist addiction services

Pilots:Brief interventions

Pilots:Hypertension

• Pilot to determine if community pharmacy can assist with the detection of undiagnosed hypertension

• Around 60 pharmacies contracted inSELCG area

• Pilot running from July 19for 6 months

• Evaluation to be undertakenby PHA

Pilots:Point of care testing

• Introduce CRP testing, in keeping with NICE recommendation for the assessment of non-pneumonic LRTIs

• Evaluate patient and pharmacist feedback on experiences of POC CRP testing in community pharmacy

Review evidence:

Develop draft:

Agree evaluation framework:

Pilot:

Publish evaluation:

NICE guidance

Service specification, guidance, training etc

MOIC

A number of pharmacies and GP practices in Northern and Western LCGs

Summer 2020

Pilots:Flu vaccination

• Value of community pharmacy based flu vaccination services recognised by DH

• Potential pilot for 2019/20 currently being scoped

Contract framework: Support available from CPNI

www.communitypharmacyni.co.uk

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Contract framework:Support available from CPNI

Katherine Kidd Head of Pharmacy Developmentkkidd@communitypharmacyni.co.uk

Kerry Grimes Clinical Governance and Service Support Pharmacistkgrimes@communitypharmacyni.co.uk

CPNI phone number: 028 90 690 444

Contract framework:Conclusion

• Challenging work plan for 19/20

• Increase the clinical services in community pharmacy

• Improve integration within primary care and across the interface

• Enhance patient care

Contract framework Intended outcomes• Understand the direction of travel in relation to the

development of community pharmacy services• Appreciate the range of core and additional services

that may/will be provided across the community pharmacy network

• Promote the role of community pharmacy in the delivery of consistent health promotion messages

• Enhance collaboration with GP practices and secondary care to promote effective care and safe practice

• Access appropriate education and training resources to develop yourself and staff in preparation for the introduction of the contract framework.

CPD:Evaluation