Community pharmacy flu vaccination services- preparing for 2014/15

Community pharmacy flu vaccination services- preparing for 2014/15

HISTORYNHS Flu vaccination 1st commissioned from pharmacy in 2012 all risk groups, for all the flu seasonFirst season 55 pharmacies involved Over 5000 vaccinations deliveredGPs really co-operative, and happy with the service.NOT!After a number of years asking about this potential service.. Genuinely believe that its commissioning was a farewell gift from the PCT

The PCT in fact neglected to inform the GPs that we were being commissioned.and a leaflet inviting people to attend their pharmacy for a vaccine if they preferred was distributed in a letter sent to all at risk patients arranged by the PCT but funded by the practices

There was uproar, and the PCT agreed to underwrite the value of unused GP vaccine and refund the cost of the letter to the practices.And so to 2013.

PCT replaced by Cumbria, Northumberland,Tyne & Wear Local Area Team

Intranasal flu pilot for Cumbria? Joint approach to NHS England Screening & Imms Team from the CNTW LPCs in April

June (ish) Screening and Imms lead agrees to commission I.M. service

Parallel Service development

It took a considerable effort to find someone in the Area Team who would take responsibility for commissioning the pharmacy flu service

and in the event, we got the wrong person anyway

In Cumbria we were separately invited to participate in a pilot to assess community delivery of intranasal flu vaccine to primary school age children, which we enthusiastically agreed to. To be one of 7 pilot sites, funding provided by PHE. All the other sites tested delivery in the school setting. At first we were led to understand that the GPs werent to be involved after showing no interest in an initial invitation however, the commissioners decided to re-issue the invite and in the event, 28 GP practices participated

We canvassed all of our 111 pharmacies and recruited 88 this time in Cumbria (79%) in essence told the pharmacies that they would have to provide both intranasal and IM vaccinations though commissioning of the seasonal flu service was still to be confirmedHowever, we did think that involvement in the intranasal pilot would be a useful lever to secure this and it probably did help eventually!

We got agreement for the adult service in June or thought so

Then developed paperwork for both services, together with Pharmoutcomes pages for recording service delivery and evaluations.

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Effective training for all staffOn Line Training provided by Area Team Screening & Imms Theory behind BLS, anaphylaxis & flu vaccinationFace to face practical training Included BLS and practical scenario training All funded by pharmacy contractorsPrivate trainerprivately contracted with a member of the area team - very cost effective @ 37.50 each!

We set up combined training for I.M. and intranasal 150+ pharmacists were trainedArea Team provided on line training for all staff and oversaw face to face training. Pharmacists training facilitated by Local Pharmaceutical Committee organised venues, trainer & booking on to training sessionsTraining was self funded by pharmaciesDisaster Strikes?Start of July we are being commissioned

End of July -No were not!

What to do?

Negotiate!!

The Director of Public Health Commissioning notices that the LPCs are telling pharmacies we are commissioned...and gets in touch to say.were not its been agreed without her knowledge and there is no budget for financing pharmacy vaccinations. We were advised to halt preparation!

We have arranged training and taken payment for it, even paid for some venues in advance. Several of last years more successful pharmacies have committed to sizeable vaccine orders

We have spent a lot of time and effort refining paperwork and developing Pharmoutcomes services for delivery and evaluation

Our flu group took the view that it would disrupt preparations too much if we allowed this uncertainty out so we decided to keep it confidential in the hope of an eventually successful outcome

In Cumbria we at least had the comfort of knowing the intranasal pilot was proceeding.

THE FRANTIC PHASE

All those PSNC negotiating skills seminars cant have been wasted..

Various tactics employed:Service was commissioned last year right across the region public expectation will be that the service continues we had substantial positive patient evaluation data tooUntil the July conversation we were preparing for the service in good faith, and substantial resources had already been devoted to its introductionIn Cumbria pharmacies had separately been commissioned by PHE- to deliver intranasal flu vaccines to primary school age children and it would be inconsistent to turn at risk adults awayPuppy dog eyes and pleading how could you do this to me? I could be lynched do you want that on your conscience etc.etc. 7PROGRESS??

August a place at the table

The initial offer

More Negotiation!

Agreement!!

The place at the table I was invited to sit on the regional Strategic Flu Implementation group (still there!) Surely this meant we were going to get commissioned?

After its first meeting taken to one side for a one to one with the DPHC their position we only have a budget of 7.64 per vaccination acceptable? Then I realised that this included the vaccine!

To cut a long story short we were already committed, wanted this service and were prepared to compromise this time so we went away to think about it. Came back to the Area Team with 12.50, settled on 12i.e 7.64 for the administration and an element of 4.36 for the vaccine all wrapped up as one vat exempt professional fee. We took the view that the independents who had forward ordered were achieving this price or better, and however the invoicing obscured it, were confident that the multiples were doing the same. The only people suffering were the independents who did not bulk buy like myself!

Our hope is that this year as we are getting encouraging noises from the Area Team about being commissioned again that the money for flu vaccine, however and whoever administers it, is taken from the drug budget as is the case when a GP does the administration. We then would expect a level playing field, and vaccine cost to be fully reimbursed without having to chase discounts.8STILL MUCH TO DO

PGD signed on Sept 19th

SLA...signed on Oct 1st

Payment mechanismsorted over October

Vaccination . Started on 21st September We had considerable input in the drafting of the SLA took lots of time over late August into September The pharmacies in Cumbria set off once a PGD had been distributed the rest of the region seemed to wait for an SLA Must have trusted us in Cumbria and accepted our assurances that they would get paid!

Commissioning the intranasal service from pharmacy also proved challenging had to use the local Partnership Trust as a 3rd party commissioner, and the additional steps involved delayed the start

Now over to John, who will share with you the tactics his group of 3 pharmacies used to become our best performing pharmacies across the whole region..

MAXIMISING PERFORMANCE

John Urwin

9224 IM Flu vaccinations 81 out of 111 pharmacies participating Average 114 per pharmacy

But....

THE BOTTOM 10 PERFORMERS

72 16 73 13 74 13 75 13 76 13 77 12 78 7 79 5 80 4 81 31% of Total

1 711 2 644 3 422 4 326 5 314 6 265 7 257 8 254 9 246 10 21040% of Total

THE TOP 10 PERFORMERS

What distinguishes the Top 10 from the Bottom 10?

EnthusiasmPreparationTeamwork

PreparationStaff TrainingSOPsOrdering Vaccine & Stock ControlFridge CapacitySharps BinsConsultation RoomResuscitationPaperworkDemand Management15Demand ManagementActive not ReactiveCreate awarenessIdentify candidatesMake appointmentsEligible Groups Over 65s Kidney DiseasePregnant Neurological DiseaseRespiratory Disease Diabetes mellitusHeart Disease ImmunosuppressedLiver Disease Main CarerLong Stay Res./Nursing HomeTeamworkEvery member of staff should be involved Identifying and recruiting candidatesCounter StaffDispensary StaffPharmacistDriversCleanerSERVICE DELIVERYGreeting and Opportunistic RecruitmentCounter Staff and Flu-Helper Helping with Flu Form and escorting patient to Consultation RoomFlu Helper Complete Flu Form, review responses, obtain consent- Pharmacist

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SIMPLE PAPERWORK! ONE SHEET ONLY

DEFINE STAFF ROLESAdminister Vaccine and record details- PharmacistSee patient out of Consultation Room and assist them with patient survey - Flu HelperComplete notifications- Anyone / Everyone

PLANNING FOR NEXT SEASONSTART EARLY MAKE SURE OF YOUR STOCK ORDER IN SPRINGLATE SPRING/EARLY SUMMER LPC MEETINGS TO CELEBRATE SUCCESS/PASS ON HINTS & TIPSLATE SUMMER PMR TO GENERATE A LIST OF VACCINATED PATIENTS - CONTACT WITH REMINDER BY POST, TEXT, EMAIL OR CARRIER PIGEON

How Did We Do?Over 15,000 I.M. vaccines given in CNTW.

9,200 of these in Cumbria

Approx. 12% - 1848 people were vaccinated in pharmacies who were NEW to flu vaccination

Still only 3.6% of the regions total though 7.5% in Cumbria. Plenty more to go at!

Pharmoutcomes was absolutely invaluable in providing information to the commissioner and streamlining invoicing.

INTRANASAL

13,573 vaccinations

Of which. 11,113 given in community pharmacies 82%

37.2% of primary school age children

The programme delivered 13,573 vaccinations 11,113 by pharmacies, 2389 in GP surgeries and 71 in the community clinic. In total 37.2% of primary school age children were vaccinated

We are convinced that we could do better still if we get the chance!

But would need to demand manage !!

Very popular service with pharmacists though25FEEDBACKFrom the public - Excellent!

From the GPs..

Largely Weary Resignation

With occasional tantrums!9500 patient evaluations recorded on Pharmoutcomes. Overwhelmingly positive

Area Team have been very supportive of the pharmacy service, and dealt politely but firmly with the (small number of) GP complaints

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