Framework and Primary Care Networks In Introductio ion Fiona - - PowerPoint PPT Presentation

New Contractual Framework and Primary Care Networks

13th October – Citrus Hotel Coventry 16th October – Kindle Hereford 20th October – Race Course Worcester

The Hive Worcester

In Introductio ion

Fiona Lowe 10:00

Agenda

Morning Session - CPCF

• 10:00 Introductions and overview
• 10:10 The new contractual framework
• Overview and transitional payments
• Concentrating on 2019-20 and 2020-21
• 10:30 Pharmacy Quality Scheme
• Gateway
• Bundles – Digital, Asthma, PCNs, Prevention,

Medicine Safety

• 11:15 Coffee Break
• 11:30 Final Bundle – Risk Management &

Resources with CPPE

• 12:10 Other training options (VO training – Sepsis)
• 12:20 CPCS
• 12:40 Action Plan, enablers and timeline

Afternoon Session – PCNs

• 13:30 Lunch (VO training – Diabetes

eye / foot) stands & networking

• 14:15 Q&A
• 14:30 Primary Care Networks

Training Session

• 15:30 Primary Care Networks –

leads, priorities and LPC support

• 16:00 Closing Remarks

Vis ision for Communit ity Pharmacy

• Less reliance on dispensing
• More clinical role for

Pharmacists

• Urgent Care
• Prevention
• Medicines
• Local engagement and

integration

• Enablers
• IT
• New Contract
• Training & Development
• Changing Mindset
• Skill mix
• Dispensing process efficiencies

LP LPC su support – we

e ar are her here to

• help

help you

• u
• Information provision –

multiple channels, accurate, simple to understand, timely and accessible

• Tailored support and

listening to what Contractors need and want

• Training and development
• Stakeholder management

and leadership

• Service implementation &

development

• Understanding NHS

Landscape and engaging at all levels

• Priorities:
• CPCF
• CPCS, TCAM and Pilots
• Primary Care Networks

Handouts

• PQS record sheets & flow diagrams samples
• PSNC briefing
• Some of NHSEi guide annexes
• Sample action plans / checklists
• CPCS flow charts

Also available to pick up

• Pharmdoctor PGD information
• Vaccination leaflets
• Pharmacist Support information
• CCG - OTC posters / leaflets and calendars
• CPPE information
• Sponsors information
• Limited supply of HLP materials for those new to it
• Small number of packs of Flu promotional materials

Jas Heer 10:10

CPCF Overview

Context to the Negotiations: PSNC NT

• This has been an intense negotiation process

involving many 100s of hours

• PSNC Negotiating Team represents all parts
• f the sector
• At the heart of negotiations were the 11,600

community pharmacies

• At every step of the way, the Negotiating

Team asked itself: “Is this in the best interests

• f community pharmacy contractors?"

The CPCF 2019/20 - 2023/24

• Secures the future of community pharmacy and

provides a roadmap for delivery and change

• Ensures five years of protected funding against

an environment of increasing economic uncertainty

• Embeds closer integration with NHSE&I and

begins to repair the damage of the Judicial Review

• Fixes an annual review of costs, capacity and

progress within the Contractual Framework

The CPCF 2019/20 - 2023/24

• Expansion of clinical services through

pharmacies over the next five years, starting with a new national NHS Community Pharmacist Consultation Service (CPCS) from October 2019

• Five-year deal secures funding of £13bn

(£2.592 billion a year plus Pharmacy

Integration Fund spend) for pharmacies –

more than original Government plans

Context to the Negotiations

• We didn’t know how the new Prime Minister and

his team will view the NHS or our sector

• We don’t know how a (no-deal) Brexit and/or a

General Election will affect us

• We don’t know what retribution might have been

dealt by DHSC/NHSE&I if we had walked away

• We don’t know how the proposed (Urgent Care)

services will develop

• We don’t know what else the NHS might want (to

pay for) from community pharmacy in the future

The CPCF 2019/20 - 2023/24

"Community pharmacies are a vital and trusted part of our NHS.

Through this deal I expect to see community pharmacies further

integrated within local primary care networks, doing more to protect public health and taking on an expanded role in urgent

care and medicines safety."

Matt Hancock Secretary of State for Health

Outline CPCF funding profile to 2023/24

£ millions

2018/19

(Baseline)

2019/20 2020/21 2021/22 2022/23 2023/24 Establishment Payments 164 123 Medicines Use Reviews (MUR) 94 59 24 Single Activity Fees (SAF) 1,315 1,315 1,315 1,315 1,315 1,315 Target Retained Medicine Margin 800 800 800 800 800 800 Other activity related payments 97 97 97 97 97 97 Pharmacy Quality Scheme (PQS) 75 75 75 75 75 75 Pharmacy Access Scheme (PhAS) 24 24 24 24 24 24 New Medicine Service (NMS) 23 23 23 23 23 23 NHS CPCS

• 4

9 13 16 19 Hepatitis C screening

• 2

2 Unallocated funding for future clinical services to include transition payments

• 69

223 245 242 239

Total Funding Profile

2,592 2,592 2,592 2,592 2,592 2,592

Short Term

• Many aspects remain unchanged e.g. SAF, NMS, PhAS etc.

PQS – Aspiration payment can be claimed to ease cashflow (for contractors who participated in QPS 2018/19)

• Establishment Payments and MURs to be

phased out by 2020/21 with funding reinvested in new services

Short Term

• Monthly Transitional payments in H2 2019/2020 and 2020/21

to recognise costs (e.g. preparation for SSPs and implementation of FMD)

• £10m set aside as a contingency for SSP

payments – if not used, this will be added to Transitional payments

• SSP fee will be set at £5.35
• CPCS fee will be set at £14.00

Long Term

• £13bn funding secured (£2.592bn

a year plus PhIF spend) – more than

• riginal Government plans
• PhIF to fund pilot services which may,

if successful, be commissioned nationally

• Discussions will be held on possible new

funding models

• Savings in cost of dispensing to free up

funding and resources for value-added service delivery

Terms of Service

• New Terms of Service requirements from 1st April 2020:

– NHSmail – Summary Care Records access – NHS 111 Directory of Services – NHS.UK pharmacy profile updating

• All pharmacies must be able to use EPS
• HLP level 1 by April 2020

Oct 2019 – Mar 2020 Apr 2020 – Mar 2021 Apr 2021 – Mar 2024

Funding

• Flat funding of £2,592bn
• Scoping changes to reimbursement

system

• Flat funding – review in Oct 20
• Establishment payment phased
• ut
• Flat funding – review in Oct 21
• Increase share of funding for

clinical services

Pharmaceutical services

• MUR capped at 250
• PCN pharmacists to start SMRs
• MURs capped at 100 and phased
• ut
• Medicines reconciliation service
• Palliative care medicines service
• Scope of NMS expanded

Consultation service (CPCS)

• NHS 111 service introduced in Oct 19
• Fee of £14 per intervention
• GP referral service due to be

introduced

• Urgent treatment referrals
• A&E referrals
• Point of care testing

Public Health

• Hep C testing service
• HLP Level 1 status becomes

mandatory

• BP and AF case finding
• Stop smoking referrals
• Early cancer diagnosis
• Possible contraception service

Pharmacy Quality Scheme (PQS)

• Prepare to engage with PCNs
• Prescribing safety
• Diabetes patient checks
• Suicide prevention training
• Inhaler technique audit
• Anticoagulation audit
• Details to be confirmed

Regulations

Mergers and closures – hub and spoke – original pack dispensing – empower technicians

Pharmacy Quality Scheme

Navigating you through to gain maximum points

Fiona Lowe 10:30

Qu Quali lity ty: : th the Ph Pharmacy Qu Quali lity ty Sch Scheme 20 2019 19-20 20

QPS is re-named PQS Annual value of £75m Some quality criteria grouped into bundles Can claim advance Aspiration payment of up to 70% of QPS earnings from 2018/19 Must meet Terms of Service

MYS

(M (Manage Your Serv ervice)

Contractors will be required to claim their Aspiration payment and make their declaration for a PQS payment using the NHS Business Services Authority (NHSBSA) Manage Your Service (MYS) application. You will also be required to claim payment for the Flu Vaccination Service 2019/20 and notify readiness to provide the new Community Pharmacist Consultation Service (CPCS) via MYS.

Decl claratio ion and revie iew poin int

There will be no review point as there has been in previous schemes You will be required to make a declaration between 9am on 3rd February 2020 and 11.59pm on 28th February 2020 on the NHSBSA MYS application You will need to declare that on the day of making the declaration, that you meet the gateway criteria and that the PQS domains claiming payment for (except if plan to meet the Sugar Sweetened Beverage (SSB) quality criterion by 31st March 2020)

PQS Asp spir iratio ion Payments

Claim in October 2019 Aspiration payment for the 2019/20 PQS. Confirm that will meet the gateway criteria, indicate which quality criteria intend to complete and so how many points they expect to achieve. Can claim an Aspiration payment only if received a QP for either the June 2018 or February 2019 QPS and have registered for the MYS application. The maximum number of points can be paid for Aspiration payment is 70% of average number of points achieved across the two declaration periods It will be paid on 30th November and reconciled with payment for the 2019/20 PQS on 1st April 2020

PQS Gateway

Advanced NHS Services – NMS or FLU – with evidence of claims in run up to declaration plus entry on NHS website NHSmail shared – in use with two active NHS accounts linked NHS website updated during October / November 2019 – all 3 sections (opening & bank holidays hours, services, facilities) 80% GPhC registered staff must have completed Safeguarding level 2 training within last 2 years Passing the gateway criteria will only deliver a payment if meet one or more of the quality criteria bundles/standalone criteria.

Dig igit ital l Bundle le (2 (2.5 .5)

The pharmacy must be able to demonstrate access to SCR between 1st October and the day of declaration. You can view this on the spine portal, using smartcard.

• PharmOutcomes allows SCR access via the SCR 1 click option
• NHS Digital publishes details of the SCR accesses made each
• Thursday. You are advised to check this and keep a

screenshot as evidence https://digital.nhs.uk/services/summary-care-records-

scr/summary-care-record-scr-in-community-pharmacy/prove-scr-access-for-the-pharmacy- quality-scheme-2019-20

You must have updated the NHS 111 DoS profile via the DoS updater in October / November:

• Including opening hours for Easter Sunday 2020, public and

bank holidays and

• Must promptly update profile as information changes, ensure

accurate in real time for referrals e.g. from NHS111 for CPCS

• You will be able to search and update using the DoS Profile

Updater, by ODS (F) code or Postcode to make sure that ALL

• f your services are listed

As Asthma Bundle (5 (5)

• Evidence that asthma patients, having more than

6 short-acting bronchodilator inhalers without any corticosteroid inhaler within a 6 months period, have since the last review point been referred to an appropriate HCP for an asthma review

• Plus can evidence that have ensured that all

children aged 5-15 prescribed an inhaled corticosteroid for asthma have a spacer device where appropriate in line with NICE TA38 and have a personalised asthma action plan. If not, you need to refer to an appropriate HCP

PCN Bundle le (2 (22.5 .5 or 12.5 .5)

More this afternoon…….

What ar are Prim imary Car are Networks?

• GP practices working together in groups with

community service providers and other health and care organisations, including community pharmacies

• NHS Long Term Plan - all GP practices to be in a PCN
• PCNs have:
• an average 30,000 to 50,000 patients
• 5-6 general practices
• 9-10 community pharmacies
• They will have teams comprising of a range of staff,

e.g. GPs, pharmacists and allied HCPs

• 100-150 clinicians and wider staff
• Small enough to give a sense of local ownership
• Big enough to have an impact
• Different names may be used to describe them locally,

e.g. locality, hubs or clusters

Primary Care Networks Bundle

• Demonstrate that your pharmacy, and all other pharmacies within the PCN ,who wish to engage

with a PCN, have agreed a collaborative approach.

• Agreement on a single channel of communication with the PCN by appointing a named lead

representative for all of the engaged community pharmacies in the PCN.

• The Pharmacy PCN Lead must have provided their name to the LPC and must have evidence

that have started the engagement process with the PCN, i.e. they have made initial contact with the Clinical Director for the PCN either by contacting by (post/email) or a meeting

• All pharmacies claiming for this domain must submit the name, pharmacy along with ODS (F)

code of their appointed Pharmacy PCN Lead as described in the NHSEi PQS Guidance.

• The Pharmacy PCN Lead must declare:
• that they are the appointed Pharmacy Lead for that PCN;
• the name of the PCN;
• that they have notified this to the LPC in which the PCN lies; and
• that they have evidence of having started the engagement process with the PCN
• The LPC will be supporting the Leads and have link LPC Leads for each PCN and have developed some

resources and training

LPC LPC Support for

• r

PCNs

• PCN Newsletters
• Section on our websites

under resources

• Resources and handouts
• Facilitate
• mapping pharmacies

to PCNs

• appointing Leads

Preventio ion Bundle le (2 (25)

HLP Dementia Friends & Friendly Diabetes Sugary Drinks

Preventio ion Bu Bundle le

• HLP Level 1 (self-assessment)
• ALL patient facing staff are

Dementia Friends

• Dementia friendly environment

standards checklist

• Discussions with all people with

diabetes – eye and foot checks

• Reduction in volume of Sugar

Sweetened Beverages sold by the pharmacy (10% or less)

He Healt lthy Liv ivin ing Ph Pharmacy (HLP)

• Most pharmacies already are HLP

accredited

• If > 3 years ago need to check still

compliant and document this – using the checklist

• If not been HLP before refer to the PSNC

and LPC websites or call the office for support

• Leadership Training is available through

CPPE and other providers

• RSPH Level 2 Health Champion training is

available from many providers including VirtualOutcomes, CHS, Pharmacy Complete, Buttercups

Heal ealth Prom

• motio

ion Ca Campaig igns

• You need to be supporting

these as part of terms of service as well as HLP

• NHSEi will be providing a

mechanism to collate data at some point until then keep a record / photos of any activities to support these campaigns

1) mid-February to mid-March 2019 Help Us Help You Pharmacy campaign (formerly Stay Well Pharmacy) 2) mid-May to mid- June 2019 Children’s oral health/Smile Month (in line with the training that was incentivised by the Quality Payments Scheme) 3) September 2019 Antimicrobial resistance Resources for this campaign and Stoptober will be delivered together in August 2019 4) October 2019 Stoptober Resources for this campaign and AMR will be delivered together in August 2019 5) November/ December 2019 Help Us Help You main Winter campaign (formerly Stay Well this Winter) 6) January 2020 Alcohol

Dementia Friends

• All patient-facing staff to be Dementia Friends.

https://www.dementiafriends.org.uk/ What is a Dementia Friend?

• Somebody that learns about dementia so they

can help their community. What does a Dementia Friend do?

• Help people living with dementia by taking

actions - both big and small: from visiting someone you know with dementia to being more patient in a shop queue, every action counts!

Dementia Friendly Environment

• Complete a dementia-friendly

environment checklist – NHSEi guide

• Create an action plan which

includes making some demonstrable recorded changes to the environment in line with the checklist

Checkli list t in inclu ludes

Quiet space Signage requirements Lighting Flooring Information Facilities e.g. toilets

Diabetic Screening

• ‘You must confirm that the pharmacy checked that all

patients with diabetes aged 12 years or over, who presented from 1st October 2019 to 31st January 2020, have had foot and eye checks (retinopathy) in the last 12 months.

• You must have recorded the patient’s response on the

PMR or appropriate form/patient record and signposted/referred patients as appropriate.

• This record should set out the total number of patients

who have had this intervention, the number that have not had one or either check in the last 12 months, and it should be recorded where they have been appropriately signposted/referred and reported as part of this criterion’.

Diabetic Screening, Eyes

Screening for eye problems (retinopathy) Everyone with diabetes, who is 12 years old or over, should receive a retinal examination once a year as part

• f the NHS retinopathy screening programme. At the

screening, they will have a photograph taken of their retina, to check how healthy it is. Screening can take place either at a hospital or invited to book an appointment with an optician. The screening is free regardless of where it takes place. National Register – check with local surgery their process to book annual checks

Diabetic Screening, Feet

Screening for nerve damage and circulation

People with diabetes should have a foot examination at least once a year. Foot complications are relatively common, with foot ulcers alone affecting up to 1 in 10 people with diabetes, and need to be treated quickly to prevent them becoming even more serious. Note that it is very important that patients check their own feet on a daily basis as well, as foot problems can quickly become serious. If they notice any changes or damage to their feet, notify their doctor or podiatrist. The foot examination may be carried out by a diabetic consultant, a GP, a podiatrist or a nurse

Sugar Sweetened Beverages (SSBs)

The sales by the pharmacy of Sugar Sweetened Beverages (SSB) account for no more than 10% by volume in litres of all beverages sold. The pharmacy must have either achieved this by the review point or declare that they will be meeting this by 31 March 2020.

For the definition of added sugar see Annex B in the following link: https://www.england.nhs.uk/wpcontent/uploads/2017 /04/sugar-action-doc.pdf .

Medicines Safety Bundle – Audits – get started!

Medicines Safety Bundle (25)

• Medicines Safety Audits complementing the GP QOF QI
• Lithium
• Complete a lithium audit, over three consecutive

months, aligned with requirements of the NPSA alert on lithium (alternatives if not any Lithium patients: in order

• f priority - Methotrexate, Amiodarone, Phenobarbital)
• Valproate
• Complete a valproate safety audit, over three

consecutive months for all girls and women of childbearing potential who have had valproate dispensed from the pharmacy

• Repeat of the NSAIDs and gastro-protection audit
• Implemented report from last audit and then repeat

audit incorporating any learning into practice

• Details in NHSEi guide along with the Annexes

Lithium Audit

Lithium

Valproate Audit

NSAID Audit it

• Must have implemented, into practice, recommendations

from the previous audit on NSAIDs for over 65 years without GI protection as part of the last QPS; the link for the report is in 4.2.4. the NHSEi PQS 2019/20 Annexes to the guidance.

• Repeat the updated audit, notifying the GP of any concerns,

sharing anonymised data with NHSEi and incorporating any learning from the re-audit into future practice.

• Note: Pharmacies that did not claim for the NSAID audit

quality criterion previously, must complete the NSAID audit for the first time and complete the other elements.

• Submission of information to NHS England & NHS

Improvement should be reported on the Manage Your Service (MYS) application for all of the above audits.

Ph PharmOutcomes Su Support

• Community pharmacy contractors can access support on

PharmOutcomes for the Pharmacy Quality Scheme (PQS) 2019/20, and further support will be available soon. This support is available to all contractors free of charge.

• Currently, support is available to assist contractors with

meeting the asthma quality criterion.

• Once a contractor has logged into PharmOutcomes, the tool

can be accessed by clicking on ‘Services’; and then the two services are listed under the title ‘Pharmacy Quality Scheme – Quality criteria’.

• The following audits/frameworks will also be available shortly;

we will alert contractors through our normal communication channels when these become available:

• PQS assessment framework;
• Lithium audit; Methotrexate audit; Amiodarone audit; Phenobarbital audit;
• Valproate safety audit;
• NSAID audit; and
• Dementia-friendly environment checklist.

Coffee Break

11:15

Risk Bundle (30) – with CPPE

• CPPE Risk Management training and

assessment

• CPPE sepsis online training and assessment

with risk mitigation and risk review entry

• Update the previous risk review and record

risk minimisation actions taken

• CPPE online training and assessment on LASA

errors

• New safety report including a focus on LASA

errors

CPPE Support

Megan Harris, Hayley Berry, Mandip Rooprai 11.30

56

Overview

57

Development of CPPE support for CPCF: Pharmacy quality scheme Development of CPPE support for CPCF: CPCS Future services- be service ready

Pharmacy Quality Scheme (PQS)

58

Pharmacy Quality Scheme: CPPE have a bespoke Pharmacy Quality Scheme webpage which has launched in line with the NHS England PQS guidance document. There is some key learning and assessments which you can complete to help you in working towards meeting some of the elements of the PQS. This page tells provides more information about the learning. By logging into the CPPE website people can track their learning. https://www.cppe.ac.uk/services/pharmacy-quality-scheme

CPPE PQS webpage

59

CPCS highlighted on home page

60

Gateway criteria

61

• Advanced services- Vaccination DoC available to help support

provision of the Influenza vaccination advanced service ➢ The CPPE immunisation programme has been withdrawn and learning replaced with eLfH modules 1 and 2

• Safeguarding level 2- must achieve level 2 status within last 2

years of declaration ➢ Safeguarding – CPPE assessment updated

• NHS website
• NHS mail

PQS support

62

Risk Management and safety domain

• The CPPE risk management guide

and associated assessment forms

• ne quality criteria
• Key message: if people have previously completed

the learning and assessment they do not need to repeat it unless they wish to keep up-to-date

Sepsis and Reducing LASA errors

63

Sepsis: learning and assessment This can be found on the CPPE Sepsis gateway page. Key message – all six cases to be completed Look-alike, sound-alike (LASA) errors: this is an e-learning programme with associated assessment

NEWS2

64

https://www.england.nhs.uk/ourwork/clinical- policy/sepsis/nationalearlywarningscore/

LASA resources

65

MUR changes

67

From 1st October 70% fall in target groups of

• patients taking high-risk medicines; or
• patients recently discharged from hospital who

had changes made to their medicines while they were in hospital.

From 1st October 2019, patients with respiratory disease and patients at risk of or diagnosed with cardiovascular disease and regularly being prescribed at least four medicines are no longer target groups for MURs.

X

MUR assessment

68

Updated to reflect changes Remind pharmacy professionals to apply new targets and changes Changes to assessment live now

Next steps

69

Consider your own learning needs and visit our website for further career development. Are you ready for the changes ahead, be service ready with CPPE support. ▪ Being aware of biochemistry and blood results: ▪ e-learning modules 1, 2 and 3 https://www.cppe.ac.uk/programmes/l/biochem1-e-01/ ▪ Epilepsy distance learning: https://www.cppe.ac.uk/programmes/l/epilepsy-p-01 ▪ theLearningpharmacy.com - Non-steroidal anti-inflammatory drugs (NSAIDs) ▪ https://www.cppe.ac.uk/programmes/l/tlp-e-05/ ▪ High risk medicines and MUR https://www.cppe.ac.uk/programmes/l/murrisk-p-01/ ▪ Pain management: https://www.cppe.ac.uk/programmes/l/pain-e-01/

Primary care networks

70

NHS Community pharmacist consultation service

71

• National curriculum – developed by HEE
• Self-assessment framework

Aim: to describe the knowledge skills and behaviours to enable pharmacists to deliver the service to the full scope of their professional capability This is not a DoC Divided into two sections: ➢ Knowing yourself, your team and the service ➢ Applying clinical knowledge and skills

Supporting resources

72

73

CPPE resources and face-to-face training The starting point………

CPCS Changes

Linked to NHS 111- easy and convenient access for patients

Reduce demands on integrated urgent care services

Increase patients awareness of the role of community pharmacy- first port of call for low acuity conditions, medicines and advice Change for patients, pharmacy teams,

• ther healthcare

professionals

Community pharmacy consultation service (CPCS)

CPPE workshops

• Across the country from October 2019
• Upskilling clinical history taking
• Clinical examination skills
• Red flags
• Record keeping
• Clinical transfer

Training details

• GP medic trainer
• Clinical demonstrator
• Two CPPE facilitators
• Full day events

SOCRATES LICEF

New: Inhaler technique: improving outcomes Available from January 2020 across the country

• On completion of all aspects of this learning programme you should be able to:
• discuss the potential implications of poor inhaler technique
• explain your role as a healthcare professional in optimizing inhaled medication
• describe the different types of inhaler devices and their instructions for use
• describe how the aerosol is made in each type of device
• describe the breathing technique required to achieve the
• ptimum inspiratory flow for each device

Dementia

Gateway page: https://www.cppe.ac.uk/gateway/dementia Consulting with people with dementia Dementia distance learning Dementia e-learning

Audits

• Valproate
• Lithium
• NSADIS

Other new clinical services in the contract

80

• HLP status for all pharmacies
• Phased role out of new services

➢ Improve access to palliative care medicines ➢ Hypertension and AF case finding ➢ Hepatitis C testing ➢ POCT for common ailments

New DoCs to support services

81

• Commissioned by

Birmingham Addiction services

• Live on the website
• New programme to

support service

• Live in the next two weeks

Blood Borne Virus Testing Atrial fibrillation detection

A note about DoC

• Please ask people to enable PharmOutcomes
• Sonar : we may be linking DoC into Sonar in the same

way in the near future

• Please ask people to sign up for their six monthly DoC

reminder

Future services

• Be service ready
• How can you prepare your teams for future services and

changes?

• What training would you like?

ACPT Train up the team to help support new contract and new services. Available to pharmacy technicians across England Fully funded by PhIF New cohorts every month- don’t wait join now

85

Training and Resources

VirtualOutcomes - Sepsis 12:10

CPCS 12:20

NHS Community Pharmacist Consultation Service

Com

• mmunity Ph

Pharmacist Con

• nsultation Se

Service (C (CPCS)

• The NHS CPCS is the first clinical service of the new CPCF to be mobilised and

starts on 29th October

• It brings together the learning from the NUMSAS and DMIRS pilots into one

service

• Referred from NHS 111 by the Advisor instead of being directed to a GP
• Patients like the service and value the consultation in a confidential environment
• Onward referrals may be necessary to other urgent care services or the GP
• The face to face consultation of minor illness symptoms includes the recognition
• f any Red Flags
• Over the course of the pharmacy contract the NHS CPCS will be monitored and

evaluated

• By 2020/21 the learning from the GP CPCS pilots will be evaluated and a decision

taken about whether to include “streaming” from general practice into the service

CPCS

• Follow up calls to no-show patients

reduced to one (from three)

• Transitional payment of:
• £900 if signed up by 1st December

2019; or

• £600 by 15th January 2020
• Fee of £14 per completed consultation
• To pilot: expansion with referrals from

GPs, NHS 111 online, Urgent Treatment Centres and possibly A&E

Result lts of

• f

NHS111 DMIR IRS pilo ilots

Phase 1: North East Phase 2: London, East Midlands, Devon

90

• Estimated 6% of all GP

consultations could be safely transferred to a community pharmacy

• Equivalent to 20.4 million

appointments per year.

Age e an and d Gen Gender Sp Split it

Top 10 referred symptoms (from DMIRS pilots)

• 1. Cough
• 2. Pain
• 3. High temperature
• 4. Allergic rash
• 5. Colds
• 6. Sore throat
• 7. ‘Flu’
• 8. Headache/Migraine
• 9. Diarrhoea
• 10. Sprains & strains

How doe does CPCS CPCS in integrate with ith othe

• ther

ser services?

Patient calls NHS 111 or IUC CAS with a request for medicine or appliance

The Call may be transferred to a clinician or handled by a call advisor. (N.B. Call advisors are non-clinical)

Patient triaged to Community Pharmacy

Patient offered choice of 2 community pharmacies providing NHS CPCS. Ideally the patient must be able to attend in the pharmacy in person. Telephone number of the pharmacy given to the patient by NHS 111 or IUC CAS And advised to phone pharmacy within 30 minutes

Message sent to Community Pharmacy electronically

Sent via the CPCS IT system* (NHSmail to be used as a backup in case of system failure)

Patient doesn’t contact The pharmacy?

Pharmacy makes one attempt to contact the patient as a minimum.

Pharmacy hasn’t received referral?

Pharmacy checks IT system Pharmacist phones NHS 111

Emergency Supply to be made

Pharmacist assessment that supply required and is legal Emergency Supply

Patient (or representative) Attends pharmacy to complete supply

No Supply

Pharmacist assessment that Emergency supply not required/ allowed or not possible Another reason for no supply

EPS Rx dispensed Patient buys item Supply not necessary Supply not clinically appropriate

Referral to GP OOH

Emergency Supply required but not possible for legal reason (e.g. controlled drugs)

Medicine/ appliance not stocked

Forwarded onto a pharmacy With stock of item(s) required

Patient telephones the pharmacy

Assessment of request and ability to attend pharmacy

Post Event Message to GP via CPCS IT system*

NHS CPCS Urgent medicines patient flow

Patient triaged to Community Pharmacy

Patient offered choice of 2 community pharmacies providing NHS CPCS. Ideally the patient must be able to attend in the pharmacy in person. Telephone number of the pharmacy given to the patient by NHS 111 or IUC CAS And advised to phone pharmacy

Message sent to Community Pharmacy electronically

Sent via the CPCS IT system* (NHSmail to be used as a backup in case of system failure)

Patient doesn’t contact the pharmacy? Pharmacy makes one attempt to contact the patient as a minimum. Pharmacy hasn’t received referral?

Pharmacy checks IT system Pharmacist phones NHS 111

Patient telephones the pharmacy or attends in person

Patient calls NHS 111 or IUC CAS with a minor illness

The call may be transferred to a clinician or handled by a call advisor. (N.B. Call advisors are non-clinical)

USE ESCALATION PATHWAY IF PATIENT NEEDS HIGHER ACUITY CARE

• Pharmacist to call NHS 111

(Out of Hours service) OR

• Support patient with urgent

appointment at own GP (In hours service) OR

• Call 999 if more urgent

Pharmacist MUST check NICE CKS to identify any risk factors Patient requires higher acuity care – escalate

Patient requires OTC medication support & self care advice The patient may often not require any medication. Self care advice is sufficient Patient can purchase an OTC medicine Patient is supplied on a local MAS The Pharmacist will complete the consultation on the CPCS IT system*

Pharmacist will supply any relevant patient information leaflets from www.nhs.uk

Patient is always advised: “IF SYMPTOMS DO NOT IMPROVE OR BECOME WORSE, THEN EITHER COME BACK TO SEE ME OR SEEK ADVICE FROM YOUR GP” Patient requires referral to a locally commissioned service Post Event Message to GP Via CPCS IT system* Pharmacist consults with the patient

& gives appropriate advice around self care and prevention

NHS CPCS Minor illness patient flow

In In th the Pharmacy

• The patient has a structured

consultation with the pharmacist in the consultation room. The pharmacist will use PharmOutcomes to collect information during the consultation

• The pharmacist will use NICE clinical

knowledge summaries and the patient’s SCR

• The pharmacist will identify any red

flags (e.g. sepsis/meningitis). If a condition is deemed as urgent the pharmacist will escalate back to NHS 111 or in a serious situation to A&E or 999)

In In th the Pharmacy

Following the consultation the outcomes are:

• Advice only (verbal, printed and self-care)
• Advice and the pharmacist recommends the patient

purchase an OTC product to help their symptoms

• Advice and referral into another NHS service
• Advice and signposting to another healthcare service
• Advice and escalation as per the previous slide
• In all cases the patient is advised what to do if their

minor illness worsens and how long they should expect their symptoms to last The post event message will be sent to the GP practice

Im Imple lementatio ion

• A national implementation group (including NHSE&I, PSNC, CCA)

is leading the implementation

• Roadshows led by the national Directory of Services (DoS) team

are taking place with all 111 Providers

• A NHSE&I roadshow is being held in each of the seven regions

with CPCF in the morning and CPCS in the afternoon

• Webinars from PSNC and NHSE&I for LPCs and contractors
• LPCs are supporting contractors locally to get ready for the

service

• Additional training is not mandatory as the supply of urgent

medicines and advice about minor illnesses is core work for community pharmacists. However, all pharmacy staff involved in provision of the service must be appropriately trained on the

• peration of the service

Preparation for delivering the CPCS

Check that your pharmacy can provide the service ✓Must be providing all Essential services and meeting clinical governance requirements ✓Have a clearly-designated consultation room (equipment must be available to allow the pharmacist to record notes electronically during the consultation from 1 April 2020 ) ✓Have access to Summary Care Record (SCR), the pharmacy’s shared NHSmail mailbox and the local secure electronic messaging system used by NHS 111 (the CPCS IT system) ✓Ensure that all staff including locums who will be involved in providing the service are trained and competent to do so ✓Must be able to provide the service throughout the pharmacy’s opening hours

Preparation for

• r delivering th

the CPCS

• Read the draft CPCS service specification & Toolkit – available

via a link from the NHSBSA page

• Sign up for the CPCS ̶ the MYS portal is the only way that you

can register for the CPCS service provision

• Confirm that the pharmacy’s DoS entry is up to date
• Use the NHS CPCS self-assessment framework and other online

resources on the CPPE website

• Enroll for CPD sessions covering consultation and physical

assessment skills (CPPE in October & January and more from April 2020) or LPC events where available

• Have relevant and current SOPs in place which the pharmacy

team have read, understood and signed

• Review and update business continuity plan to include CPCS

Sample Checklist for CPCS

Futu ture Clin linical Services

2020-2024

TCAM (T

(Transfer of f care around medicines)

• 5-10% of hospital admissions are medicines related, of which 2/3rd

are preventable

• 60% of patients have three or more changes made to their

medicines during a hospital stay

• Only 10% of elderly patients will be discharged on the same

medication that they were admitted to hospital on

• 30-70% of patients experience unintentional changes to their

treatment, or an error is made because of a lack of communication

• r miscommunication
• 20% of patients have been reported to experience adverse events

within 3 weeks of discharge, 60% of which could have been ameliorated or avoided

• Ten days after starting a medicine almost a third of patients are

already non-adherent, of these; ₋ 55% don’t realise they are not taking their medicines correctly ₋ 45% are intentionally non-adherent

Coventry and Warwickshire STP – 13th Nov Hereford and Worcs STP – 14th Nov

Patients needing support with their medicines are referred through a secure digital platform when discharged for advice from their local community pharmacist.

Action Plan and Enablers

Liam Stapleton 12:45

Pharmacists can’t do everything themselves!

What stops you succeeding?

What are the things you do that have value added because they are done by a pharmacist? What are the things you do that could be done by someone in a different role? Work in groups to create two lists.

Pharmacists have no place in the dispensing process

What needs to happen to make a change?

• Do you have the right structure and roles?
• Do different team members have the skills or potential to take on

bigger roles?

• Do you need to make some team members redundant and recruit

more suitable people?

CD3 – identifying what you should be doing

Commence what you need to start doing Continue what you need to keep doing Conclude what you need to wind down Delay what you need to do later Delegate what you need to have others do Dump what you need to stop now

What stops you delegating more?

Do you delegate tasks or responsibility?

Good delegation

• Clear instructions

Goo

• od dele

legatio ion

• Clear instructions
• What to do
• How to do it
• Standards
• Boundaries
• When / where to get help
• Supervision, support and feedback
• Accept accountability for errors

A process for

• r dele

legating – STOP-QC QC

• Situation
• Task
• Options
• Plan
• Questions
• Confirmation

What processes do you need to have in place to ensure you are confident to delegate responsibilities to your support teams?

What changes to your pharmacy’s infrastructure will be needed to deliver the CPCF?

Action planning

Action Milestones Who will do it What support will they need When will they complete it

Timeline - short term

October November December January February March April

Register for CPCS (£900) Claim aspiration payment Register for CPCS (£600) PQS Diabetes Start lithium & valproate audit Deadline for update NHS website End diabetes audit Start NSAID audit Claim PQS payment Deadline for sugar sweetened drinks Deadline for IT in consultation room and HLP level 1

Tim imeli line – mediu ium to

• lo

long term

• Changes to IT
• Enrol staff onto courses
• To train a team member to become an ACT takes 30 months
• Develop processes and SOPs
• Staff training
• New processes and SOPs
• Management / staff supervision
• Changes to premises