Integrating NHS Pharmacy and Medicines Optimisation into the new NHS landscape Richard Seal, Regional Pharmacist Midlands and East 6 th November 2018
The need for change 5-Year Forward View Domiciliary Care Voluntary Nursing Sector Homes Mental Patient Hospital Health services NHS 111 Care Homes Primary care • Service provision is fragmented in multiple different types of organisations • Too often, these services don’t communicate effectively with each other • The totality of patients’ needs are not always understood by those serving them • Care is not always delivered in a person-centred way 2 | 2 | System leadership for pharmacy and medicines optimisation
System leadership and integration 1. A cultural shift towards systems leadership 2. Create the right environment and incentives to support the integration of services STPs will provide the 3. Develop sustainable and autonomous opportunity for… systems, that can make the decisions required to improve care in their area within their share of the budget 1. Work together to address systemic challenges 2. Collaboratively develop a care model that In time, mature local more proactively manages need and gets upstream to prevent illness systems will… 3. Makes the necessary decisions to improve services in their area, within their share of the budget 3 | 3 | System leadership for pharmacy and medicines optimisation
Integrated Care Systems 4 | 4 | System leadership for pharmacy and medicines optimisation
Primary Care Networks (PCN) Practices as Primary care networks are small enough teams of teams to give a sense of local ownership, but big enough to have impact across a 30- Personalisation 50K population. Aligned and improved incentives outcomes Informed and enabled patients They will comprise groupings of 100-150 clinicians and wider staff Growing Integrated motivated and primary care sharing a vision for how to improve enabled staff service the care of their population and will serve as service delivery units and a Digitally unifying platform across the enabled country. working 5 | 5 | System leadership for pharmacy and medicines optimisation
NHS Long Term Plan 14 working groups to develop the next plan for the NHS, due to be published Nov/Dec 2018: Efficiency still a major priority given funding Clinical priorities: challenges Cancer Cardiovascular and respiratory Learning Disability and Autism Life course programmes: Mental Health Prevention, Personal Responsibility and Health Inequalities Healthy Childhood and Maternal Health Integrated and Personalised Care for People Enablers: Workforce, Training and Leadership with Long Term Conditions and Older Digital and Technology People with Frailty, including Dementia Primary Care Research and Innovation From December 2018 to March 2019, staff, patients, the public Clinical Review of Standards and other stakeholders will have the opportunity to help local System Architecture health and care organisations determine what the plan means for their local area Engagement 6 | 6 | System leadership for pharmacy and medicines optimisation
Whole Systems Leadership • The NHS has taken a ‘whole system approach’ to delivering the Medicines Value programme • NHS England, NHS Improvement, NHS Digital, Health Education England • Regional offices link with STPs, ICSs, CCGs, and providers • Nationally coordinated with AHSNs, Getting It Right First Time, NHS Right Care and NHS Clinical Commissioners • Working together to explore the requirements for system leaders at local level to deliver system wide medicines optimisation across the whole health economy • Working closely with the ICS and New Care Model teams to develop a framework for a local pharmacy system • Survey to understand how pharmacy leaders are working together across the country 7 | 7 | System leadership for pharmacy and medicines optimisation
Pharmacy Integration Fund • The NHS has taken a ‘whole system approach’ to delivering the Medicines Value programme • NHS England, NHS Improvement, NHS Digital, Health Education England • Regional offices link with STPs, ICSs, CCGs, and providers • Nationally coordinated with AHSNs, Getting It Right First Time, NHS Right Care and NHS Clinical Commissioners • Working together to explore the requirements for system leaders at local level to deliver system wide medicines optimisation across the whole health economy • Working closely with the ICS and New Care Model teams to develop a framework for a local pharmacy system • Survey to understand how pharmacy leaders are working together across the country 8 | 8 | System leadership for pharmacy and medicines optimisation
Survey feedback • Senior pharmacy leaders suggested issues, barriers, and solutions for pharmacy and medicines system leadership across STPs and ICSs • The following themes were identified: 1. A need for joined-up working 2. A need for cultural change 3. Improving current ways of working 4. Lack of capacity 9 | 9 | System leadership for pharmacy and medicines optimisation
IPMO Governance A project to establish a leader who is accountable for and the governance structure for decision-making about NHS pharmacy and medicines optimisation across an STP/ICS for the benefit of patients 10 | 10 | System leadership for pharmacy and medicines optimisation
Choosing the 7 Pilot Sites • Performance for delivering against the Hospital Pharmacy Transformation Plans • Aggregate Single Oversight Framework scores for acute trusts within the relevant footprint • Existing involvement with PhIF programmes (GP Clinical Pharmacists, IUC/NHS 111 Pharmacists, Medicines Optimisation in Care homes) • STP/ICS leadership maturity • STP/ICS overall progress • Other factors • existing leadership in pharmacy and medicines optimisation Black Country STP (Midlands) • pharmacy and medicines workstreams in the STP/ICS Cumbria and North East STP (North East) plans • STPs/ICSs which feature new models of care that may Dorset ICS (South West) alter pharmaceutical service delivery in the future Hertfordshire & West Essex STP (Central & East) Lancashire & South Cumbria ICS (North West) South East London STP (London) Surrey Heartlands ICS (South East) 11 | 11 | System leadership for pharmacy and medicines optimisation
What sites need to do • Identify a dedicated senior NHS pharmacy and • A description/organogram demonstrating the wider structure of medicines optimisation programme manager the STP/ICS and how pharmacy interacts with each part of the (minimum 0.8 WTE) system • Establish a NHS pharmacy and medicines • An organogram describing a pharmacy leadership structure, leadership group (with appropriate protected lines of accountability and job descriptions for new roles that time and resource) that reports into the STP/ICS structure and has board level enable this sponsorship • A “plan on a page” for delivery of national priorities related to • Demonstrate the process for identifying a pharmacy and medicines optimisation (e.g. medicines value STP/ICS Lead for Pharmacy and Medicines programme and medicines safety programme) and contribution Optimisation to STP/ICS priorities and workstreams over the next two years • Develop and implement a NHS Pharmacy and • A “plan on a page” for developing a flexible clinical pharmacy Medicines Optimisation Transformation plan addressing key national and local priorities workforce over the next two years ensuring it is fully integrated into wider • A stakeholder engagement plan STP/ICS plans • Involve regional stakeholders through a • The above outputs should be developed through close links with regional engagement event pharmacy leaders within the STP/ICS, STP/ICS Leads, and the regional NHS England/NHS Improvement leadership team (Including the regional directors, regional medical directors and regional pharmacists) 12 | 12 | System leadership for pharmacy and medicines optimisation
What might this look like? The Northumberland Vanguard Model: stratifying patients according to need https://www.pharmaceutical-journal.com/research/perspective-article/impact-of-an-integrated-pharmacy-service-on-hospital-admission-costs/20204550.article 13 | 13 | System leadership for pharmacy and medicines optimisation
Progress to date • Nationally • All pilot STPs are at different stages of development and maturity • Some have existing medicines optimisation workstreams • System leadership development not restricted to pilot sites • Black Country STP • Steering Group established – Chief Pharmacists of local trusts, CCG Medicines Optimisation leads, LPC and LPN • Draft job description for project manager agreed • Project planning day – 15 th November • Hertfordshire & West Essex STP • Planning the way forward for the Herts and West Essex STP with a core group of senior leads • Agreeing how to communicate this widely • Exploring how the ownership for delivery will sit with the STP medicines optimisation workstream • Governance mechanism for the funding arrangements of the £150k allocated to the STP for the programme • Developing reporting functions and relationship with colleagues external to the STP 14 | 14 | System leadership for pharmacy and medicines optimisation
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