Integrating NHS Pharmacy and Medicines Optimisation into the new - - PowerPoint PPT Presentation

6th November 2018

Integrating NHS Pharmacy and Medicines Optimisation into the new NHS landscape

Richard Seal, Regional Pharmacist Midlands and East

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The need for change

5-Year Forward View

Voluntary Sector Hospital Care Homes Domiciliary Care Mental Health services Primary care Nursing Homes NHS 111

Patient

• 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

System leadership for pharmacy and medicines optimisation

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System leadership and integration

1. A cultural shift towards systems leadership 2. Create the right environment and incentives to support the integration of services 3. Develop sustainable and autonomous 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 more proactively manages need and gets upstream to prevent illness 3. Makes the necessary decisions to improve services in their area, within their share of the budget

In time, mature local systems will… STPs will provide the

• pportunity for…

System leadership for pharmacy and medicines optimisation

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Integrated Care Systems

System leadership for pharmacy and medicines optimisation

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Primary Care Networks (PCN)

Informed and enabled patients Practices as teams of teams Personalisation and improved

• utcomes

Integrated primary care service Digitally enabled working Growing motivated and enabled staff Aligned incentives

Primary care networks are small enough to give a sense of local ownership, but big enough to have impact across a 30- 50K population.

They will comprise groupings of 100-150 clinicians and wider staff sharing a vision for how to improve the care of their population and will serve as service delivery units and a unifying platform across the country.

System leadership for pharmacy and medicines optimisation

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NHS Long Term Plan

System leadership for pharmacy and medicines optimisation

14 working groups to develop the next plan for the NHS, due to be published Nov/Dec 2018:

Life course programmes:  Prevention, Personal Responsibility and Health Inequalities  Healthy Childhood and Maternal Health  Integrated and Personalised Care for People with Long Term Conditions and Older People with Frailty, including Dementia Clinical priorities:  Cancer  Cardiovascular and respiratory Learning Disability and Autism  Mental Health Enablers:  Workforce, Training and Leadership  Digital and Technology  Primary Care  Research and Innovation  Clinical Review of Standards  System Architecture  Engagement

From December 2018 to March 2019, staff, patients, the public and other stakeholders will have the opportunity to help local health and care organisations determine what the plan means for their local area

Efficiency still a major priority given funding challenges

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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

System leadership for pharmacy and medicines optimisation

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Pharmacy Integration Fund

System leadership for pharmacy and medicines optimisation

• 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

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• 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

Survey feedback

System leadership for pharmacy and medicines optimisation

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A project to establish a leader who is accountable for and the governance structure for decision-making about NHS pharmacy and medicines

• ptimisation across an STP/ICS for

the benefit of patients

IPMO Governance

System leadership for pharmacy and medicines optimisation

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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
• ptimisation
• pharmacy and medicines workstreams in the STP/ICS

plans

• STPs/ICSs which feature new models of care that may

alter pharmaceutical service delivery in the future System leadership for pharmacy and medicines optimisation

Black Country STP (Midlands) Cumbria and North East STP (North East) Dorset ICS (South West) Hertfordshire & West Essex STP (Central & East) Lancashire & South Cumbria ICS (North West) South East London STP (London) Surrey Heartlands ICS (South East)

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• Identify a dedicated senior NHS pharmacy and

medicines optimisation programme manager (minimum 0.8 WTE)

• Establish a NHS pharmacy and medicines

leadership group (with appropriate protected time and resource) that reports into the STP/ICS structure and has board level sponsorship

• Demonstrate the process for identifying a

STP/ICS Lead for Pharmacy and Medicines Optimisation

• Develop and implement a NHS Pharmacy and

Medicines Optimisation Transformation plan addressing key national and local priorities ensuring it is fully integrated into wider STP/ICS plans

• Involve regional stakeholders through a

regional engagement event

What sites need to do

• A description/organogram demonstrating the wider structure of

the STP/ICS and how pharmacy interacts with each part of the system

• An organogram describing a pharmacy leadership structure,

lines of accountability and job descriptions for new roles that enable this

• A “plan on a page” for delivery of national priorities related to

pharmacy and medicines optimisation (e.g. medicines value programme and medicines safety programme) and contribution to STP/ICS priorities and workstreams over the next two years

• A “plan on a page” for developing a flexible clinical pharmacy

workforce over the next two years

• A stakeholder engagement plan
• The above outputs should be developed through close links with

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) System leadership for pharmacy and medicines optimisation

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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

System leadership for pharmacy and medicines optimisation

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• 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 – 15th 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

Progress to date

System leadership for pharmacy and medicines optimisation