Medicines Optimisation in Care Homes: Personalised care for care - - PowerPoint PPT Presentation

Dr Wasim Baqir

National Pharmacy Lead (Care Homes) Pharmacy Integration Team

Medicines Optimisation in Care Homes:

Personalised care for care home residents

RPS Scotland

Medication Erro rors rs

Medicines Wa Waste

Silo working

Exces ess m medicines es (unnec eces essary/ inappropriate) e)

Lack ck o

• f

f struct ctured review ew Rare patient involvement

Care Homes

Integrating to improve care

• Quality & safer care when we:
• Understand each other
• Join up care
• Share Decisions
• Co-develop
• Work across organisations
• Involve patients, families
• Relationships and good

conversations

Next S Steps on

• n the Fi

Five Year F r For

• rward Vi

View

4

Deliver improvements in the priority areas:

• cancer
• mental health
• primary care
• urgent and emergency care

A national move towards integrated care. Learning from the vanguards is integral to Sustainability and Transformation Plans

The Medicines Value Programme

The NHS wants to help people to get the best results from their medicines – while achieving best value for the taxpayer

Savings will be reinvested in improving patient care and providing new treatments to grow the NHS for the future The NHS policy framework that governs access to and pricing of medicines

1

The commercial arrangements that influence price

2

Optimising the use of medicines

3

Developing the infrastructure to support an efficient supply chain

4

A whole system approach….

• NHS England, NHS

Improvement, NHS Digital, Health Education England

• Regional offices link

with STPs, ACSs, CCGs, and providers

• Nationally

coordinated with AHSNs, Getting It Right First Time, NHS Right Care and NHSCC

Following the Next Steps on the NHS Five Year Forward View and Carter Report

Pharmacy Integration Projects

300 Pharmacists & technicians in IUC & Care Homes

Quality Payments Scheme

Digital Minor Illness & NUMSAS referrals from NHS111

NHS Digital Integrating pharmacy through SCR, NHSmail, EPS, ERD, single source of pharmacy services data, referrals/ discharge from secondary care

Pharmacy Workforce development with HEE 2,000 prescribers; GP, care home and urgent care pathways; post-registration and leadership training

GP pharmacists Investment in 2,000 new pharmacist roles by 2021

NHS England is enabling the transformation of pharmacy practice to improve the quality and efficiency of services for the public

Seven care elements

• Enhanced primary care support
• Medicine reviews
• Multi-disciplinary team (MDT) support including coordinated

health and social care

• Reablement and rehabilitation
• High quality end-of-life care and dementia care
• Joined-up commissioning and collaboration between health

and social care

• Workforce development
• Data, IT and technology

Enhanced Health in Care Homes

Mo Moving Medicines Opti timisati tion (MO) Up Upstrea eam

• No system wants to pay for a health professional to fix the ‘mistakes’
• f another health professional!
• MO by Pharmacy should be
• Making the right decision first time
• Challenging poor systems
• Deprescribing when the time is right
• Giving residents an equal say
• Working together

Case Study: Northumberland

• Pharmacy team work across

primary and secondary care

• Support network between Mental

Health and other local pharmacy services

• Team works closely with

community pharmacy, general practice, social care and voluntary sector

89yr old lady admitted to A&E following epileptic fit Assessed on A&E: decision to increase Lamotrigine Discharged back to care home Pharmacist liaised with A&E and prescriber Community Pharmacy supplied Admission to ward avoided

Brighton and Hove CCG

• Contract with an independent provider
• 20,000 care home residents had their medicines reviewed by a

pharmacist

• £300k + savings due to

medicines being stopped in one year

• Similar savings from

avoidance of hospital admissions

Slide courtesy of Heidi Wright, RPS

Stratifying t to create capacity

High Risk Complex Moderate Risk/Need Low Risk/Need

Complex Medication Review, MDT Discharge, new patients Low acuity interventions, waste management

Integrated teams working together across

• rganisational

boundaries

Involving Residents ts

• Sharing decisions with residents and/or their family

and carers

• Don’t make assumptions
• Better and easier decisions
• More likely to deprescribe and have GPs accept

deprescribing suggestions

• Change the conversation

Working b g better er w with C Community Ph Phar armacy

• Small clinical teams cannot see every

resident

• Northumberland
• Move from traditional ‘home by

home’ approach

• 50% would be new residents by the

time we get back to the first home

• A role for community pharmacy?

Northumberlan and Community Ph Pharmacy C Care Home Medici cine U Use Reviews

Pass it on Let’s talk Do it

Vanguard Pharmacists, Geriatricians, MDT Vanguard team & Comm Pharmacy

Community Pharmacy MUR Complexity

• f care

15% 21% 64%

• 240 Pharmacists and technicians working across

care settings to support care homes

• Medicines optimisation (including deprescribing)
• Care home systems and staff (reduce errors, waste)
• Antimicrobial stewardship
• Training pathway
• HEE commissioned training provider – CPPE
• 600 Pharmacists and Pharmacy Technicians
• Independent Prescribing
• Infrastructure
• Networks, IPACS, Data & Metrics, Polypharmacy Support

Scaling & Spreading good care

STP offered funding

• Lead CCG
• Plans

35 STPs and 10 ICSs

Training Pathway Network to share, learn & spread Monitoring (Population Health Dashboard/ Metrics)

16

Suppo upport f for e ever ery a y area

• Equity – every system in

England will get funding

• Based on indicative care home

population

• Enough to get started and

make a difference

• Integrating services working across CCGs
• Innovative partnerships
• Community Pharmacy part of the NHS team
• Thinking beyond (MH, Antimicrobial

Stewardship)

• Adding to the funding
• Competition  Collaboration

Sys Syste tem L Leadership

Integrating Pharmacy Medicines Optimisation ( IPMO)

• What’s your system
• Who does what, where?
• Duplication/ confusion; gaps/ opportunity
• Local networks
• Pharmacists and Pharmacy Technicians enabled to work together
• Cross-organisational
• Start with the patient and their needs
• 7 Pilot Areas

www.health.org.uk/pills

“When we strive to become better than we are, everything around us becomes better too”

Paulo Coelho, The Alchemist

@wasimbaqir

england.pharmacyintegration@nhs.net