Put on Your Oxygen Mask: Take Charge of Your Life, Learning and - - PowerPoint PPT Presentation

Put on Your Oxygen Mask:

Take Charge of Your Life, Learning and Prosperity

Hemant Patel, NEL LPC, Secretary

INDEPENDENTS Evolving Together

Video: Changes

The NHS Health and Wellbeing Framework

• The NHS needs staff that are well and at work to deliver

effective, quality care for patients. It is more important than ever that NHS workplaces become environments that encourage and enable staff to lead healthy lives and make encourage and enable staff to lead healthy lives and make choices that support positive wellbeing.

• Everyone should feel able to thrive at work. The launch of the

NHS Health and Wellbeing Framework sets out the standards for what NHS organisations need to do to support staff feeling well, healthy and happy at work.

Put on Your Oxygen Mask:

Take Charge of Your Life, Learning and Prosperity

Hemant Patel, NEL LPC, Secretary

INDEPENDENTS Evolving Together

• The NHS Long Term Plan
• January 2019

Prevention Technology

Workforce

A new service model for the 21st century

Five major, practical changes

• 1. Boosting ‘out-of-hospital’ care and finally dissolving the divide between primary

and community health services

• 2. Redesigning and reducing pressure on emergency hospital services
• 3. Enabling more personalised care
• 4. Making digitally-enabled primary and outpatient care mainstream
• 4. Making digitally-enabled primary and outpatient care mainstream
• 5. Focusing on population health and partnerships with local authority-funded

services, through new Integrated Care Systems everywhere

Backed by additional investment of at least £4.5 billion in primary and community care by 2023/24

• Preventing illness and

tackling health inequalities:

• Making better use of

data and digital technology:

• Backing our workforce:

The NHS Long Term Plan

• Backing our workforce:
• Getting the most out of

taxpayers’ investment in the NHS:

• Doing things differently:

Next steps

March: Clinical review of standards NHS Assembly established Early 2019 Summer ‘19 Autumn ‘19 Spring ‘19 5-year local planning Detailed national LTP implementation published established Workforce interim report published LTP national implementation framework published Field testing new clinical standards Workforce implementation plan published implementation

Consideration of …. Doing things differently:

• Transparency in outcomes
• Supervision and delegation
• Clinical capacity within primary care and pharmacy
• Workforce development: clinical and leadership developments
• Workforce development: clinical and leadership developments
• Control of Entry: Closures, Hub and spoke model and robotics
• Primary Care Network development: ?Pharmacy Group Practice
• Premises re-design to include clinical space
• IT and digital enablement
• Population health sharing of data and income

Re-organisation of Community Services & Relationships

• Clinical capacity
• PRN service:
• Community & Prevention

services

• MDTs and Integrated Care
• MDTs and Integrated Care

Provider contracts

• 10 Year NHS Plan: PCNs
• Care pathways redesign with a

difference e.g. AF care pathway in NEL

Lead Provider and alliance

New Ways of Contracting

Lead Provider and alliance agreement

New Contracts

National Contracts

• Dispensing
• What else

Primary Care Contracts

• Part of ICP network
• Shared goals
• Shared funding
• Shared funding

What are Primary Care Networks?

• GP practices joining together as groups of practices working

with community service providers and other health and care

• rganisations, including community pharmacies
• The NHS Long Term Plan said that all GP practices should be in
• The NHS Long Term Plan said that all GP practices should be in

a PCN by June 2019

• PCNs are based on GP lists, typically serving populations of

around 30,000 to 50,000 patients ………80,000?

London LPCS Mapped against LPCs APRIL 2019

14

NW London STP

NC London STP NE London STP SW London STP SE London STP

What are Primary Care Networks (PCNs)?

PCNs will typically comprise:

• 5-6 general practices
• 9-10 community pharmacies
• They will have teams comprising of a range of staff, e.g. GPs,

pharmacists and allied health professionals pharmacists and allied health professionals

• 100-150 clinicians and wider staff
• Small enough to give a sense of local ownership
• Big enough to have an impact across the local population
• Different names may be used to describe them locally, e.g. locality
• r neighbourhood teams

What Will the PCNs be Discussing? Discussing?

• From ‘virtual’ integration

through shared protocols to integrated teams and in some cases shared budgets and

• rganisational integration

Clinicians involved in CCGs will need to shift their focus

• This will:
• 1. Reduce

dependence on both GP practices and emergency services

• 5. More integrated

models of care

Patients are arguably the greatest untapped resource within the NHS

• A key challenge for commissioners

is to direct resources to the patients with greatest need and redress the ‘inverse care law’

Clinicians involved in CCGs will need to shift their focus from the patients that present most frequently in their practice to the wider population that they serve

• This will:
• Improve

health

• utcomes
• Reduce

inappropriat e use of hospitals

• Have a

significant impact on health inequalities’

• 2. More systematic

and proactive management of chronic disease

• 3. Empowerment of

patients

• 4. A population

health approach

A population health systems perspective

requires:

• greater pooling of data and budgets;
• population segmentation;

place-based leadership drawing on skills from different

• place-based leadership drawing on skills from different

agencies and sectors based on a shared vision and strategy;

• shared goals based on analysis of local needs and evidence-

based interventions;

• effective community engagement; and
• incentives to encourage joint working.

CVD Prevention programme: need for MDT work and system intelligence

Hypertension AF Detection CKD

• Complex care
• Polypharmacy
• Non-Compliance
• Mental health
• Prevention
• Early

Diagnosis

• Treatment

CVD risk detection Type 2 Diabetes Obesity

• Mental health
• Drug interactions
• Problems with

pharmacovigilance

• Treatment
• Independent

Living

• Urgent care

Are we really making the most of medicines?

• Only 16% of patients prescribed a new medicine take it as

prescribed, experience no problems and receive as much information as they need

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

are already non-adherent are already non-adherent

• A study conducted in care homes found that over two thirds of

residents were exposed to one or more medication errors

• An estimated 1.8million serious prescribing errors occurred in 2010
• In primary care around £300 million of medicines are wasted every

year, of which £150 million is avoidable

• At least 6% of emergency re-admissions are caused by avoidable

adverse reactions to medicines

Cost of medication errors Cost of medication errors

• Research evidence indicates the following medication error rates in the medicine use process

Prescribing

Prescribing errors rate in general practice

• 5% of prescriptions
• f which 0.18% were

Dispensing Dispensing Prescribing error rate in hospital

• 7% of

prescription items

• f which 0.18% were

severe errors

• With a billion

prescription items prescribed in primary care in the NHS in England annually

• This research

predicts 1.8 million serious prescribing errors each year

Dispensing error rate in hospitals

• 0.02 – 2.7% of

dispensed medicines

Dispensing error rates in community pharmacies

• 0.01 – 3.32%

dispensed medicines

Medicine administrati

• n errors in

hospital

• 3 – 8%

Polypharmacy: Getting our medicines right

• People will, over time, be better supported to have meaningful conversations with

their healthcare professionals about their medicines

• All healthcare organisations will support initiatives to help people to have shared

decision making conversations about their medicines

• Holistic, shared decision making conversations become part of routine practice
• Holistic, shared decision making conversations become part of routine practice
• Healthcare organisations will support efforts to rigorously and meaningfully

measure the size and impact of polypharmacy on both individuals and healthcare systems

• Policy makers remove perverse incentives in the current healthcare system that

drive up polypharmacy and may inadvertently be increasing harm, and

• Regulators build this guidance into their inspections of all healthcare organisations.

Quality focused focused interventions

What the system can do: the role of national bodies in realising the value of people and communities in health and care

How will they be resourced?

• An extension to the GP contract is being made to provide a

package of funding to support the creation and staffing of PCNs

• Many CCGs will also provide additional funding, as well as

support from their staff support from their staff

• NHS England expects the funding to cover the cost of each PCN

hiring, on average, five clinical pharmacists, three social prescribers, three first-contact physiotherapists, two physician associates and one community paramedic by 2024

Technology: Key Messages

• Help users self-manage their disease or

condition without providing specific treatment or treatment suggestions

• Provide patients with simple tools to
• rganize and track their health information
• Provide easy access to information related

Mobile phones have become instruments of accountability and preventive care.

Apps

• Provide easy access to information related

to a patient’s health conditions or treatments

• Help patients document, show, or

communicate potential medical conditions to healthcare providers

• Automate simple tasks for healthcare

providers

• Enable patients or providers to interact with

personal health records or electronic health record systems

Clinical Workforce

THESE ARE MASSIVE CHANGES BUT WHAT ABOUT PHARMACIST’S ABOUT PHARMACIST’S HUMAN NEEDS?

What will Create Stress?

• Mindset: victim vs challenger
• Failure to prepare in advance
• Multiple changes taking place in parallel
• Different type of work
• Different type of work
• Inability to organise and delegate
• Time pressure
• Inability to use new technology fluently
• Inability to work as a team with other

pharmacies and PCN members

Mindset:

Changing The Way You Think To Fulfil Your Potential

Carol Dweck

Fixed Mindset Those with a fixed mindset may not believe that intelligence can be enhanced, or that you either “have it or you don’t” when it comes to abilities and Growth Mindset Those with a growth mindset believe that they can get smarter, more intelligent, and more talented through putting in time and effort. you don’t” when it comes to abilities and talents. What is a Fixed Mindset?

• A fixed mindset is one that assumes

abilities and understanding are relatively fixed. putting in time and effort. What is a Growth Mindset?

• A growth mindset is “the

understanding that abilities and understanding can be developed” (Mindset Works, n.d.).

Mindset: Fixed and Growth (I)

Human Motivation Carol Dweck, a researcher on human motivation.

• Such self-conceptions are crucial

in self-regulation and the ability in self-regulation and the ability to improve.

• A fixed mindset entails the belief
• f static traits and that talent is

the key to achievement.

• A growth mindset involves hard

work and the zest for improvement which is correlated with success.

Mindset: Fixed and Growth

• Look at Difficult

Situations as Opportunities

• Determine One’s

Unique Learning Unique Learning Style

• Focus on a Goal
• Embrace

Weaknesses

• Quality over

Quantity

Mazlo’s Hierarchy of Needs & Creation of Stress

SYMPTOM CYCLE

Poor Sleep Physical Limitations Pain Shortness Fatigue

SYMPTOM CYCLE

Difficult Emotions Pain Stress/Anxiety Shortness

• f Breath

Depression

Stress Resiliant or Fragile?

Multiple Changes Resiliant? ME Over 45? Impact? Time Pressure

£ £ £ Emotional Mental Intellectual Physical Social Spiritual Values Sleep Diet+ Alcohol+ Smoking

STRESS H&WB Outcome: Resiliant or Fragile? H&WB Outcome: Resiliant or Fragile?

Physical Effects of Stress on Body:

• Weakened immune

system

• High blood pressure
• Tense muscles
• Headaches
• Decreased pain

threshold

• Increased risk of heart

attack

• Pounding heart
• Heartburn
• Rapid but shallow

breathing

• Stomachache/nausea

threshold

• Anxiety and

Depression

• Insomnia
• Increased sugar level

and T2Diabetes

• Stomachache/nausea
• Low sex drive
• Fertility problems
• Concentration
• Altered behaviours

Resiliant vs Fragile?

Resiliant

• What makes you more resilient?

Fragile

• What makes you more fragile?

Are you a liability or an asset to your family?

Manage The Effects Of Stress On Health And Well-being

Step 1) Become more self-aware: do you know your personality, mindset? Step 2) Change the way you manage stress: How? Change the way you manage stress: How? Step 3) Change the way you manage your workload: do you have a plan? Step 4) Know where to seek help:

Continue Doing What You are doing: Accept a Technician’s Wage

Undertake Clinical Training and Work in Networks: Accept a service- led contract

Quit the Community Pharmacy Network: Enjoy retirement or new vocation

Choices Community Pharmacy 2019 Choices

Recommendations:

• Negotiators: A Balanced Score Card
• Pharmacists: Consider options and commit

Necessary Problem Solving Skills

• Learn to build new habits
• Learn to assess and mitigate risk
• Health and Wellbeing assessment

‘Pharmacy in PCN’: joint working planning

• ‘Pharmacy in PCN’: joint working planning
• Financial planning and ‘what if’ scenarios
• Training needs analysis

When Will You Put on Your Oxygen Mask?

hemant.patel@nellpc.org.uk

INDEPENDENTS Evolving Together