System Leadership and Medicines Optimisation in Surrey Heartlands: - - PowerPoint PPT Presentation

System Leadership and Medicines Optimisation in Surrey Heartlands: Our Journey East Sussex, West Sussex and Surrey LPCs

Linda Honey Interim Director of Pharmacy and Medicines Optimisation 10th July 2019

The recent system

The recent system

• Fragmented and complex health system
• Multiplicity of providers
• Different employers and different employing arrangements
• Multiple information systems
• Results in silo thinking and missed opportunities

But people want a:

And we have these priorities

• Reducing variation
• Reducing polypharmacy
• Antimicrobial stewardship
• Improving transfer of care
• Improving access to our services
• Reducing medicines waste
• Addressing workforce challenges
• Preventing patient harm (WHO global challenge)
• Improving pharmacy input into the prevention agenda

• 1. Making sure

everyone gets the best start in life

• 2. Delivering world class

care for major health problems

• 3. Supporting

people to age well

And we need to deliver the LTP

The NHS Long Term Plan is about integrating services around the patient more effectively, and making inroads into the major ‘killer’ diseases and causes of ill health. Its three main ambitions:

Ambitions underpinned by action to overcome specific challenges: Personalised care, Prevention and health inequalities, Workforce, Data and digital technology, Delivering better value

So, what if we….?

And what if we….?

Primary Care CCG Community Pharmacy Community Trust Ambulance Trust Mental Health Acute Care

And went from here

To here

Primary care CCG Community Pharmacy Community Providers Ambulance Trust Mental Health Acute trust

Patient Surrey Heartlands Pharmacy Workforce

What if we started to see the pharmacy workforce as one – what would that look like from a system leadership perspective?

Started with a belief that we are better together

• We began by sharing our stories, our vision, our pressures
• Began to collaborate on workforce issues, training,

recruitment and development, opportunities for sharing resources

• Started to build a coalition of the willing
• Developed a model for system leadership
• Began to engage our own workforce in this journey (OD)

From sharing strategies to owning shared

• bjectives
• Transfer of care around medicines (PharmOutcomes)
• Medication safety
• Workforce
• Tackling antimicrobial resistance
• Medicines Optimisation in Care Homes
• Digital
• Medicines Value Programme
• Acute Pharmacy Transformation

Integrating Pharmacy and Medicines Optimisation (IPMO) into STPs/ICS: aims

‘to develop a framework which will set out how to systematically tackle the medicines optimisation priorities for the local population in an STP/ICS footprint and use the expertise of pharmacy professionals in the strategic transformation of systems in order to deliver the best patient

• utcomes from medicines and value to the taxpayer’

IPMO into STPs/ICS: objectives

• To develop and test a core set of principles that set out how NHS pharmacy and medicines
• ptimisation can be best integrated into STP/ICSs
• To define the functions of leadership for NHS pharmacy and medicines that should be undertaken

at system level and describe how these would be delivered

• To ensure visible professional expertise and leadership in NHS pharmacy and medicines at system

level

• To identify and accelerate strategies to achieve medicines optimisation at scale to improve

patient outcomes and value for money across primary and secondary care

• To explore the approach to developing an integrated, flexible, clinical pharmacy workforce that

can deliver high quality and sustainable medicines optimisation at scale, across a local system

• To inform the national priorities on how best to support systems in unlocking the barriers that

will increase opportunities for effective medicines optimisation in STP/ICSs

From medicines

• ptimisation

group to established and recognised transformation work stream

• Medicines Optimisation Programme Board
• Medicines Optimisation Steering Group
• Executive Sponsors
• Strategy Lead
• Programme Manager

Chief Pharmaceutical Officer

SH Draft Long Term Leadership Structure

Transformation Board

NHSE/I Regional Pharmacist

SH Clinical Director of Pharmacy 1WTE

• Med. Opt. Programme Board
• NWS ICP
• Chief Pharmacist 1

WTE

• LPC Rep
• G&W ICP
• Chief Pharmacist 1

WTE

• LPC Rep
• SD ICP
• Chief Pharmacist 1

WTE

• LPC Rep

SH SRO

Delivery Board Surrey & Borders Chief Pharmacist (wider role than Surrey Heartlands)

LPC CEO

Surrey Heartlands ICS Pharmacist (lead for pharmacy services provided at scale across SH ICS) 2WTE

DRAFT MODEL

• ES ICP
• Chief Pharmacist 1

WTE

• LPC Rep

18 | Supporting the development of primary care networks

• Practices continue to provide core services
• Network Contract DES provides practices opportunity to work collaboratively with
• ther practices health, social care and voluntary partners to deliver services
• Practices and other health, social care and voluntary partners collaborate as primary

care networks, providing additional services that can’t be delivered on a smaller scale

Place c.250-500k ICP

• Primary care interacts with hospitals, mental health trusts, local authorities and

community providers to plan and deliver integrated care

• Primary care participates as an equal partner in decision making on strategy and

resource allocation

• Action is taken to ensure collaboration across hospitals, community services, social

care and other partners, helping to join up and improve care

• Data is used to deploy resources where they can have the maximum impact
• Each person can access joined up, proactive and personalised care, based on ‘what

matters’ to them and their individual strengths, needs and preferences

Neighbourhood c.30k~50k PCN System c.1+m ICS Individual

Vision for the integrated clinical pharmacy team

• All pharmacists and pharmacy technicians supporting patients are

part of the multi-professional team in a PCN

• Clinical pharmacists are a central part of the PCN team
• Community pharmacy teams deliver consistent, high-quality

minor illness care and support the public to live healthier lives

• Community pharmacists have capacity to deliver more

clinical care

• Hospital and mental health pharmacists continue to be part of

specialist teams and extend their practice into primary care, including providing consultant pharmacist support

• CCG pharmacy teams leading on population health
• Consistent delivery of these goals will require clinical and

professional leadership across the health and care system, by Regional Chief Pharmacists and proposed Clinical Directors of Pharmacy and Medicines in each ICS

IPMO next steps:

• Publish 7 case studies for

Integrating Pharmacy and Medicines Optimisation across an ICS pilots

• Further develop

governance framework for IPMO and evaluate

• Pilot project to continue for

two years and roll-out to

• ther STP/ICSs
• Regional chief pharmacists

continue to lead

Surrey Heartlands Medicines Optimisation Workstream

Workstream – Outline Strategy: Getting the most from medicines for both patients and the NHS is becoming increasingly important as the aging population mean more people have complex multimorbidities. The NHS spends £17.4 billion a year on medicines but up to half of medicines prescribed for long-term conditions are not taken as intended, and around 5 to 8% of hospital admissions are medicines-related. Many of these are preventable. The identified MO projects involve collaborative work with all pharmacy professionals, all other health & social care professionals and patients to ensure prescribing is high quality, safe and good value. The outputs will have a positive impact on population health for Surrey Heartlands residents whilst supporting the delivery of the national Medicines Value Programme (MVP) in ensuring that we are getting the best value from the medicines bill.

• 1. Electronic Prescribing & Medicines Administration (EPMA)

Project to implement the computerization of the processes of prescribing, processing, stock control and recording the administration

• f medicines. EPMA replaces the current paper prescription and

administration record chart normally completed for every in-patient, as well as discharge and outpatient prescription forms. Aims to improve the quality of prescribing, reduce risks associated with prescribing processes, and reduce the occurrence of adverse events. National requirement by 2020.

• 2. PharmOutcomes

Implementation of a web-based system which helps community pharmacies provide services more effectively. A standardized approach to discharge medication across the 4 main Acute Trust providers within Surrey Heartlands. PharmOutcomes will provide an automated transfer of patient discharge medication information between the Acute Trust provider and the patient’s community pharmacy. This will help to improve the patient transfer between care settings where historically there have been problems with the medicine reconciliation and management of patients.

• 3. Medication Safety

Recruitment of a dedicated resource across Surrey Heartlands to develop processes to provide leadership across the partnership to support “medication without harm” across all organisations. Development of a common system for reporting / analysis / monitoring, establish an open culture of sharing and learning & develop solutions and support implementation of initiatives that lead to safe use of medicines, including opportunities to change culture.

• 4. Care Homes

National funding of £370k received to implement programme of dedicated pharmacists & technicians into Care Homes to improve safe use of medicines, reduce risks & improve quality of prescribing (thereby reducing acute admissions). Links to SD ICP ‘Quality in Care Homes’ initiative. Funding split amongst each CCG to enhance the existing work in each area. National metrics being developed. Project overseen by Meds Optimisation Care Homes Group.

• 5. Medicines Value Programme

Aligns with national programme that has been set up to improve health outcomes from medicines and ensuring we are getting the best value from the NHS medicines bill. A range of initiatives in place such as best value biologics and generic medicines, polypharmacy and reducing waste. A dashboard is being developed to track progress.

• 6. Workforce

The development of a collaborative workforce strategy to provide integrated services around the patient to enable system-wide MO across Surrey Heartlands. This strategy will utilise the expertise and clinical knowledge of pharmacists, as medicines experts, providing the capacity to address the wider workforce challenges, the competency to relieve the pressures within primary care, and the skills to enable system-wide medicines optimisation across Surrey Heartlands.

• 7. Antimicrobial Stewardship:

We are working to reduce variation and improve standards of antibiotic prescribing. This work will include the establishment of a Surrey Heartlands Antimicrobial Resistance Strategic Collaborative Group to lead on local implementation of the UK 5 Year Antimicrobial Resistance Strategy and professional education, training and public engagement.

• 8. Surrey Care Records

We are working to provide access for Community Pharmacies to the Surrey Care Records in phase 2 of the roll out. This work is closely linked to the digital workstream. Programme Board Marianne Illsley (Exec Sponsor), Linda Honey(Strategy Lead) Alex Stoddart (Programme Manager), Kevin Solomons, Damien Kelly, James Wood, Simon Whitfield

Projects & deliverables

Workforce (feedback from a stakeholder event)

What are we trying to do?

• ‘One Team’
• Permission to cross boundaries
• Deployment of workforce to meet needs of population
• Development of workforce with greater competencies to work

cross-sector

• Portfolio roles/rotational working/foundation programme
• Integration across professions (MDT working)
• Collective succession planning for emerging leaders
• Potentially staff employed by one organisation

How will we do it?

• Visibility
• Create a ‘social system’
• OD sessions and word of mouth
• Permission for staff to suggest ideas – genuine co-design
• Put support mechanisms in place
• Demonstration of ‘doing something’
• Training and skills courses that are transferable across sectors

Who needs to do it?

• A system leader for Pharmacy Workforce
• Staff Champions in each sector
• Support from Exec Leaders
• GPs in PCNs
• ICP Leads
• IT
• IG
• HR and Workforce Work stream
• HEE

How will we know when we’ve done it?

• Vacancy and Retention rates
• Developmental measures
• Staff surveys/feedback
• Patient Survey/feedback

Transfer of Care around medicines

• The Transfer of Care Around Medicines Programme aims to ensure a seamless

transfer of medicines discharge information directly from hospital to the patient’s choice of Community Pharmacy using a safe and secure IT system called PharmOutcomes

• Working across Surrey Heartlands with:
• ASPH
• RSCH
• ESHUT
• SASH
• SABPT
• First Trust going live ASPH in Oct 2019 with a launch event 8th Oct at HG Wells
• Consideration about how this links with the Surrey Care Record

Surrey Care Record (SyCR)

• Summary Care Record is to be phased out by 2024 and is being replaced by a

network of regional patient records covering the country

• The Summary Care Record is based solely on a short summary of a person’s

GP record with the intention that the regional records will combine GP, hospital, and other health and social care information.

• Surrey Care Record is in Phase 1 linking with GP practices
• Work ongoing with other partner organisations across Surrey currently
• Community Pharmacies are within scope looking to:
• ensure that community pharmacies will be able to view SyCR Clinical Data in a

clinically safe and secure way

• ensure that community pharmacies will be able to contribute to SyCR Clinical

Data in an IG compliant and secure way within the agreed timeframe

Linda Honey Associate Director Medicines Optimisation, North West Surrey CCG Damien Kelly Chief Pharmacist, Royal Surrey County Hospital NHS Foundation Trust Rachel Mackay Associate Director Medicines Optimisation, G&W CCG Olatokunbo Ogunbanjo Chief Pharmacist , Ashford and St Peter’s Hospitals NHS Foundation Trust Priti Shah Lead Medicine Management Pharmacist, CSH Surrey Kevin Solomons Associate Director Medicines Management, Surrey Downs CCG - Hosted Service Sarah Watkin Associate Director Pharmaceutical Commissioning, Surrey Downs CCG - Hosted Service Simon Whitfield Chief Pharmacist , Surrey and Borders Partnership NHS Foundation Trust James Wood Chief Executive Officer, Community Pharmacy Surrey & Sussex

Pharmacy Leadership Team Surrey Heartlands

To read the NHS Long Term Plan: https://www.longtermplan.nhs.uk/ Sign up for the quarterly Pharmacy and Medicines Bulletin: https://www.england.nhs.uk/email-bulletins/pharmacy-and-medicines/ The FutureNHS site includes a highly active discussion forum and a range of PCN resources, including recent ‘Working with Pharmacy’ webinars – request access to the site via england.PCN@nhs.net Webinars and events, FAQs and other materials at www.england.nhs.uk/pcn Primary care networks: A briefing for pharmacy teams: https://www.england.nhs.uk/wp-content/uploads/2019/06/pcn-briefing- pharmacy-teams.pdf Guidance for Local Pharmaceutical Committees – How to help contractors get involved with Primary Care Networks: https://www.england.nhs.uk/publication/guidance-for-lpcs-how-to-help-contractors-get-involved-with-primary-care-networks/ Listen to the latest #primarycarenetworks podcast online at www.england.nhs.uk/gp/gpfv/redesign/primary-care-networks/primary-care-network-podcasts Tweet #primarycarenetworks to join in the conversation