Northumberland Vanguard Creating Primary Care Capacity Wasim Baqir

Our health and care system 11 HOSPITAL SITES PRIMARY/SOCIAL CARE 322k patients 1.7m primary care consultations 44 GP PRACTICES Beds 1049 Providing care for 73,000 patients on 48 wards every year UK’s first specialist emergency care hospital 167k Adult social care Home visits 70k £485m Northumbria £440m CCG £50m Mental Health FT staff circa 9,000 3000 care home residents

Our Vision for Pharmacy Ensuring safe and optimal use of medicines for the people of Northumberland Integrating Pharmacy into existing and new structures/ services Medicines should be seen as an investment; not a cost

Northumberland Vanguard Pharmacy – Our drivers for care Enhance patient care through better integration of the Pharmacy Team Improve quality and safety with medicines Improve quality of care for patients Improve patient experience Better use of skill mix in primary care Increase primary care capacity Foundation General Practice Pharmacists Enhanced care: Acute Visiting Service Enhanced care: Complex Patients Community Pharmacy Integrate with secondary care

An army of pharmacists

Can we deliver? Delivering New Models of Care at Scale 20-25 pharmacists across Northumberland Prescribing (or experienced) Demand for pharmacists NHS Eng GP pilots New hospital roles (A&E) Impact on the local health (pharmacy) system

Foundation GP Pharmacists Programme Developing a workforce fit for purpose Pre-reg  General Practice Create integrated pharmacist roles to: Create a future workforce Improve medicines use Clinical training in acute and primary care Little impact on system

Our Integrated Model 1WTE per practice (other models negotiable) for 6 practices Role split between hospital (backfilled by experienced clinical pharmacist) Developmental 4 week rotation with buddy GP to co-fund (similar to GP pilots) Y1 40% of band 6: £20,200 Y2 60% of band 6: £30,800 Y3 100% of band 78a: £52,000 to £63,000 F1F2Prescribing

Increasing quality and capacity Year 1 Medication review Discharge reconciliation Care home reviews Clinical audit Year 2 Complex medicines clinics Manage QoF and/or therapeutic area Education & Training Year 3 Domiciliary visits Supporting acute patients or visit requests

What Support is needed? Foundation Y1 Consultation skill Systems/ orientation GP mentorship Clinical training Foundation Y2 Year 1 + Clinical examinations General Level framework IP Training Prescribing mentorship Advanced clinical skills

Training Support Inhouse (hospital & GP) CPPE Community of interest Resources Regional tutors Community of interest Peer support Whatsapp, Periscope

Developing core roles – care homes Complexity of care Patients that I pass on Patients that I need help with Interventions that I can do

Metrics Indicator 1. Volume of patient focussed activity: consultations, medication reviews, patient queries – per practice pharmacist 2. Medicines information queries 3. GP workload Anything that pharmacist does that would have been done by GP % acute prescription requests/month 4. Medication Reviews done as % of all completed 5. Medicines reconciliation for patients discharged from hospital - % of all patients discharged 6.Disease specific reviews, according to national priorities (e.g. AF, using shared decision making approach)  7. Repeat dispensing (Medicines Optimisation dashboard) 8. Patient Experience 9. Antimicrobial Stewardship  10. Feedback from stakeholders

So, how’s it going? GP Mentor and pharmacist support Diverse range of tasks – variation may be an issue! COPD & osteoporotic fracture risk Asthma reviews and inhaler technique; Q Risk assessment and prescribing of statins; IHD reviews Nursing home/care home reviews AF management and developing NOACs/group clinics Antidepressant reviews for long term patients; RA AF anticoagulation clinics/group clinics

Clinical care whilst releasing capacity

Clinical care whilst releasing capacity What is this?

Clinical care whilst releasing capacity Why so low?

Variation SDev Patient Focussed activity 124.46 Medicines information queries 46.08 Medication review done by pharmacist 22.31

Variation: % acute requests

Chronic Disease Management P2 P3 P4 P5 IHD 14 NHS Health Checks 3 82 5 12 RA Hypertens-ion 7 AF

Bridging the gap between primary and secondary care: the role of a foundation pharmacist Karsan, Rathbone, Baqir 17 semi-structured interviews 10 with F1 pharmacists & 7 with GPs General satisfaction with the role from all stakeholders Capacity, patient safety Integration valued Key roles identified Discharge, medication review & optimisation, prescription requests, support with prescribing Case loads

Role valued by GPs “I think the reduction in workload feels significant, I wouldn’t know how many patients per week, as it were, or how many hours per week it is reduced but, as much as the reduction in workload it is the reassurance that you know it is being done right ” –P2,GP “if somebody has been discharged, they will chase up secondary care, because they’ve got that in that we’ve never had and passing information on to get staff to do it, they do that side so that is useful, having that interface” – P8, GP

Issues Lack of clarity of role Inappropriate work Workload GPs wanted better understanding of their role

Local Recognition “It is really exciting to be at the forefront of something so new and innovative in the NHS. To feel like you are making such a positive difference by being proactive in reviewing patients and helping to avoid any problems that might with arise medication in future.” Alastair Green, F1 GP Pharmacist http://www.northumberlandgazette.co.uk/news/pharmacists-right-at-the-heart-of-new-model-of-health-care-1-8222823

Working across Organisations

One Team Blurring the edges Shared directory of services Single clinical systems Clever integration Caring for our patients wherever they are in the system

Moving Forward Engage patients and service users – co-design future services & roles Community pharmacy What’s out there – share and learn

Watch our film at www.health.org.uk/pills