Adam Williams MSc BSc (HONS) NIP RNA Head of Nursing Quality Patient Outcome Spend Improving care quality through Non-Medical Prescribing in the Out of Hours and Out of Hospital setting. Adam Williams MSc BSc (HONS) NIP RNA Head of Nursing

Content Overview of what Mastercall provides Out of Hours, Walk in Centre and Community-based IV service Non-medical prescribing structure Benefits for patients Benefits for clinicians Benefits for commissioners How does NMP improve patient experience? How do we measure performance of non-medical prescribers? Conclusion

non-medical prescribing Mastercall and NMPs Social Enterprise Out of Hours across Stockport and Trafford Community-based IV Therapy Service Pathfinder/Alternative To Transfer service Walk in Centre in Trafford Home visiting service Frontline clinician in A&E service 120 nurses and paramedics 200 sessional GPs Mastercall could not function without non-medical prescribing

Non-medical prescribing structure Nurse practitioners, advanced nurse practitioners can use either PGD or are independent prescribers Paramedics as emergency care practitioners can issue drugs from a PGD We have approximately 25-30 drugs on our PGDs from antibiotics, pain relief and many others Prescribing is electronic wherever possible Prescribing of intravenous antibiotics in the community under consultant microbiology guidance

Benefits of NMP to patients Care closer to home – IV service/OOH Reduced delay in definitive treatment ‘One stop shop’ for a patients Avoids hospital admission/attendance No disruption to usual therapies Improves access to treatments for patients with long term conditions

Benefits of non-medical prescribing to commissioners Supports the Right Care/Commissioning for Value agenda Supports the NHS Outcome Domains framework Positive experiences of care Enhancing life for patients with long term conditions Helping people recover from periods of ill health Treating patients safely and avoiding harm 6/27/2018

Benefits of NMP for clinicians Maximise staff wellbeing and learning Improve patient experience PATIENT OUTCOMES Increase value and efficiency Greater autonomy and freedom in job role Job satisfaction increased Enables independent management of patients Enhances care by enabling timely access and management of conditions Avoids hospital admission Releasing time to care NHS Improving Quality 6/27/2018

Top 5 conditions NMPs prescribed for 2014/15 In 2014/15 – 22,000 prescriptions issued by non-medical prescribers

Top 10 Drugs Prescribed by NMPs at Mastercall Prescribing is audited by a quality panel Feedback in writing to clinicians Incidences of inappropriate prescribing is flagged Non-compliant clinicians may have higher audit Driver for quality

Community Managed IV Therapy Service (COMMIT) Nurse led service under a medical director 11,000 bed days saved July 2013 – April 2013 Approximate savings circa £2.5+ saving vs inpatient stay NMP has been vital to the success of the service Very high patient satisfaction based on detailed patient survey Complex patients – brain and liver abscesses, spinal infections, sepsis, and post-op complications I am the main carer for my disabled wife and recently used the service for a skin infection. Previously I had to be admitted to hospital, which meant my wife needed carers who she didn’t know. This service enabled me to remain at home and did not disrupt my wife’s care. Patient feedback, 2014

How does NMP improve patient experience? PATIENT A Long term conditions PATIENT B Positive experience of care PATIENT C Care closer to home

How do we train our staff for NMP? Bespoke, unique 6 month degree-level minor illness course validated by Liverpool John Moores University Support staff to undertake the V300 in near future Regular teaching sessions from clinical experts Regular audit and feedback on performance Measured against local prescribing guidance and policy Clinicians asked to provide written feedback on prescribing decisions as part of development and learning

The future? The future Paramedics More NMPs Workforce development to include paramedics Increase non-medical prescriber led services and care provision Measure NMP vs GP Recent co-amoxiclav audits – 100% compliance from NMP More NMPs Paramedics The future

Thanks for listening… Any questions? adam.williams@nhs.net