Managing the Performance of Homecare Medicines Services Jane Kelly, Procurement Project Pharmacist Mick Butterfield, Specialist Technician: Homecare Medicines

PDIG Award  Project proposal  Survey other Trusts across the UK to find out how they performance manage their Homecare Contracts  On-line Survey  Distributed via primary and secondary care networks  Limitations  Distribution of survey  Secondary care bias

National Survey  114 responses obtained  Differing geographic locations  Homecare Provider survey  100,000 patients  Top 6 companies  5 homecare companies responded

Survey Results - Background Sector Response (95 responses from hospital)

Is the Homecare route ever used in your organisation? (n = 95) Survey Results - Background

Approximate number of patients on Homecare medicines (n = 93)

Survey Results -Background Top 10 Homecare therapy areas (n = 78)

Survey Results - Background Homecare Providers (n = 71)

Why is performance management important?  Puts the patient at the centre of the homecare service  Aims to deliver safe and effective patient care  Ensures the same high quality standards at home as in hospital  Aims to engage the clinical multidisciplinary team, procurement, and homecare providers for the benefit of the patient  Aims to demonstrate value for money  Monitors compliance and contractual obligations  Helps inform at future homecare contract adjudications

Practical performance management  Contracting  Key performance indicators  Service Reviews  Patient Surveys

Contracting  Performance management starts with a well written tender document and service specification  A ‘specification checklist’ is one of the documents on the NHMC website  The specification must include clear information about how the homecare service is going to be performance managed and / or audited

Survey Results - Contracting Who arranges the contract for each therapy area? (n = 77)

Survey Results – Contracting Pharmacist 72% Pharmacy procurement 66% Clinician 68%Nurse 37% Pharma. sponsored 32% Supplies 13% Finance 11% Patient 10%

Practical performance management  Contracting  Key performance indicators  Service Reviews  Patient Surveys

Key Performance Indicators  Agreed KPI’s can be used to assess the quality of the service provision  Targets are set to maintain a high level of service to our patients  KPI results are reviewed regularly with the homecare provider and action taken to resolve any issues

Survey Results -KPIs Rank the following KPIs in terms of importance (62 / 32)

Incidents and Complaints Monitoring  Formal incident and complaints procedures  Sharing Trust policy with Homecare companies  Define contact pathways  Collaborative reporting / resolving issues

Practical performance management  Contracting  Key performance indicators  Service Reviews  Patient Surveys

Service Reviews  Who – involve the whole team  Frequency – quarterly, half yearly or yearly depending on contract  Agenda  Review actions from last meeting  Presentation of KPIs  Review incidents and complaints  Invoice/finance issues  Staff changes  Contractual changes

Survey Results – Performance management Do you performance manage your homecare contracts? (n = 69)

Survey Results – Service Reviews How often is performance reviewed? (n = 40)

Survey Results –Service Reviews Pharmacist 72% Pharmacy procurement 66% Clinician 40%Nurse 44% Pharma sponsored 14% Supplies 12% Finance 10% Patient 0%

Practical performance management  Contracting  Key performance indicators  Service Reviews  Patient Surveys

Patient Surveys  Just 17% have used patient questionnaires to review the performance of the homecare provider  Surveys are undertaken after a change of provider or every year  Patients are asked to rate the performance of their homecare service provider  Ensure results are fedback to clinical teams / homecare providers and patients

Patient consent to homecare  Current project at Leeds is to review how patients consent to homecare  Professional guidance is that healthcare professionals should obtain consent for everything involving the patient  How should consent be obtained and recorded?

Survey Results – Patient Consent Do patients have a choice? (n = 61)

Patient Consent Are patients asked for their consent to homecare? (n = 73) Don’t Know 43%

Survey Results – Patient consent Is the consent informed? (n = 71)

Survey Results - NHMC  72% did not know NHMC existed  15% had visited the website  70% who visited the web site used the information they found there

Summary  Contracting – ensure clear service specification that includes performance management  Formal Review – pharmacy should co-ordinate formal reviews of service at regular intervals  Homecare incidents and complaints – ensure these are reported and learned from  Patient involvement – increase patient involvement  NHMC – raise profile in the NHS

Future / Next Steps  Visit other centres  Share best practise with NHMC