Prime Ministers Challenge Fund “Together for the health of Halton” Community Pharmacy and General Practice joint event 10 th September 2015 H ALTON, S T H ELENS & K NOWSLEY L OCAL P HARMACEUTICAL C OMMITTEE

Running order Welcome Overview of the PMCF The pharmacy scheme – the vision and aims View from the LPC Specifics of the scheme Plenary Opportunity for Q&A throughout

Overview of the PMCF Rob Foster PMCF Programme Lead H ALTON, S T H ELENS & K NOWSLEY L OCAL P HARMACEUTICAL C OMMITTEE

Overview of the PMCF National initiative Aims are to: – improve access to general practice; – develop a more integrated approach to providing general practice and wider out-of-hospital services; – develop more innovative ways for people to access and relate to general practice. Non recurrent money Delivery in 2015/16

Overview of the PMCF Building on Halton General Practice Strategy “Together for the health of Halton” 8 schemes totalling £1.548m 5 patient facing schemes – blend of: – Improving access; – Alternative access; – Reducing demand Pharmacy input/influence in a number of areas

Overview of the PMCF GP/Practice leads for all schemes Focus and consideration on sustainability – Impact and evaluation critical Joint working Using money where possible as an investment to achieve longer term benefits All schemes are pilots – opportunity to develop and test approaches and gain evidence of update, benefits and impact Opportunity to gain patient and public feedback Consider future investment…and funding

PMCF and pharmacy – CCG perspective Dr Claire Forde CCG Clinical Prescribing Lead H ALTON, S T H ELENS & K NOWSLEY L OCAL P HARMACEUTICAL C OMMITTEE

PMCF and Pharmacy - CCG Perspective Why did we include community pharmacy projects in the PMCF bid? Very accessible clinical resource Underutilised clinical skills Can help improve access within GP practices Links to self-care agenda Already commission services which we need to build on

But also… Pharmacists can massively contribute to improving the health of our patients Need to improve engagement and relationships Desire to work collaboratively to develop services Recognise community pharmacy as an essential part of the primary care team Feel more involved with the CCG Ultimately a common goal – a healthier population

Our Vision This is just the start – it will develop further over time (probably years) Openness and transparency Collaboration to ensure we commission effectively Build trust and confidence Build a common future vision – together Improved joint working with our GP practices to improve clinical outcomes for our patients Improved communication and engagement

View from the LPC Kath Gulson – Chair Bertha Brown – Chief Officer H ALTON, S T H ELENS & K NOWSLEY L OCAL P HARMACEUTICAL C OMMITTEE

Opportunity for GPs and Community Pharmacists to work more closely together Improve patient choice Improve patient access Build better relationships with other healthcare professionals

Joint approach PMCF project lead GP lead CCG medicines management lead LPC chief officer LPC chair

Journey So Far Rob came to LPC meeting March 2015 Meeting to discuss options Recruitment Tonight

Benefits of providing services in pharmacy Reduce pressure on GP services Improved access with extended opening times Reach those people who rarely set foot in GP surgery People with long term conditions speak to pharmacy once a month when ordering or collecting repeat prescriptions Increased choice for patients

Pharmacy is easy to access Range of pharmacies No appointment Extended hours Nationally 84% people visit a pharmacy every year Nationally 96% of people can access a pharmacy within 20mins by walking or using public transport

Proposed services Respiratory asthma in schoolchildren COPD respiratory reviews in adults Blood Pressure Measurement To include AF detection Identify people with undiagnosed hypertension Referral to pharmacy for routine BP measurement Improvements to Care at the Chemist

Opportunities for pharmacies Services pharmacy wants to deliver Fair remuneration An opportunity to influence and shape the development of those services To make a real difference to the patient Good data collection and evaluation of services will provide a good evidence base to prove the value of the service locally and influence future commissioning

Challenges Things to think about Time management – appointment/ad hoc Use of team and training Consultation room Support those delivering the service Not currently available to all pharmacies

Data Collection Electronic reporting via PharmOutcomes Real time information for the CCG Help evolve the project Demonstrate outcomes Provide evidence for project evaluation Support prompt payment for pharmacies

GP PMCF projects E consultations Referral to pharmacy is part of e-consultation 1.For self care 2.For services such as care at the chemist

The schemes Lucy Reid Medicines Management Lead NHS Halton CCG H ALTON, S T H ELENS & K NOWSLEY L OCAL P HARMACEUTICAL C OMMITTEE

PMCF Pharmacy Projects – Project Development Group Lead Pharmacist NHS Halton CCG – Lucy Reid CCG GP Clinical lead for Medicines Management LPC – Bertha Brown/Kath Gulson 2 Project Managers – Lisa Allman – Senior Pharmacist – Gareth Rustage – Senior Technician CCG GP Clinical Lead for IM&T

What are they? Respiratory a)Schools Asthma Education project b)COPD Support Service Monitoring/Screening a)Blood Pressure Testing b)AF Screening Self-care a)Minor Ailments Service Education

Key Principles for All Schemes Fair remuneration Training to be provided Awareness raising/patient materials – joint approach with CCG Engagement with local GP practices – joint approach with CCG IT support to improve communication with GPs re: outcomes of interventions Things will develop over time! Robust evaluation and ongoing feedback vital Recording via PharmOutcome

1a) Schools Asthma Project Aims To provide a pharmacy-led education session in schools that will contribute to a measurable improvements in inhaler technique, adherence, and associated health outcomes To assess, and if necessary improve, inhaler technique for each child or young person (CYP) during a school-based pharmacy-led workshop To show an improvement in quality of life – in terms of symptoms, activity limitation and emotional function – at follow-up To assess, and increase if necessary, the self- and/or parent-reported adherence of CYP to their asthma therapy To increase the confidence of CYP, parents and teachers in the use of inhalers To provide improved asthma awareness for all CYP To ensure clear communication with schools, parents, GPs and CYP

The Sessions Fun and interactive Targeting children in years 4-5 (8-10 year-old students) and years 9-10 cohort (13-15 year-old students) Mix of primary and secondary schools Up to 4 pharmacies to deliver this project Initial session approx. 1 hour (depending on age group and advice from schools) Follow up session/meeting with the school approx. 8 weeks later Could focus on only those with asthma or all children in that class/year group

1b) COPD Support Service Aims – To support patients with diagnosed COPD to get the most from their respiratory medicines through improved understanding, adherence and technique. – To improve quality of life and confidence to get involved in additional activities as a result of feeling better. – To reduce exacerbations and reduce avoidable admissions for COPD patients. – To support the optimal use of rescue packs (antibiotics and steroids) – To support the development of patient COPD self- management plans alongside local GPs and practice nurses.

The scheme -Pharmacist reviews within the community pharmacy setting -Will be required to perform a specific number of reviews over 6-9 months per pharmacy -Follow-up reviews needs to be included -Approx. 6 pharmacies to deliver this pilot -Assessment of Inhaler technique required -Development of patient resources – jointly with CCG/LPC -Actively review and manage rescue packs in conjunction with the GP -Communicate back to GP outcome of review so can be recorded in notes

2a) BP Testing More pharmacies can potentially get involved Routine monitoring of BP for patients on specific medications or conditions Improved access to routine BP testing for patients – evenings and weekends, wont need to take time off work Referrals from GPs – if patient chooses (saves GP/PN time) Communication direct back to GP to record in patient notes Accreditation for pharmacists to ensure confidence in service Support management of patients on oral contraceptives? Support management of stable hypertensive patients Equipment funded by PMCF scheme

2b) AF screening Small number of pharmacies to be involved Links to pilots possibly being done in GP practice CCG priority to improve diagnosis of AF Improved access for patients – evenings and weekends Accreditation for pharmacists to ensure confidence in service Equipment funded by PMCF scheme

Self Care Minor Ailments Service – Pharmacist Education -CPPE education (Assessment and Management of urgent cases) -Shadowing UCC staff -Specific therapeutic area sessions from A&E or UCC clinicians -Face to face group sessions rather than e- learning

Thank you for listening Any Questions?