1. Locality Clinical Pharmacy Pilot in the West New Forest Vanguard
Ginny Ward, Helen Plumb, Sally Johnston
2nd November 2016

2. West New Forest Vanguard 7 practices included

3. Aims of the Pilot
Supplement and complement the current services to provide
Fully-integrated, primary-care-embedded medicines optimisation service, where
Clinical medication review particularly for the frail elderly is a priority
and
With a move to being a much more patient-facing role
Supplement and complement the current pharmacy services to develop a fully integrated service across the South West New Forest area which is embedded in primary care
Focus on undertaking clinical medication review of high risk patients e.g. frailty, patients with multiple LTCs, care home residents and patients at high risk of admission to hospital and becoming an integral part of the discharge process for vulnerable patients with medicines issues
Work with local community pharmacists to support effective use of medicines, along with the provision of integrated pharmaceutical input into the seven practices

4. Traditional role of Medicines Management in primary care
WHCCG Workplan 16/17 (Meds Optimisation Incentive Scheme) cost and quality initiatives including deprescribing problematic polypharmacy
Other Financial Recovery Plan savings
Other quality and safety issues (e.g. MHRA alerts)
Medicines queries from practices and prescribers
As 0.67wte pharmacist and 0.5wte technician across 8 practices

5. Team working across the 7 Vanguard practices
Increased to allow approx. 2-3 days a week of clinically-focussed pharmacist input to each practice and doubled technician input
We see the “extended roles” as an important and natural development
(e.g. in 2014/16 approx 2,500 problematic medicines for elderly patients were de-prescribed in conjunction with prctices and prescribers across the whole CCG area)

6. 3 interlinked and important aspects to balance
BLC outcome priorities
GP workload priorities
CCG sustainability priorities

7. Working in practices
identify areas for improvement repeat prescribing-including problem-solving for individual patients and increasing use of e-prescribing to reduce workload
contribute to medicines integrated care team work
provide clinic sessions and domiciliary visits (special interest/independent prescribers)
resolve queries, provide general medication reviews
WHCCG MO Workplan 16/17 cost /quality & safety interventions
other FRP-related savings / quality and safety issues (e.g. MHRA, SIRIs)

8. Working with Hospital Trusts
seamless care on admission and discharge
liaison with Interface Pharmacist and follow-up outpatient ‘red/amber’-status medication queries
medicines reconciliation on admission & discharge
working with hospital pharmacy (medication reviews pre-admission and post-discharge)

9. Working with local Community Pharmacies
liaise around supply (problems and alternatives) and discharge issues particularly e.g. MDS for individuals
review managed repeat over-ordering especially PRNs, inhalers and skin products
reduce waste from unnecessary repeats requested
encourage practices to highlight patients for New Medicines Service and MURs

10. Working with Nursing Homes
focus on clinical medication reviews and appropriate de-prescribing of problematic medicines
develop ability to perform basic clinical assessment – e.g. BP, pulse etc.
advice on appropriate sip feeds (nutrition) and dressings use forms
advice on practical aspects of medicines use e.g. PEG tubes or swallowing difficulties
review ordering processes and prevent unnecessary ordering e.g. PRNs ordered regularly

11. The 7 Practices individualised “Top 5” focus
nursing homes: med reviews on admission, and relating to falls, annual reviews, sip feeds, ordering and reducing waste
other med reviews: polypharmacy in frail elderly, post discharge, from virtual ward/ICT
monitoring high risk drugs
up-titrating/ follow-up of meds changes
meds reconciliation admission/ discharge
domiciliary visits for housebound if needed
repeat prescribing: dealing with queries, reviewing processes and systems and managed repeats to reduce waste
liaising with community pharmacies about out-of-stocks, ordering and problems

12. Where are we now? “Go-live dates” First month joint induction
One practice 19th September 2016
Two practices 26th September 2016
Two practices 17th October 2016
One practice 31st October 2016
First month joint induction

13. FAQs
How will these roles be recruited and what say will practices have?
Joint interviews with two of the BLC GPs
Discussed priorities with practices prior interview
Who is setting their objectives?
Jointly between CCG Meds Optimisation team and the lead GP/Practice Manager in the practice
Won’t it increase GP workload and queries?
Aim is to reduce not increase workload but inevitably there may be an embedding process during induction phase

14. FAQs Insurance liability
Does not fall on the practice – CCG vicarious liability for activities in Job Description and most have own professional indemnity as well
Are there advantages in being hosted by CCG team?
Yes. Back up from wider team includes formulary support, DPC, commissioning of high cost drugs, provides professional support and leadership, avoids duplication, promotes networking etc.

15. The Pharmacist Perspective : 6 weeks in
Mrs Helen Plumb
Medicines Optimisation Pharmacist
Wistaria and Milford Surgery
West Hampshire CCG

16. The GP Perspective : 6 weeks in
Dr Sally Johnston
GP Chawton House Surgery, Lymington
Clinical Lead, West Hants MCP (BLC)