1. Chronic Medication Service

2. Objectives To describe the background and policy context for the introduction of the Chronic Medication Service To outline the general elements of the Chronic Medication Service To look at each of the three stages of the Chronic Medication Service To share the plans being considered for implementation of the service

3. Background & Policy

4. The patient journey Prescribing –Prescribing error rate 7.5% Dispensing –Dispensing error rate 3.3% of all items Compliance / concordance –non-adherence 30-50% –hospital admission due to ADR 2.7% - 6.5%

5. Building on existing evidence Repeat dispensing pilots –Paper based trials –Reduce wastage –Improve access Pharmaceutical Care Model Schemes –Care of the elderly –Chronic disease areas –Medication review

6. General Description of the Chronic Medication Service

7. Purpose To ensure patients obtain optimal therapeutic benefit from their medicines and minimise any predictable undesirable effects. Chronic Medication Service (CMS) Description A system of personalised pharmaceutical care to patients with long term medical conditions.

8. Purpose Move focus from dispensing to clinical practice and quality Patient centred, medicines focused Building on what people already do Based on a systematic approach Document practice Improve continuity of care

9. A A GP (1000) Pharmacy (1200) NSS PSD GP SystemCP System ePharmacy Message Store Information Services Division Payment process Elec msgs via N3 network CHI Forms sent to PSD Patient Registration Service ePay rules engine Scanning and message processing Core Infrastructure

10. The Three Stages Of CMS

11. Overview Stage 1Patient registrationCommunity pharmacy Priority profiling Stage 2Pharmaceutical Understanding care planningReinforcement Problem solving Informed choice Stage 3Therapeutic Serial prescribing & partnershipdispensing Disease protocol Referral Feedback

12. Mapping out the processes Patient Registration Risk Assessment Serial Prescription Identify Pharmaceutical Care Issues Monitor & ReviewFormulate Care Plan Care plan based on ‘risk’ Patient Registration Notification message Stage 1 Stage 2 Stage 3

13. Stage 1: Registration Voluntary opt-in Patients registers with pharmacy of their choice Register with one pharmacy Via the Patient Registration System (PRS) using CHI Underpinned by explicit patient consent Eligibility: –Patient must be registered with a Scottish GP practice –Patient must have a long term condition/s –Not resident in a Care Home GP practice receives an electronic registration notification message

14. Stage 1: Priority Profiling Completed within three months of registration Based on –Medication profile Questionnaire on medicines and consequences Yes, No, Not Recorded & free text field –Patient profile General health Medical conditions Allergies & sensitivities Patient factors Supported by a web based care planning tool Assign an overall priority rating: –low, medium or high priority

15. Stage2: Pharmaceutical Care Planning The patient and pharmacist –discuss and assess the patient’s condition/s, medicine/s and general health –identify any issues / problems –establish desired outcomes –agree any actions to address them The pharmacist –documents the issues, desired outcomes and actions using the care plan system –Monitors, reviews and updates the care package Supported by a web based care planning tool

16. Web-based care Planning Tool

17. Pharmacy Care Record Web based –a secure system (holds patient data) –fully robust (data recovery, data replication to a backup site) –username and password protected Hosts the pharmaceutical care plan –priority profiling –pharmaceutical care plan Build in additional applications e.g. PHS?

18. PCR Search Screen

19. Finding a patient Search from: PCR –Enter patient details –Click search –If ‘not found’ you can generate a PCR record by uploading data from your PMR PMR –Link up from patient record on PMR Information uploaded from PMR: Patient demographics –Name –Address –Postcode –Date of birth –CHI –Gender –Telephone number Dispensing history

20. PCR Medication Details

21. PCR Priority Profiling: Medication Profile Free text box for notes

22. PCR Priority Profiling: Patient Profile Record priority based on patient and medication profile: Low, medium, high

23. PCR Care Planning: Care Issue Summary

24. PCR Care Plan

25. Stage 3: Serial prescribing & dispensing The patient’s GP –Eligibility based on age, medical and maternity exemptions –decides on their suitability for a 24 or 48 week serial prescription –selects dispensing intervals The pharmacist –dispenses the prescription according to defined intervals –engages with the patient over the time period according to the disease specific protocols Feedback –dispensing information with each dispensing episode –end of care treatment summary information dispensing information and any specific relevant care information can include a request for new serial prescription

26. Benefits Improved clinical outcomes Improved concordance Reduced wastage Easier patient journey Promotion of self care Better utilisation of the workforce Encourage team working

27. Further information… Establishing effective therapeutic partnerships: The Ritchie Report http://www.scotland.gov.uk/Publications/ 2009/12/08131756/0 NES CMS Implementation Resource Pack: http://www.nes.scot.nhs.uk/pharmacy/ne wcontract/cms.asp

28. Implementation

29. CMS Dates Commence roll out from 1 April 2010 (final date still to be agreed) Operationalise working processes from April – September 2010 CMS ‘live’ from September 2010

30. Operationalisation Phase ‘Bedding in’ stage Phased from April to September CPs familiarise themselves with eCMS software –Registration –Care planning –Serial dispensing –Reporting GPs familiarise themselves with eCMS software –Serial prescribing –Managing end-of-care treatment summaries

31. Current position All GP and Pharmacy IT system suppliers on course for April delivery NSS PSD system changes in place –Patient Registration Service (PRS) –ePay ePharmacy infrastructure in place –ePharmacy Message Store (ePMS) –Pharmacy Care Record (PCR) Early Adopter phase underway in NHS Fife

32. National Priorities for Next 2 Months GP and Practice Manager NES Packs PCR User Manual PCR ‘test’ patients for training on PCR PCR user name and password processes Identifying a process to issue user names and passwords Finalising and distributing CMS patient leaflet CMS disease specific protocols

33. Supporting Implementation Locally Local awareness sessions Identifying community pharmacists who require PCR user names & passwords Issuing user names & passwords Agreeing local working processes Endorsing NES sponsored GP & CP workshops (May & June 2010) Supporting practitioners during the implementation phase

34. Milestones Agree final service specification –During March 2010 Finalise national implementation plan –During March 2010 Agree CMS start date –During March 2010 Delivering CMS! –From April 2010