1. Prescribing context, benefits, dilemmas and challenges Liz Plastow Medicines Management Lead NMC

2. Context of Strategic Change Policy Initiatives – Darzi Review, PBC, WCC, MNC Reforming NHS Patient Choice Plurality of Provision Patient Led Care Workforce Developments – modernisation Career Developments and changes

3. Future Service Provision First Contact and Urgent Care Long Term Conditions Specialist and Restorative Services Public Health

4. Commissioning for Change Getting the right mix of services to meet needs and preferences of patients Seeking views of patients Understanding concepts cost-benefit, productivity, opportunity costs, developing workforce! Addressing health inequalities Familiarity with commissioning frameworks and tools!

5. Services –future?-Patient Driven Longer GP opening times and when needed? Community centred services – Children’s Centres, WIC’s and LTC’s High St Diagnostics One Stop Shops New providers – social enterprise, voluntary and independent sector!

6. Why Now? 2020 twice as many people >85 yrs 15 million with one or more LTC- Account for 50% Primary Care Consultations, 75% inpatient days, high use urgent/emergency care Desire – personalised services 15% H/Care budget and rising – 13.1 prescribed items per person 2003 up by 40% over previous decade

7. Extension of Prescribing Rights Timely Provides alternatives Improves access and choice Reduces travelling – patients and staff Selling point for organisations Must be seen – wider context – conformance, reactions, health changes, life style changes

8. Benefit to Patients Immediate and timely Reduction in number staff involved Improves continuity of care Empowers patients- concordance Skills workforce – confident, competent and capable

9. Accountability Prescribing pts –LTC, multiple pathology/ morbidity, mental health?, and closer to home? Acute care skills working outside hospitals Skill mix Clinical supervision Develop advanced competencies Providers in own right?

10. Ethical dilemmas Patient led? Patient demands? Contractual obligations – plurality provision Choice requires options Demonstrating value for money Risk assessment Clinical governance

11. Why continue? Leading the way Enables flexible services and flexible working Supports multi-disciplinary working Encourages shared learning Enables modernisation clinical careers – MNC Career pathways

12. It’s a Celebration! Well done! Where to now? As professional groups where to now?

13. The future! Performance Management Staff appraisal Risk assessment Clinical governance CONTINUING PROFESSIONAL DEVELOPMENT