Member of Walgreens Boots Alliance

How Community Pharmacy can support the STP and Vanguard programs

Garwyn Morris Shirley WalkerSenior Manager External Partnerships Healthcare Partnerships Manager NHS South NHS London

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NHS Five Year Forward View…

….concluded that to sustain a comprehensive, high-quality NHS, action is needed on three fronts:

1. Demand2. Efficiency 3. Funding

Current Situation• NHS remains financially stretched

• Capacity in primary care

• A&E waiting times, especially winter pressures

• Evidence that 20% of population spend 80% of the total heath budget*

• STPs at initial stages and Vanguards are looking for solutions for new models of care.*Yeovil District Hospital –Leading the change 2014

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How can Community Pharmacy help?• Some basic numbers

– 11674 community pharmacies in England*

– Over 1.6m people visit a community pharmacy every day*

– 96% of the population can reach a pharmacy within 20 minutes by walking or using public transport*

• Services you can now see in a pharmacy:- 595,467 patients got an NHS flu vaccination from community pharmacy in England last year*– Anti-coagulation services– Travel vaccinations

*Pharmacy Voice,**Community Pharmacy Forward View, ***Pharmacy Voice, ****PSNC

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Where can Community Pharmacy help primary and secondary care?1. Minor Ailments

2. Emergency Supply of Medicines service

3. Discharge services and Admissions avoidance

4. Anticoagulation

5. Impact on Long Term conditions

and many more……

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1. Minor Ailments• 8% of consultations undertaken in an A&E

department could be handled by a community pharmacist*

• Common ailments cost the NHS an extra £1.1 billion a year when patients are treated at A&E/GP surgeries rather than at Community Pharmacies*

• The NHS Five Year Forward View highlights the need to make far greater use of pharmacists

*Pharmacy Research UK, 2015

A Tale of 2 Counties’ Minor Ailments service

Somerset*61 pharmacies commissioned out of 106 pharmacies

10 conditions

1169 patients over a 9 month period.

– 81% said would have gone to GP

– 10% OOH/emergency service

– 5% said A&E

Devon*2235 patients over 15 months

Only 5 conditions

278 GP hours saved

19% said would have used OOH or A&E – 72 OOH & 12 A&E hours saved

Winter ailments service 3300 patients, 45% would have used OOH or GP* An evaluation of the Somerset community pharmacy ailments service Jan 2016,

** Devon Pharmacy first evaluation 20157

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Impact of Inconsistency

• Different PGDs • Different range of conditions • One has OTC product, one does not.• One has Winter Ailments, one does not• One limited to some pharmacies, one open to all

What message does the Patient receive from this?

What impact could be achieved with consistent Commissioning?

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Sore Throat and Treat service

• Launched Oct 2014

• Service supports Diagnosis of infection and provides treatment options

• The service demonstrated two thirds of patients who would have seen the GP did not need to be seen*

• Also added benefit of reduce antibiotic use

*Boots UK and Professor APR Wilson, Dept of Microbiology and Biology UCE – August 2016

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2. Emergency Supply of Medicines service• Emergency supply rules have been in place for many

years, but at a cost to the patient.• Many medicines cost a lot more than the prescription

fees, especially insulin and many of the inhalers• Patients opt for OOH GP or A&E to get their “free”

prescription

• A commissioned service ensures Community Pharmacy can supply the patients, whatever their economic situation, without driving increased NHS capacity/cost burden.

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3. Admissions avoidance • 5-8% of hospital re-admissions are due to medicine related

issues

• 30-50% of patients do not take their meds as intended

• 30-70% of patients have an error or unintentional change in their medicines when their care is transferred

• DMR service in Wales – report published March 2014

– reviewed 14,600 patient interventions, the total number of discrepancies recorded was 19,878

– 52% of discrepancies related to re-starting or discontinued meds following discharge.*PJ Oct 2014,

**www.rpharms.com/getting-the-medicines-right/keeping-patients-safe-report . ***NICE guidelines, ****EVALUATION OF THE DISCHARGE MEDICINES REVIEW SERVICE March 2014

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3. Admissions avoidanceC&D 16/8/16……

NHS trust uses community pharmacists to cut discharge delays

Alistair Grey, lead pharmacist at East Lancashire Hospitals NHS Trust, told C+D that a scheme to share electronic patient discharge letters with local community pharmacists has improved the safety and speed of patients leaving hospital…….We are starting to see a reduction in readmissions

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• Community pharmacy has the capability to care for clinically stable anticoagulation patients

• Up to 70% of warfarin patients could be clinically stable enough to be managed outside of hospital*

• Boots manages 6,000 patients across all of our anticoagulation services

4. Anticoagulation

** Percentages derived from the current Boots services run in Brighton, Croydon and Bromley

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Community pharmacy can monitor INRs and manage dose adjustments of warfarin in addition to;

• Manage over-anticoagulated patients by use of vitamin K rather than refer them to A&E

• Collaborative working with secondary care for the peri-operative management of low risk patients

• Initiate patients according to NICE guidelines on either warfarin or NOACs by use of non-medical prescribers

• Support Patients who self-test

4. Anticoagulation

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Benefits to the NHS

– Better value for money

– Achieving clinical outcomes and KPI’s

– Reducing inequalities by covering a geographical and socio-demographical areas, caring for both ambulatory and domiciliary patients

4. AnticoagulationBenefits to the patient

– Improved waiting times and 10 minute tests

– Better accessibility to clinics closer to home

– Point of care testing which is potentially less painful

– Improved patient satisfaction and patient feedback

“Excellent – resulting in my eye test being carried out at Boots Bromley.

Look forward to further services being established”

"Promptness, clarity of purpose, pleasant manner,

positive clear advice."

“Perfect in every sense”

" Instead of waking up at 6am to get to PRUH for 7am, I can now make an

appointment and get there at leisure within 10 minutes.”

“Excellent! Seen immediately and counselled with perfect

clarity”

“Very satisfied, I prefer this to the hospital – brilliant so far!”

“Really enjoy coming to Boots”

“No improvements required – a brilliant service!”

“Very helpful to have home visits and good clear advice from a very friendly person”

What are the Boots Anticoagulation Services Patients saying?

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5. Impact on Long Term conditionsCommunity Pharmacy Future COPD project

• Support people with COPD making them better able to manage their condition, and improve their quality of life

• Help people with COPD reduce risk factors associated with the worsening of their condition by promoting and providing services where appropriate

• 306 patients enrolled by 34 pharmacies across Wirral in three months, across all socio-demographic areas

• Patients were already diagnosed with COPD

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5. Impact on Long Term conditions

Community Pharmacy Future COPD project

Key results after six months;

– A significant increase in medicines adherence

– Reductions in overall NHS resource use by patients

– A significant increase in patients’ quality of life

How can these services make a difference?It’s not just about commissioning…………

– Consistency is key – Patient message/engagement– Internal NHS engagement– NHS 111– Move away from Pilotitis!

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How will your STP/vanguard use community pharmacy to help shape the future?

Any Questions?