Medicines Waste CollaborativeInitiative

1
Medicines Waste Collaborative/Initiative

• John Hamley(Chief Pharmacist Primary Care
  Division)

2
Medicines waste a continuing problem

• and the cost?
• Value of medicines not used
• Collection and disposal
• Staff time
• Treatment failure/harm

3
Drivers

• NHS Tayside Waste inefficiency
• Patient Safety
• New GMS Contract
• Imminent new CP Contract

4
NHS Tayside - Waste Inefficiency FR
Committee December 2003

• Weight of unused medicines returned to pharmacies
• Cost of disposal
• Value of unused medicines in Tayside

5
Primary Care Director FR Report December 2003

• Increasing weight of returned medicines
  15,000kg (2003/04)

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Cost of Disposal
7
Estimate of value of medicines returned to
pharmacies 2004/51.1m 95 Confidence Intervals
(0.8m 1.3m)
16-34 of people return medicines to
pharmacies (total value waste medicines 3.2 -
6.8m)
Median 1.1m
8
Reason for return of Medicines(Grampian Survey
1998)

• Patient died 33
• No longer required 10
• Medication changed 15
• Side-effect 4
• Out of Date 3
• Wrongly prescribed/supplied 1

Cromarty 1998
9
Patient Safety Poisoning Accidental
Deliberate

• 2.1 of AE Admissions (Leicester 1994)
• 8500 child admissions per annum
• 600 child admissions in 10 months (Yorkhill 1997)

Cromarty 1998
10
Two New Contracts!

• New GMS Contract
• Medicines Management non-clinical domains
• New Community Pharmacy Contract

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New Community Pharmacy Contract

• ?Emphasis on Dispensing Volume
• ?Emphasis on Pharmaceutical Care
• 4 Core Elements
• Minor Ailments Service (MAS)
• Chronic Medication Service (CMS)
• Acute Medication Service (AMS)
• Public Health Service (PHS)
• Transitional Payment Structure - April 2005

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NHS Tayside Primary Care FR March 2004

• Primary Care Director Primary Care Chief
  Pharmacist tasked to develop proposals

13
The Approach

• Tayside-wide
• Primary Care Modernisation Agenda
• Building on existing initiatives
• Using Collaborative approach - Community
  Pharmacies General Medical Practices
• evidence-based
• small systems change
• continuing quality improvement
• PDSA (Plan, Do, Study, Act).

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The Agreement

• LHCCs/CHPs to fund
• 15 community pharmacies/45 practices
• Savings to go back to CHPs
• First call on savings to underwrite locally
  enhanced services that sustain improvement.

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Model for accelerating improvement Associates in
Process Improvement
Setting Aims Time specific, patient population
specific and measurable
What are we trying to accomplish?
Establishing Measures Quantitative that
determine if a change leads to improvement
How will we know that a change is an improvement?
What changes can we make that will result in
improvement?
Selecting Changes Identifying changes most
likely to result in improvement
Testing Changes Testing changes in the real work
setting
P
A
D
S
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PDSA Improvement Model
Rationally on results for next cycle
The Test
PLAN
ACT
DO
STUDY
Execute it
On results
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Collaborative approach
1 day expert reference panel
Orientation Day
Learning Workshops
Measures Outcomes
1
2
3
Action Period 1
Action Period 3
Action Period 2
Spread
Timeline zero
3/12
6/12
9/12
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Medicines Waste Collaborative/Initiative

• 14 teams recruited - 16 community pharmacies 14
  practices
• Methodology modified Initiative renamed
• Orientation 11th May 2005 First Learning
  workshop scheduled for June 2005

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Considerations

• Timing
• New community pharmacy contract
• Many practices already involved in quality
  improvement
• Advanced Access QuISP Primary Care
  Collaborative
• Approach
• Collaborative/QuISP
• Novel community pharmacy/practice teams
• Roll-out of service improvements via locally
  enhanced service contracts
• Orientation event material
• Tayside ahead of the game!
• Motivators ?

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• Never doubt that a small group of thoughtful,
  committed citizens can change the world. Indeed,
  it is the only thing that ever has.
• Margaret Mead
• Anthropologist 1901-1938

21

• "If everything seems under control, you're just
  not going fast enough."
• Mario Andretti.

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• The new GMS quality-based contract is now in
  place and a new community pharmacy contract that
  places a greater emphasis upon delivering care
  than upon dispensing volume is imminent.
• Pharmacist are being actively recruited to
  train as supplementary prescribers and
  pharmacist independent prescribing is imminent.
• This creates an unique opportunity to develop
  new partnerships between practice and community
  pharmacy teams to make best use of skillmix and
  improve patient care.
• Question How might this opportunity be exploited
  and,
• what sorts of shared care arrangements might be
  developed?
• Question What are the barriers to closer liaison
  and sharing of care between community pharmacies
  and practices and,
• how might these be overcome?
• Question What kind of response might we expect
  from patients?
• What messages can be given by practice and
  community pharmacy team members to convince and
  assure patients of the benefits to them of new
  shared care arrangements between practices and
  pharmacies and,
• how might these messages be given?

23

• As with any new venture, there are a small
  number of innovative practices and pharmacies
  that are willing to take the lead in developing
  new ways of working. Others will await the
  outcome of early implementers before deciding
  whether to get involved.
•  
• Question What will be required to convince the
  second wave practices and pharmacies to become
  involved?

24

• The whole purpose of developing new shared
  care arrangements between community pharmacies
  and general practices is to improve efficiency by
  making best use of the skills of all members of
  the team and to improve care for patients
• Question What is the role of Qualitative,
  Quantitative and Health Economics Research in
  helping to assess whether these improvements have
  been achieved?
• Question, Qualitative Research is increasingly
  being accepted as an important tool for measuring
  and assessing change. However, many healthcare
  professionals are less familiar with qualitative
  than quantitative research methods. Should
  greater emphasis be given to increasing the
  awareness of the role of qualitative research and
  an understanding of qualitative research methods
  within healthcare staff? If so, how might this
  be delivered and by whom?