South West Primary Care Leads Network

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South West Primary Care Leads Network

• Challenges to PbC (and pharmacy!)
• Sue Taylor
• Devon LPC
• sue_at_devonlpc.org

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Topics covered

• Why pharmacy?
• Why COPD?
• Developing a COPD business case
• Local challenges
• Gaining support
• What you can do

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Integrating Pharmacy into the NHS

• Our Health, Our Care, Our Say
• People need to be treated nearer to home and
  before their condition causes more serious
  problems
• Supporting People with LTC to self care
• Delivering self care packages through
  professionals and practitioners to raise self
  care awareness
• Commissioning a Patient Led NHS
• Empowering communities to address inequalities in
  health by targeting interventions towards those
  most at risk.
• A Vision for Pharmacy in the new NHS
• they should be clearly seen as places where
  patients are able to access readily an increasing
  range of healthcare services.
• Choosing Health through Pharmacy
• Empowering the nation to understand their health

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Integrating Pharmacy into the NHS

• Accessing Services closer to the patients home
• Choice of provider
• Promoting Self care management
• Reaching new patients
• Efficiency gains
• Adding value to planning and service re-design

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Integrating Pharmacy into the NHS

• How is this achieved?
• Community Pharmacy Contractual Framework
  Advanced and Enhanced Services
• Local Enhanced Services (PCT wide)
• Practice Based Commissioning (locally)

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Integrating Pharmacy into the NHS

• Pharmacists are considered integral to the NHS by
  the Government and the PCTs
• Devon LPC want pharmacists to be recognised as
  integral to the NHS by the commissioners of a
  service - the doctors.

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Why did we look at COPD in Devon?
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COPD

• 900,000 people in UK diagnosed
• Responsible for the deaths of 30,000 people
  annually
• Major cause of medical admissions
• Accounts for more than 10 of acute admissions
• 31 of medical admissions associated with
  deprivation
• Source British Thoracic Society Briefing Paper
  on COPD February 2006

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COPD Service Evolution

• We want the clinical skills of pharmacists to be
  accessed by patients, recognised and valued by
  doctors
• We targeted a condition that touched the current
  PCT buzz words
• Hospital admissions
• Long term conditions
• s
• We wrote a business proposal that will
• Potentially save money
• Meet the Invest to Save philosophy
• Treat people closer to home
• Enhance patient choice and access to healthcare

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What we did wrong

• We titled the project COPD
• We called the service a clinic
• Under-estimated level of detail required
• Needed a champion

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What we did right

• Invested resource into the business case
  development
• Produced a sound business case with measurable
  benefits
• Identified a fair price for the service
  worthwhile for pharmacists and value for money to
  budget holders.

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Challenges What we have done?

• Taken to the PCT commissioners
• Taken to GPs
• Taken to Practice Managers
• Presented at PBC workshops through the
  Improvement Foundation
• Taken to Directors of Primary Care
• Shared our work with the DH as part of the COPD
  NSF
• Involved the Met Office to integrate with the
  pharmacy service

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The Business case

• Improving Patient Care
• Integrating Community Pharmacy into the NHS
• Providing Choice
• Early detection and patient education
• Reducing Hospital Admissions
• Link to GP QOF registers

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Preventing Emergency Hospital Admissions
Source Dr W Bird Met Office
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Preventing Emergency Hospital Admissions
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Preventing Emergency Hospital Admissions

• What was the actual cost in 2005 for hospital
  admissions for COPD within an area?
• Locality or PCT
• What is the cost of the Pharmacy COPD service?
• 4,000 (for 60 patients on the programme)
• What are the set up costs?
• Approximately 3,000.00 (equipment and training)

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Preventing Emergency Hospital Admissions

• How many patients will be prevented from hospital
  admission?
• The British Thoracic Society quote 21.1
  reduction in emergency admissions (26.9 in
  admissions).
• LPC have used conservative figure of 1 in 10
  patients
• What is the break even point?
• Approximately 2 patients avoiding hospital (1 in
  30)

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Preventing Emergency Hospital Admissions

• Whats known to work?
• Stopping smoking
• Optimal use of medication
• Management of exacerbations
• Pulmonary Rehab
• Source ABC of chronic obstructive pulmonary
  disease Primary care and palliative care
  (Freeman and Price BMJ 2006 333188-190 (22
  July)

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Preventing Emergency Hospital Admissions

• The Pharmacy based Service
• Medication Concordance Review
• Spirometry/FEV1
• Smoking cessation
• Inhaler technique assessing and correcting
• Flu Vaccine Advice
• Ongoing patient education and advice

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Preventing Emergency Hospital Admissions

• The Service
• Physical Activity Advice
• Keeping Warm Advice
• Signposting
• Dietary Advice
• Social Support
• Anxiety and Depression
• Expert Patient
• GP/Respiratory Nurse
• Met Office Project
• Recruit patients to telephone scheme

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Supporting Surgeries with QOF

• COPD1           Patients on register  
• COPD2           COPD since 1/4/2003 and have
  Spirometry  
• COPD3           and have Spirometry    
• COPD4           and smoking history           
• COPD5           who smoke and offered
  advice       
• COPD6           COPD and FEV1 checked in the last
  27 months   
• COPD7           who have inhalers and have
  inhaler tech checked 
• COPD8           who had flu vaccine

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http//www.gpcontract.co.uk/sha.php?orgcodeQ21ye
ar5

• Q01 NORFOLK, SUFFOLK AND CAMBRIDGESHIRE
• Q02 BEDFORDSHIRE AND HERTFORDSHIRE
• Q03 ESSEX
• Q04 NORTH WEST LONDON
• Q05 NORTH CENTRAL LONDON
• Q06 NORTH EAST LONDON
• Q07 SOUTH EAST LONDON
• Q08 SOUTH WEST LONDON
• Q09 NORTHUMBERLAND, TYNE WEAR
• Q10 COUNTY DURHAM AND TEES VALLEY
• Q11 NORTH AND EAST YORKSHIRE AND NORTHERN
  LINCOLNSHIRE
• Q12 WEST YORKSHIRE
• Q13 CUMBRIA AND LANCASHIRE
• Q14 GREATER MANCHESTER
• Q15 CHESHIRE MERSEYSIDE
• Q16 THAMES VALLEY
• Q17 HAMPSHIRE AND ISLE OF WIGHT
• Q18 KENT AND MEDWAY
• Q19 SURREY AND SUSSEX

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Data requirements

• Hospital
• Doctor Foster
• Local PCT Data
• Prescribing
• Potential savings in prescribing

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Where are we now?

• Met Office want to work with us
• PCTs want the service commissioned
• DH interested in our results
• GPs are beginning to listen
• COPD training required for PWSI in right area
• Purchase spirometer
• Agree the communication and patient selection
• Launch the programme
• Evaluate

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What can you do?

• Local knowledge
• How many patients do you see not on medication
  but requesting cough mixtures?
• Practice results
• www.gpcontract.co.uk/sha.php?orgcodeQ21year5
• Year6 should now be available
• Local Support
• LPC help in providing business case or liaison
  with PCT and/or commissioners
• PCT Information
• To provide Dr Foster data to assist with
  tendering process