A new approach extending the role of pharmacy in primary care workstream lead ramiz bahnam
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A new approach: Extending the role of Pharmacy in Primary Care Workstream lead: Ramiz Bahnam. Contents. Vision of the service Scope Service model Care pathways IMT solutions Metrics Governance and assurance Training Outstanding issues. Vision of the service.

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A new approach: Extending the role of Pharmacy in Primary Care Workstream lead: Ramiz Bahnam

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A new approach extending the role of pharmacy in primary care workstream lead ramiz bahnam

A new approach:

Extending the role of Pharmacy in Primary Care

Workstream lead: RamizBahnam


Contents

Contents

Vision of the service

Scope

Service model

Care pathways

IMT solutions

Metrics

Governance and assurance

Training

Outstanding issues


Vision of the service

Vision of the service

Pharmacists will have a key role to play supporting general practice to manage the routine, non urgent case mix and those people who struggle to access primary care in working hours.

Pharmacists will offer an enhanced service underpinned by access to the patient’s medical record, PGDs, training and a robust clinical governance framework.

There will be more opportunities for people to access this enhanced service.

Ultimately by redirecting a proportion of routine case mix to Pharmacists it will contribute to increased capacity within general practice to see more complex or frail patients.


Vision for pharmacy

Vision for Pharmacy

Incorporate Pharmacy as part of the first line primary care team

Provide appointments for patients in a familiar and accessible environment

Use Pharmacists to their full potential, up-skilling and supporting them to work in an extended role

Work with Pharmacists to optimise use of medicines in the city and reduce medicine waste


Scope

Scope

In scope:

Extended Pharmacy primary care service (requires clear definition);

Extended service will include minor ailments/illnesses underpinned by PGDs and all repeat prescriptions documented within the medical record.

Access to the extended Pharmacy service will be via:

GP triage (non urgent)

NHS 111 or IC24

Clear pathways for on going clinical areas.

Out of scope:

Existing Pharmacy services;

Patient does not meet referral criteria.


3 levels of service

3 Levels of Service

EPiC Pharmacies

Level 1

Access to medical records. Pharmacist trained to use them and answer medication queries

Level 2

Trained Pharmacist working with PGD’s. 3-4 trained Pharmacist per module

Level 3

Independent Prescriber provides clinical consultations


Care pathways

Care pathways

People

Receptionist

Training and support

Admin

GP Triage and Booking

EPiC

Pharmacist

Access to medical records

Self care

Management and discharge

Refer to GP


Primary care modules

Primary Care Modules

Participating GP Surgeries have been divided into 4 Primary Care Modules

Modules 1 and 2 are Fast Starters

Modules 3 and 4 are Early Adopters

Each Module will have several Pharmacies linked to them, based on geography and the fact that they already provide services to those Practices


Primary care modules1

Primary Care Modules


Costs 2014 15 normal working hours

Costs 2014-15Normal working hours

M-F

Module 1 (34wks)

Module 2 (34wks)

Module 3 (26wks)

Module 4 (26wks)

No. Appts/day

15

15

15

15

No. appts/wk

75

75

75

75

Total no.appts

2550

2550

1950

1950

Cost @ £6.25/appt

£15,938

£15,938

£12,187

£12,187

Total Cost

£56,248


Costs 2014 15 extended hours

Costs 2014-15Extended hours

Sat/Sun

Module 1 (34wks)

Module 2 (34wks)

Module 3 (26wks)

Module 4 (26wks)

No. Appts/day

5

5

5

5

No. appts/wk

10

10

10

10

Total no.appts

340

340

260

Cost @ £6.25/appt

£2,125

£2,125

£1,625

£1,625

Total Cost

£7,500

Evenings

M-F

No.appts/day

2

2

2

2

No appts/wk

10

10

10

10

Total no appts

340

340

260

260


Imt solutions

IMT solutions

IM&T requirements for Pharmacies are:

Access to a booking system with appointments made in real time;

Access to the full patient record to support clinical decision making

Two way feedback mechanism between GP and Pharmacist to be put in place.

Progress to date:

All Pharmacies have N3 and SMART cards.

Pilot to Load System1 onto a Pharmacy system was successful but connectivity centrally was not achieved probably because of firewall issues.

Ongoing challenges with EMIS, especially in relation to a two way interaction between the GP and the Pharmacy system.


Metrics

Metrics

Process outcomes:

Service take up: No. people seen within Pharmacy service vs available slots

No. people seen with service and discharged to self care or with management

No. people referred back to GP

Person experience outcomes:

Patient experience/satisfaction surveys

GP/Nurse practitioner/Pharmacist experience surveys

Service effectiveness outcomes:

Audit trail and tracking of PGDs

Compliments and complaints

Near miss and clinical incident reporting


Governance and assurance

Governance and assurance

General:

All PGDs developed within local prescribing guidelines

On going consultation with stakeholders including LPC, CCG etc.

Clinical

Use of current national guidelines and evidence base to inform development of the PGDs

PGD sign off via EPiC clinical lead and project board

Each pharmacist will sign each individual PGD accepting responsibility for adherence to the PGD and that that they are clinically competent to deliver care in line with the PGD

Triaging GP to ensure that referral meets inclusion criteria for Pharmacy.

IM&T:

Key issue around Pharmacist access to the medical record. Triaging GP will gain consent at point of onward referral and again at patient appointment.


Training

Training

Pharmacy training plan needs to be developed for Fast Starters to include:

IM&T:

Booking system,

Accessing the medical record,

EPiC metrics

Clinical:

PGDs

PGD tracking system

Relationship building with GPs

Learning from first wave will then inform on going training needs for the Fast Starters as well as the Early Adopters.


Dbs checks

DBS Checks

It is essential that all Pharmacists accessing patient records hold an up to date DBS.

All Pharmacists will be asked to provide relevant details.


Outstanding issues

Outstanding issues

IM&T: Work to resolve existing issues of connectivity with System1 as well as with EMIS.

Finalise and sign off PGDs for inclusion with go live Fast Starters

Develop training plan for Pharmacists in Fast Starters group and implement

Develop Communications for all parties in Fast Starters group and implement. Consider team building session.

Financial: Finalise and agree payment schedule for EPiC Pharmacists both in and out of hours.

Agree method of re-imbursement for medication supplied by EPIC Pharmacies

Get final agreement to participate from Pharmacies and prepare and agree rotas of clinical appointments


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