Medicines Optimisation in Care Homes: Personalised care for care home residents Dr Wasim Baqir National Pharmacy Lead (Care Homes) Pharmacy Integration Team RPS Scotland
Care Homes Exces ess m medicines es Medication (unnec eces essary/ Erro rors rs inappropriate) e) Lack ck o of f Medicines struct ctured Wa Waste review ew Silo Rare patient working involvement
Integrating to improve care • Quality & safer care when we: • Understand each other • Join up care • Share Decisions • Co-develop • Work across organisations • Involve patients, families • Relationships and good conversations
Next S Steps on on the Fi Five Year F r For orward Vi View Deliver improvements in the priority areas: • cancer • mental health • primary care • urgent and emergency care A national move towards integrated care. Learning from the vanguards is integral to Sustainability and Transformation Plans 4
The Medicines Value Programme Following the Next Steps on the NHS Five Year Forward View and Carter Report A whole system approach…. The NHS wants to help people to get the best results • NHS England, NHS from their medicines – while achieving best value for Improvement, NHS the taxpayer Digital, Health Education England Savings will be reinvested in improving patient care and providing new treatments to grow the NHS for the future • Regional offices link with STPs, ACSs, CCGs, and providers The NHS policy framework that Optimising the use of governs access to and pricing of 1 3 medicines • Nationally medicines coordinated with AHSNs, Getting It Developing the infrastructure The commercial arrangements 2 4 Right First Time, NHS to support an efficient supply that influence price Right Care and NHSCC chain
Pharmacy Integration Projects GP pharmacists 300 Quality Payments Pharmacists & Investment in technicians in Scheme 2,000 new IUC & Care pharmacist Homes roles by 2021 NHS Digital Integrating pharmacy Pharmacy Workforce through SCR, NHSmail, Digital Minor development with HEE EPS, ERD, single source of Illness & NUMSAS 2,000 prescribers; GP, care pharmacy services data, home and urgent care referrals from referrals/ discharge from pathways; post-registration NHS111 secondary care and leadership training NHS England is enabling the transformation of pharmacy practice to improve the quality and efficiency of services for the public
Enhanced Health in Care Homes Seven care elements • Enhanced primary care support • Medicine reviews • Multi-disciplinary team (MDT) support including coordinated health and social care • Reablement and rehabilitation • High quality end-of-life care and dementia care • Joined-up commissioning and collaboration between health and social care • Workforce development • Data, IT and technology
Mo Moving Medicines Opti timisati tion (MO) Up Upstrea eam • No system wants to pay for a health professional to fix the ‘mistakes’ of another health professional! • MO by Pharmacy should be • Making the right decision first time • Challenging poor systems • Deprescribing when the time is right • Giving residents an equal say • Working together
Case Study: Northumberland • Pharmacy team work across primary and secondary care • Support network between Mental 89yr old lady admitted to A&E following epileptic fit Health and other local pharmacy Assessed on A&E: decision to increase Lamotrigine Discharged back to care home services Pharmacist liaised with A&E and prescriber Community Pharmacy supplied • Team works closely with Admission to ward avoided community pharmacy, general practice, social care and voluntary sector
Brighton and Hove CCG • Contract with an independent provider • 20,000 care home residents had their medicines reviewed by a pharmacist • £300k + savings due to medicines being stopped in one year • Similar savings from avoidance of hospital admissions Slide courtesy of Heidi Wright, RPS
Stratifying t to create capacity High Risk Complex Medication Review, MDT Complex Integrated teams working Moderate Discharge, new patients together across Risk/Need organisational boundaries Low acuity interventions, waste Low Risk/Need management
Involving Residents ts • Sharing decisions with residents and/or their family and carers • Don’t make assumptions • Better and easier decisions • More likely to deprescribe and have GPs accept deprescribing suggestions • Change the conversation
Working b g better er w with C Community Ph Phar armacy • Small clinical teams cannot see every resident • Northumberland • Move from traditional ‘home by home’ approach • 50% would be new residents by the time we get back to the first home • A role for community pharmacy?
Northumberlan and Community Ph Pharmacy C Care Home Medici cine U Use Reviews Vanguard 15% Pass it on Pharmacists, Geriatricians, MDT 21% Vanguard team & Let’s talk Comm Pharmacy Complexity of care 64% Community Do it Pharmacy MUR
Scaling & Spreading good care • 240 Pharmacists and technicians working across care settings to support care homes o Medicines optimisation (including deprescribing) o Care home systems and staff (reduce errors, waste) o Antimicrobial stewardship • Training pathway o HEE commissioned training provider – CPPE o 600 Pharmacists and Pharmacy Technicians o Independent Prescribing • Infrastructure o Networks, IPACS, Data & Metrics, Polypharmacy Support
Suppo upport f for e ever ery a y area Monitoring STP offered Network to (Population funding Training 35 STPs and 10 share, learn & Health - Lead CCG ICSs Pathway spread Dashboard/ - Plans Metrics) • Integrating services working across CCGs • Equity – every system in • Innovative partnerships England will get funding • Community Pharmacy part of the NHS team • Based on indicative care home • Thinking beyond (MH, Antimicrobial population Stewardship) • Adding to the funding • Enough to get started and • Competition Collaboration make a difference 16
Sys Syste tem L Leadership Integrating Pharmacy Medicines Optimisation ( IPMO) • What’s your system • Who does what, where? • Duplication/ confusion; gaps/ opportunity • Local networks • Pharmacists and Pharmacy Technicians enabled to work together • Cross-organisational • Start with the patient and their needs • 7 Pilot Areas
“When we strive to become better than we are, everything around us becomes better too” Paulo Coelho, The Alchemist www.health.org.uk/pills @wasimbaqir england.pharmacyintegration@nhs.net
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