Medicines Optimisation PINCER in Wessex PINCER Workshop November 2017 Clare Howard FFRPS FRPharmS Clinical Lead
Innovation Adoption in the NHS
It gets worse…. Principal Investigator Even in the Stone Age, publishing research on “round things” did not guarantee adoption
The Innovation Curve
PINCER IN WESSEX Back at the beginning………… • In 2014, we started the Wessex Medicines Optimisation Programme. • We based the programme on areas of the NHS England Medicines Optimisation dashboard where we felt we could improve or where we had a strong evidence base to implement an innovation. • PINCER met that criteria. It had been shown in an RCT to lead to demonstrable change in patient safety. • It was recommended in NICE Guideline NG5
A bit of a hard sell…. • In 2015, we held our first PINCER workshop. • Sarah Rodgers presented the findings and we showed practices how to use the tool. • GPs’ and Pharmacists’ responses to the tool were very, very different!
Medicines Optimisation Dashboard Use of PINCER by ASHNs
Use of tools proven to improve medication safety
So what’s changed? • We ran the session again with a video of Sarah’s presentation and a very practical session on how to use the tool. • Then we ran 3 action learning sets (ALS in the morning and a generic PINCER/PRIMIS training session in the afternoon). • Action learning sets were very useful…. • A common question was “I can get these indicators from my clinical system why use PINCER?” • In our experience, only 1 -2 practices per session were unable to use first time.
The lovely Chris • By Dec 2016 over 150 practice staff were trained. • Then we got a grant for a facilitator… The lovely Chris. • Chris visited CCGs and Practices. Key themes • A CQUIN is very helpful in encouraging practices to download. • Practices and CCGs don ’ t always use the PRIMIS helpline to resolve issues. There is a tendency to sit on them. • ICE data in practice systems is an issue. • The CCG is instrumental to change. • Practices now need help to use the data and do their action plans. • Still some concerns about uploading to CHART.
Number of Practice downloads of PINCER tool by quarter 2016/17
Proportion of practices engaged with the PINCER tool (1)
Percentage of practice downloads by CCG Cumulative figures over 4 quarters No of practices downloading % uptake Dorset 88 90% Fareham and Gosport 15 71% Cumulative figures over 4 quarters Portsmouth 17 81% North East Hampshire and Farnham 21 88% South Eastern Hampshire 18 75% North Hampshire 19 95% Southampton 30 94% Total 208 87%
Much more work to be done on uploading to CHART
We aren’t perfect… • Still have issues with Practices’ fear about uploading to CHART. • CCG Medicines Management teams are instrumental in either supporting this or not. • You need to keep up the momentum. • Phase 1 has been about using the tools and downloading the data. • Phase 2 will be about using the data properly, action plans to address the findings and roll out of PINCER 3.
Some Thank Yous • Thank you to Sarah, Tony A and the researchers for doing the work to show us the way. • Thank you to the PRIMIS team who have helped us every step of the way. • Thank you to Boehringer Ingleheim. Ross Rotherham works so hard with the NHS to help us to implement PINCER and PRIMIS. • Finally, thank you to the CCGs and Practices in Wessex who have worked really hard to get this far.
Final destination • Our aim is to deploy full implementation of PINCER and to be confident that the findings in EM can be used to show benefit in Wessex. • Ultimately its about reducing the level harm from medicines that we expose our patients to. Need to remember that!
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