NHS Urgent Medicines Supply Advanced Service (NUMSAS) Pilot Implementation Workshop Welcome and introductions
London Region NUMSAS workshop 9 th March 2017 Liz Wize Director of Primary Care Commissioning – NHS England (London Region) & Programme Director - Transforming Primary Care, Healthy London Partnership Healthy London Partnership – “ Transforming London’s health and care together”
Primary Care Update – Commissioning Activities Primary Care Delivery in London is a large scale challenge Scope of Service Financial Information • Commission and co-commission Primary Medical • Budget value; £1.17bn GP / £0.6m primary DOP / Services (1365), Optometry (c.2000) and Dental (c.1400) £0.17m secondary dental contracts throughout London • In year; On plan • Manage market entry of Pharmacy (c.1900) activity • Expected out-turn; £25m reduction in Pharmacy budget • Support definition of and implementation of new contracts – dependent on national re-negotiation of contract • Define operational processes to work effectively with CCGs in Joint and Delegated Co-Commissioning arrangements • Support co-commissioning arrangements Achievements to Date Next Steps • Implementation of co-commissioning and delegated • Support CCGs to take on further delegated Primary commissioning arrangements: of 32 London CCGs - 20 Care responsibilities level 2 CCGs 11 level 3 CCGs • Final implementation of PMS review – contracts to be • Restructuring to one single team for London from the implemented in 2017 Commissioning Function and the Contract Team • Organisation Design Review of Primary Care Commissioning staffing to support move to place-based commissioning • Implementation of General Practice Forward View and of the Strategic Commissioning Framework for London • Implementation of National Pharmacy Contract changes 3
GP commissioning delegation is currently at various levels across London Enfield Barnet Haringey Harrow Redbridge Waltham Hillingdon Forest Camden Brent Islington City & Barking and Havering Hackney Dagenham Ealing Central London Tower Newham Hamlets H&F West Hounslow London Southwark Greenwich Lambeth Richmond Wandsworth Bexley Lewisham Merton Already fully delegated ( 11 CCGs ) Kingston Croydon Bromley Sutton Level 2 delegation ( 20 CCGs ) Croydon Sutton Croydon Level 1 delegation ( 1 CCG ) 4
But is expected to be fully delegated in 17/18 We expect all CCGs to be at delegated by Apr 17 (pending membership Votes) Enfield Barnet Haringey Harrow Redbridge Waltham Hillingdon Forest Camden Brent Islington City & Barking and Havering Hackney Dagenham Ealing Central London Tower Newham Hamlets H&F West Hounslow London Southwark Greenwich Lambeth Richmond Already delegated ( 11 CCGs ) Wandsworth Bexley Lewisham Expected to be delegated from April 2017 ( 21 CCGs ) Merton Kingston Croydon Bromley Sutton Croydon Sutton Croydon 5 It is important to note that NWL, C&H and Camden do not expect to have completed membership voting/ sign off until February 2017
The practice environment is changing, with practices closing and merging Between April 2015 – March 2016 Between April 2015 – March 2016 22 practice merged across London 11 practice closed across London Practice merges Practice closure 4.5 12 4 10 3.5 8 3 2.5 6 Practice merges 2 Practice closure 4 1.5 2 1 0.5 0 North North East North West South 0 Central London London West North North East South West South East London London Central London London London London 6
By the end of 2017/18, we will have extended access throughout London We have now had plans in from 31/32 areas of London, outlining their plans for this delivery: 2017/18 2016/17 9.2m (97%) of London will have access as per the Over 6m (65%*) of London will have access as per London definition of extended access by the end of the London definition of extended access by the end of 2017/18 2016/17 * Current plans received in December outline that this is tracking for 3% of London would be providing partial delivery (City greater than 65% - and further assurance of plans is underway to confirm and Hackney are currently scoping opportunity to Other areas of London (35%) would be providing deliver some extended access via the hub model in partial delivery/ setup etc. 17/18, ahead of becoming a GPAF scheme in 18/19) 7
And increasing the workforce is a key aim of the GPFV 8
The GPFV outlines ambitions for more resource and investment National Resource Increase Key discussion questions 5,000 GPs 5,000 extra by 2020 • What are your biggest workforce concerns? • As employers what would you like to input into the National workforce debate ? 3,000 extra MH therapists 5,000 other roles, including 1,500 more clinical pharmacists Supporting Activities Additional Funding • Further work to deliver the 10 point action plan £143m Clinical Pharmacy Funding improvement • Major national and international recruitment campaigns Workforce activities • Bursaries for the areas which have struggled the most to attract into GP training Nurse development £15m • Induction and refresher courses for those looking to return to work • Support for flexible working £45m Reception & clerical staff training • Support for practices to be more resilient Improvement • Review of best ways of working to manage outpatient Workload activites £6m Practice Manager Development demand • Reduction in CQC inspections for the best rated practices • Programme to release time for patients through • Better automation of tasks where possible Pharmacy integration £100m* 9
PHARMACY IN PRIMARY CARE Pharmacists in General Practice NHS England London Region is now taking forward the Pharmacist in GP Practice work Programme. • Part of the GP Five Year Forward View. • The Application are made through GP Practices and Federations. • In February 2017 more applications were received from GP practices and GP federations for pharmacists to work clinically in GP practices. • The application process will be on a rolling basis throughout 2017. • London has to achieve recruitment of 84 pharmacists/year over the next 3 years. It will be important to establish links between Community pharmacy and GP based pharmacists particularly around medicines optimisation, supporting referrals into MURs and NMS, and discharge planning. More joint working supports and reinforces the role of the pharmacy profession in Primary Care. 10
PHARMACY IN PRIMARY CARE Community Pharmacy reforms The following contractual changes came into effect from 1st December 2016:- The reforms are a mixture of contractual efficiencies , changes to pharmacy regulations and new innovations. Some of innovations include the • Introduction of a Pharmacy Access Scheme. • Introduction of a Quality Payments Scheme. • A new national Pharmaceutical advanced Service for Urgent Repeat Medicines supply • Introduction of a Pharmacy Integration fund. 11
Pharmacy in primary care Integrating pharmacy into urgent care NHS England is working to embed pharmacy into the urgent care pathway by expanding the services already provided by community pharmacies in England. This will include:- • treatment for urgent minor ailments and common conditions. • who need urgent repeat prescriptions - NUMSAS is a very good example of this. London currently has a Pharmacy Urgent repeat medication service, set up in December 2014., which is being transitioned to NUMSAS There is a review taking place on how London can consistently commission community pharmacies to provide extended hours over the Public holiday period. 12
NHS Urgent Medicine Supply Advanced Service Pilot Overview of service www.england.nhs.uk
Urgent Care • Pressures will be familiar to all • Five Year Forward View: • “need to redesign urgent and emergency care services in England for people of all ages with physical and mental health problems” • Urgent and Emergency Care Review: • “a fundamental shift in the way urgent and emergency care services are provided to all ages, improving out-of- hospital services so that we deliver more care closer to home and reduce hospital attendances and admissions” www.england.nhs.uk
Urgent and Emergency Care Review • The vision of the review is simple: • For adults and children with urgent care needs, we should provide a highly responsive service that delivers care as close to home as possible, minimising disruption and inconvenience for patients, carers and families. • For those people with more serious or life- threatening emergency care needs, we should ensure they are treated in centres with the right expertise, processes and facilities to maximise the prospects of survival and a good recovery. www.england.nhs.uk
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