Integrating
Clinical
Pharmacy into a
wider health
economy
Dr Keith Ridge CBE
Chief Pharmaceutical Officer
NHS England
PCPA Annual Conference #PCPA16
www.england.nhs.uk
Achieving the 5YFV vision
For the NHS to meet the needs of future patients in a
sustainable way, we need to close all three of these gaps:
1
Health &
wellbeing
gap
2
Care &
quality
gap
3
Funding
and
efficiency
gap
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Radical
upgrade in
prevention
New Care
Models +
new
support
Efficiency &
investment
2
5YFV: Implementation progress
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3
Where the savings will come from
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4
Background: Medicines Utilisation in Practice
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www.england.nhs.uk
Patients report having insufficient
supporting information
Poor adherence: 30 - 50% of medicines not
taken as intended
Medicines wastage in primary care: £300M
pa with £150M pa avoidable
UK literature suggests 5 to 8% of hospital
admissions due to preventable adverse
effects of medicines
Inadequate review and monitoring of
medicines outcomes
Polypharmacy
Uptake of newer medicines can be patchy
There is unwarranted variation in use of
medicines across England: from
innovative medicines to biosimilars
The threat of antimicrobial resistance
Unacceptable level of medication error
5
5
Medicines optimisation:
better patient outcomes and value, whilst creating headroom
http://www.rpharms.com/promoting-pharmacy-pdfs/helping-patients-make-the-most-of-their-medicines.PDF
DH – Leading the nation’s health and care
West Hampshire CCG: Deprescribing in Polypharmacy
Polypharmacy
cardiovascular
Polypharmacy
analgesia
Polypharmacy
endocrine
Aspirin &/or
dipyridamole
Opioids
Bisphosphonates
74
42
Polypharmacy
other
205
ACE-I/ARB
combinations
86
14
‘Triple
whammy’
(ACE-I/ARB;
diuretic;
NSAID)
229
9
Statins or
ezetimibe
174
NSAIDs
24
Alphablockers
Diuretics &
CCBs
19
PPIs
53
Antimuscarinics
277
Inhalers
Digoxin
63
SSRIs &
NSAIDs
27
Antipsychotics
15
Other
396
Quinine
526
Pregabalin or
gabapentin
Metformin
4
Specials
275
Amiodarone
1
Grand Total:
items deprescribed
2513
Community pharmacy already plays
a vital role in:
Key facts and figures
-
Dispensing medicines
Advising on medicines use
Promoting good health and supporting the
prevention agenda
Supporting people to look after themselves
But it could play an even greater role, as part of
more integrated local care models, in:
-
Optimising medicines usage
Supporting people with long term conditions
Treating minor illness and injuries
Taking referrals from other care providers
Preventing ill health
Supporting good health
1.6 million visits to community pharmacy
every day, of which 1.2 million are for health
reasons
Over 1 billion medicines dispensed in
community pharmacy every year
£8 billion spend every year in primary care
on NHS medicines
2.5% current yearly rate of prescription
growth
Medicines optimisation
Up to half of patients don’t use medicines in
the way intended; many are simply thrown
away
1 in 7 over 75s are admitted to hospital
because of incorrect medicines use
70% of people in care homes may be at risk
from medication errors
www.england.nhs.uk
Carter Report
“’Hospital pharmacy’s primary function is to work closely
with patients, doctors and nursing staff to choose, prescribe
and monitor clinical outcomes of medicines’.
“Acute trusts must ensure their pharmacists and clinical
pharmacy technicians spend much more time on clinical
pharmacy services than on infrastructure activities”
“The delivery of hospital pharmacy services and the
optimisation of medicines are intrinsically interwoven and,
from a value perspective, can’t be separated. Simply put,
the NHS needs to focus the pharmacy workforce to drive
optimal value and outcomes from the £6.7bn it spends on
medicines.”
www.england.nhs.uk
The Pharmacy Integration Fund
Pharmacists’ skills make them
invaluable to patients and the public, but
too often those skills are not used
effectively, resulting in avoidable
hospital admissions, medicines wastage
and sub-optimal care. NHS England has
taken important steps to integrate
pharmacy into the NHS and the
Government would like to make further
progress.
www.england.nhs.uk
The Pharmacy Integration Fund will
support a programme of work aimed at
accelerating the integration of clinical
pharmacy roles, including those
provided by high quality community
pharmacies with the appropriate skill
sets, into primary care, so that they can
become an embedded part of wider
health and social care.
The consultation responses – up until
24th March 2016
• 24th March 2016 closing date
• 39 written responses specifically mentioned the Pharmacy
Integration Fund in detail. Responses received from a
range of stakeholders
• Similar themes noted from interim responses at 12th
February 2016. Particular focus on:
 General practice integration with community pharmacy
 Urgent care integration with community pharmacy
 Care home pharmacy services
 Workforce development
 Digital development
 Access to the Fund
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The Responses- 24th March 2016
• Community pharmacy
• Diabetes
• Mental health
• Learning disabilities
• Health improvement
• Well being
• Transfer of care
• General practices
• Multi-speciality
community providers
• Urgent care hubs
• Care homes
• NHS 111/OOHs
Primary care
settings
Medicines
optimisation
Pharmacy Integration
Infrastructure
• Workforce development
• Digital integration
• Referral pathways
• Patient registration
• Care record – read/write
• Monitoring/reporting process
• Transfer of care
www.england.nhs.uk
Evaluation
• Vanguards
• Community pharmacy
services review
• New care models
• Service evaluation
methodologies
12
Community Pharmacy Review
• NHS England to commission independent community
pharmacy services review to advise the Chief
Pharmaceutical Officer
• Timetable: anticipated to run from May to Autumn
2016
• Richard Murray, Director of Policy for the King’s Fund,
has agreed to chair the independent review
www.england.nhs.uk
Terms of reference
In the context of:
• the changing patient and population needs for healthcare
as set out in the Five Year Forward View, in particular the
demands of an ageing population with multiple long term
conditions,
• the changing demands and roles in primary care as set
out in the GP Forward View
• emerging models of pharmaceutical care provision from
the UK and internationally
• the evidence of sub optimal outcomes from medicines in
primary care settings
• the objective to improve value through integration
of pharmacy and clinical pharmaceutical skills into
patient pathways and the emerging new care models
www.england.nhs.uk
The review will:
• examine the evidence base, value and operationalisation
of the clinical elements of the current community
pharmacy contractual framework and other clinical
services provided by community pharmacy that are
commissioned by NHS England
• identify the barriers that prevent best use of community
pharmacy and the community pharmacy workforce in
integrated, safe, clinical and cost effective, high quality
care of patients with acute and long term conditions and
examine how those barriers might be addressed
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The review will:
• taking into account the barriers identified, make
recommendations for commissioning models and clinical
pharmacy services that both integrate and transform the
clinical contribution of community pharmacy and the
pharmacy workforce to the delivery of good outcomes and
patient care, whilst considering the relevant evidence
generated from local commissioning of community
pharmacy clinical services and aligning with the emerging
new care models,
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The review will:
• make recommendations for commissioning models for
community pharmacy and the pharmacy workforce
that deliver good patient outcomes and optimal value
for money for the taxpayer, when compared to
services delivered elsewhere in primary care, taking
into account both published national clinical priorities
and the need to be able to respond flexibly to local
clinical priorities
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In Summary
• The Five Year Forward View is in implementation
mode
• Review the evidence base for current services
• Identify barriers that prevent us making best use of
the pharmacy workforce
• Make recommendations as to what services should
be commissioned in the future
• Make recommendations as to the how those services
should be commissioned
www.england.nhs.uk