LES – Polypharmacy
Contract Mechanism and Specification 09/03/2015 to 31/03/2016
Main Features and changes to Polypharmacy LES Specification for 2015-2016
The work required for this version of the Polypharmacy LES has some minor changes from the last
version which are summarised below.
1. Face-to-Face Medication Reviews
Continue to provide enhanced face to face medication reviews in a cohort of the practice
population identified from the Polypharmacy Priority Lists.
Patients are now excluded (see appendix 1.1) if they:
• reside in a nursing home with the read code 13F61 (see Nursing Home LES Specification
for definition)
• have received a Polypharmacy LES medication review during 2014/15 or
• have an Anticipatory Care Plan (ACP)
The criteria for inclusion on the Priority 1 patient list have changed (See appendix 1.1 for details).
The maximum number of patients to be reviewed has been reduced from 2.5% of the practice list
to 1.5%. However the reimbursement for face to face polypharmacy review will be a flat rate of
£40 per patient (previously two rates of £40 or £20 depending on whether the patient also had an
ACP) and there will be additional remuneration of £420 available for submitting one polypharmacy
case study and attending both reflective learning sessions.
2. Reflective Learning Sessions
Addition of two reflective learning sessions, one internal and one external (see appendix 1).
3. External Reflective Learning Session Pre work
Practice to submit one Polypharmacy case review (see appendix 1) to local Prescribing lead by
27th March 2015. This case is expected to be discussed by the attending GP at the external
reflective learning session.
4. Medicines Reconciliation
Summary of the medicines reconciliation work for the 2015/16 LES:
a) Carry out the medicines reconciliation care bundle for all patients in your defined cohort
b) Sample and return data on 5 per month using standard data collection spreadsheet (was 10
in 2014/15)
c) OPTIONAL with corresponding additional remuneration: on the same 5 patients apply the
secondary care discharge measures care bundle including the hospital and ward on the
same standard data collection spreadsheet (new)
d) Practice to reflect on 2015/16 medicines reconciliation activities and submit a completed
reflection template (appendix 2.3) to be submitted by 30th November 2015
e) Practice to submit one enhanced significant event analysis (see appendix 2.4) detailing an
issue relating to discharge medication (this can be a “positive” or a “negative” event) by
15th March 2016 (new)
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Introduction
1. All practices are expected to make available to all their patients the essential and those
additional services they are contracted to provide. This enhanced service provides for GP
Level 3 medication review in a planned consultation for patients highlighted as a priority for
review (see Appendix 1.1 for details of patients on the Polypharmacy Priority List).
In addition, this LES aims to support practices review their processes around medicines
reconciliation when medication changes are recommended following hospital discharge. This
will support implementation of a reliable process for medicines reconciliation to minimise the
risk of patient harm.
No part of the specification by commission, omission or implication defines or redefines
essential or additional services.
Background
Medication is by far the most common form of medical intervention for reasons stated in the Quality
and Outcomes Framework guidance for the GMS Contract1. This LES aims to support provision of
enhanced Level 3 face to face reviews in a planned consultation by a GP to promote patient
engagement in the medication review process.
There is a need for ongoing, holistic medication review to assess appropriateness of all medicines
responding to changes in patient status e.g. increasing frailty, increasing co-morbidities, changes
recommended by specialist colleagues following hospital discharge, adverse drug reactions, drug
interactions, approaching end of life etc2 3.
Service Aim
2. To promote safe, effective, evidence based use of medicines in patients considered most at
risk of adverse effects with the objectives:
 To increase the provision of GPs undertaking face to face medication reviews in a planned
consultation to promote patient engagement in the medication review process
 To reduce the level of inappropriate polypharmacy, in particular, medicines from high risk
BNF sections
 To review processes and contribute to a shared measurement strategy around medicines
reconciliation following hospital discharge
Service Outline
3. This enhanced service, will fund the following from 9th March 2015 to 31st March 2016.
a. Practices to nominate a GP to lead on the Polypharmacy LES activity within the
practice.
b. Practices to run the Polypharmacy LES 2015/16 EMIS/VISION Microsoft Access
application to identify high risk patients in the practice considered priority for
polypharmacy review:
1
Scottish Quality and Outcomes Framework guidance for the GMS contract 2014/15 http://bma.org.uk/practicalsupport-at-work/contracts/independent-contractors/qof-guidance
2
SGHD National Polypharmacy Guidance
3
NHSGGC Mindful Prescribing Strategy December 2012
http://www.ggcprescribing.org.uk/media/uploads/prescribing_resources/mindful_prescribing_strategy_-_1212.pdf
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i.
See Appendix 1.1 for details of patients at high risk of adverse effects from
medication on the Polypharmacy Priority List for this LES
ii.
See Appendix 1.2 for Standard Operating Procedure for EMIS/VISION Microsoft
Access application
c. Medication review (See link below for resources to support medication review process)
i.
GPs to perform an enhanced face to face medication review during a planned
consultation for a maximum of 1.5% of the practice population on the
Polypharmacy Priority Lists by 31st March 2016.
ii.
Practices to READCODE patient records with the code 8B31B ‘Polypharmacy
Review noted as active and significant (or medium)’ when undertaking the
enhanced medication review. Text should be associated with the Polypharmacy
Review READCODE to describe medication changes made during review.
Coding as active and significant priority or active and medium priority with the
appropriate associated descriptive text will support communication with other
services via referral letters. An EMIS/ VISION template is available to support
capture of this information and can be downloaded from the LES resource page
(See Appendix 1.1).
d. Peer review
i.
Practices to nominate a GP to attend an external small group reflective learning
session, providing an opportunity to share best practice in managing the clinical
and practical challenges of undertaking medication review. Sessions will be
organised at a local level to run between April and May 2015. Practices are
required to submit one Polypharmacy case review (see Appendix 1.3 for
template) to their local Prescribing Leads by the 27th March 2015 and bring a
copy for discussion at the external small group reflective learning sessions.
ii.
Practices to arrange protected time before January 2016 for an internal
reflective learning practice review. The session should include a minimum of
70% of prescribers in the practice, the prescribing support pharmacist and be
facilitated by the nominated GP. The purpose of the session is, to share best
practice in managing the clinical and practical challenges of undertaking
medication review by cascading the learning from the external small group
reflective learning session. Dates of completed internal review sessions will be
fed back to the Local Prescribing Leads by the Local Prescribing Support Team.
e. Medicines reconciliation (See Appendix 2 for tools to support the medicines
reconciliation process)
i.
Practices to carry out the medicines reconciliation care bundle for priority
patients (See Appendix 2.1)
ii.
Practices to feed back care bundle compliance and CHI numbers for a random
sample of 5 patients from this cohort every month using a reporting spreadsheet
(See Appendix 2.2)
iii.
OPTIONAL: Practices to apply secondary care measures to the same random
sample of patient discharges and feedback care bundle compliance with
hospital site and ward every month using same reporting spreadsheet (See
Appendix 2.2)
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iv.
Practice to complete and submit a Medicines Reconciliation reflection template
on 2015/16 medicines reconciliation activities by 30th November 2015 to
[email protected] (see appendix 2.3)
v.
Practice to complete and submit one enhanced significant event analysis
detailing an issue relating to discharge medication (this can be a “positive” or a
“negative” event) (See Appendix 2.4) by 15th March 2016 and submit to
[email protected]
Reporting LES Activities
4. Summary of reporting activity
a. Medication reviews – CHI numbers and date of review will be auto extracted on a
quarterly basis to support local and national evaluation
b. Medication reviews– Peer Review
i.
Practices are required to submit one Polypharmacy case review (see Appendix
1.3 for template) to their local Prescribing Leads by the 27h March 2015 for
discussion at the external small group reflective learning sessions.
ii.
The member of the Prescribing Support Team attending the internal review
session will feed back to the Local Prescribing Lead when the session has taken
place.
c. Medicines Reconciliation – Monitoring tool
i.
Practices to feed back CHI numbers with practice care bundle compliance of a
random sample of 5 patients per month from the priority medicines reconciliation
cohort to [email protected] using a reporting
spreadsheet (See Appendix 2.2). Spreadsheets can be downloaded from:
http://www.staffnet.ggc.scot.nhs.uk/Acute/Division%20Wide%20Services/Pharmacy%2
0and%20Prescribing%20Support%20Unit/Prescribing/Pages/PolypharmacyLES.aspx
ii.
OPTIONAL (additional remuneration). Practices to feed back secondary care
discharge measures compliance for the same random sample of 5 patients per
month from the priority medicines reconciliation cohort to [email protected] using the same reporting spreadsheet as
above (See Appendix 2.2). The spreadsheet is the same as above
d. Medicines Reconciliation – Reflection Template
Practices to undertake a reflection of medicines reconciliation activities undertaken
during 2015/16 and submit the Medicines Reconciliation Reflection Template by 30st
November 2015 to [email protected] (see appendix 2.3)
e. Medicines Reconciliation – Enhanced Significant Event Analysis
Practice to submit one enhanced significant event analysis detailing an issue relating to
discharge medication (this can be a “positive” or a “negative” event) (see appendix 2.4)
by 15th March 2016 and submit to [email protected]
f.
In the event that a practice does not complete the agreed contracted work set out in the
LES then practice payment recovery mechanisms for the LES will be instigated.
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Enhanced Service Time line
5. The Polypharmacy LES will follow a 13 month time line detailed below:
a. Practices are asked to opt in by 3nd March 2015 LES to commence 9th March 2015 and
run until 31st March 2016
b. Practices to receive a one off engagement payment (6a) in March 2015 if opted in to
LES and undertake service outline sections relating to staff nomination and running the
EMIS/VISION Microsoft Access application (3a and 3b)
c. Reports on CHI number and date of polypharmacy review will be auto extracted
quarterly.
Payment
6. a. Engagement Fee
Payment will be made on the basis of a one off engagement fee of £200 per practice in March
2015.
b. Achievement Payments
Medication Review
Payment is based on face to face medication review by a GP in a planned consultation
for priority patients and participation in external and internal peer review sessions
around the medication review process
i.
A payment of £40 per patient will be available for enhanced polypharmacy
review of high risk patients (as per Appendix 1.1), during a planned face to face
consultation with a GP for the payment period 9th March 2015 to 31st March
2016. Payment at this level will be made for an aspirational number of
enhanced polypharmacy reviews for high risk patients to a maximum of 1.5% of
the practice population (pro rata).
ii.
Only one polypharmacy review payment will be made for any individual patient
during the timeframe of the LES
iii.
Patients receiving a polypharmacy review in 2014-2015 will be excluded from
the Polypypharmacy LES for 2015-2016
iv.
60% of the aspirational achievement payment for reviews will be paid in
advance to practices in March 2015
v.
A total payment of £420 will be made to practices in March 2015 on the
assumption of achievement submission of one polypharmacy case study and
participation in an external review session and participation in an internal peer
review sessions
vi.
The remainder of the achievement payment will be paid in June 2016 subject to
quarterly reports providing evidence of review activity
vii.
Failure to complete the case study submission and attend the external and
internal reflective peer review sessions will result in payment recovery of £420
from the practice
Medicines reconciliation
Payment is based on implementation of a reliable process for medicines reconciliation
in the practice:
i. An advanced payment of £1000 will be made to practices in March 2015 for
carrying out the medicines reconciliation activities as per 3.e.i and ii. above.
ii. OPTIONAL: A payment of £900 will be made for the measurement and
submission of the secondary care measures care bundle as per 3 e iii above
iii. A payment of £50 will be made for completion and submission of the Medicines
Reconciliation Reflection Template 3 e iv above
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iv.
A payment of £50 will be made for completion and submission of the
enhanced significant event analysis as per 3 e v above
v. Payments ii-iv above (payment (ii) only if opted in) will be made to practices in
June 2016 subject to submission of monthly reports providing evidence of
medicines reconciliation activity, completed final Medicines Reconciliation
Template and enhanced significant event analysis
c. At the discretion of the practice, payment recovery can be instigated if it is felt that
actual activity is falling significantly below the aspirational level. To discuss contact
[email protected]
d. If monitoring reports indicate that service outline actions (items 3a-3e(v) (with 3 e(iii)
optional) are not completed within the specified time frame then fees will be subject to
the process for payment recovery
e. For medicines reconciliation activities
i.
If less than 9 out of 12 monthly care bundle reports are received, (item 3e.ii)
payment recovery will be instigated. Deductions of £100 for each month of nonsubmission will be applied (to a maximum of £1000)
ii.
For practices opted into the secondary care measures, if less than 9 out of 12
monthly care bundle reports are received, (item 3e.iii) there will be no payment
of £100 for each month of non-submission (to a maximum of £900)
iii.
If the Medicines Reconciliation Reflection Template and enhanced significant
event analysis are not submitted there will be no payment of £50 each (to max
of £100)
iv.
Maximum deduction for non achievement of medicines reconciliation activities
(items 3e i and ii) will be £1000
f.
In the event of a dispute the practice will be required to provide evidence of work
undertaken. The PMG PC will act as arbiter on the dispute using the evidence provided.
Withdrawal
7. Both parties will provide a minimum of three months notice that they wish to withdraw from the
contract.
Resources
All Polypharmacy LES resources will be available on the NHSGGC website at
http://www.staffnet.ggc.scot.nhs.uk/Acute/Division%20Wide%20Services/Pharmacy%20and%20Pr
escribing%20Support%20Unit/Prescribing/Pages/PolypharmacyLES.aspx
including:
Appendix 1
Tools to support the polypharmacy medication review process
Appendix 2
Tools to support the medicines reconciliation process
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