Dr Wasim BaqirNational Pharmacy Lead (Care Homes)Pharmacy Integration Team

Medicines Optimisation in Care Homes: Personalised care for care home residents

RPS Scotland

Medication Errors

Medicines Waste

Silo working

Excess medicines (unnecessary/ inappropriate)

Lack of structured

review

Rare patient involvement

Care Homes

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 Steps on the Five Year Forward View

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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

The Medicines Value Programme

The NHS wants to help people to get the best results from their medicines – while achieving best value for

the taxpayerSavings will be reinvested in improving patient care and providing new

treatments to grow the NHS for the future

The NHS policy framework that governs access to and pricing of

medicines1

The commercial arrangements that influence price

2

Optimising the use of medicines3

Developing the infrastructure to support an efficient supply

chain

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A whole system approach….

• NHS England, NHS Improvement, NHS Digital, Health Education England

• Regional offices link with STPs, ACSs, CCGs, and providers

• Nationally coordinated with AHSNs, Getting It Right First Time, NHS Right Care and NHSCC

Following the Next Steps on the NHS Five Year Forward View and Carter Report

Pharmacy Integration Projects

300 Pharmacists & technicians in

IUC & Care Homes

Quality Payments Scheme

Digital Minor Illness & NUMSAS

referrals from NHS111

NHS DigitalIntegrating pharmacy

through SCR, NHSmail, EPS, ERD, single source of

pharmacy services data, referrals/ discharge from

secondary care

Pharmacy Workforce development with HEE

2,000 prescribers; GP, care home and urgent care

pathways; post-registration and leadership training

GP pharmacists

Investment in 2,000 new pharmacist

roles by 2021

NHS England is enabling the transformation of pharmacy practice to improve the quality and efficiency of services for the public

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

Enhanced Health in Care Homes

Moving Medicines Optimisation (MO) Upstream

• 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 Health and other local pharmacy services

• Team works closely with community pharmacy, general practice, social care and voluntary sector

89yr old lady admitted to A&E following epileptic fitAssessed on A&E: decision to increase Lamotrigine

Discharged back to care homePharmacist liaised with A&E and prescriber

Community Pharmacy suppliedAdmission to ward avoided

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 to create capacity

High Risk Complex

Moderate Risk/Need

Low Risk/Need

Complex Medication Review, MDT

Discharge, new patients

Low acuity interventions, waste management

Integrated teams working together across organisational

boundaries

Involving Residents

• 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 better with Community Pharmacy

• 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?

Northumberland Community Pharmacy Care Home Medicine Use Reviews

Pass it on

Let’s talk

Do it

Vanguard Pharmacists,

Geriatricians, MDT

Vanguard team & Comm Pharmacy

Community Pharmacy MUR

Complexity of care

15%

21%

64%

• 240 Pharmacists and technicians working across care settings to support care homeso Medicines optimisation (including deprescribing)o Care home systems and staff (reduce errors, waste)o Antimicrobial stewardship

• Training pathwayo HEE commissioned training provider – CPPE o 600 Pharmacists and Pharmacy Technicianso Independent Prescribing

• Infrastructureo Networks, IPACS, Data & Metrics, Polypharmacy Support

Scaling & Spreading good care

STP offered funding

- Lead CCG- Plans

35 STPs and 10 ICSs

Training Pathway

Network to share, learn &

spread

Monitoring (Population

Health Dashboard/

Metrics)

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Support for every area

• Equity – every system in England will get funding

• Based on indicative care home population

• Enough to get started and make a difference

• Integrating services working across CCGs• Innovative partnerships• Community Pharmacy part of the NHS team• Thinking beyond (MH, Antimicrobial

Stewardship)• Adding to the funding• Competition Collaboration

System LeadershipIntegrating 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

www.health.org.uk/pills

“When we strive to become better than we are, everything around us becomes better too”

Paulo Coelho, The Alchemist

@wasimbaqirengland.pharmacyintegration@nhs.net