nhs long term plan... the nhs long term plan focuses on two main issues: 8 • connectivity the...
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www.england.nhs.uk
NHS Long Term Plan
14th May 2019
Sejal Parekh for
Jill Loader, Deputy Director of Pharmacy
Commissioning (England)
www.england.nhs.uk
NHS Politics
2
www.england.nhs.uk 3
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Long Term Plan – an overview
4
The NHS Long term Plan published
on 7 January 2019 marks the NHS
70th anniversary.
National debate has centred on three
big truths.
These concerned:
1. funding,
2. staffing,
3. increasing inequalities and
pressures from a growing and
ageing population.
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Long Term Plan – an overview
7
This Plan sets out how 3 main concerns will be tackled
by:
• secure and improved funding path for the NHS,
averaging 3.4% a year over the next five years,
(cf 2.2% over the past five years)
• wide consensus about the changes now needed.
(confirmed by patients’ groups, professional bodies
and frontline NHS leaders who have helped shape
this plan)
• work that kicked-off after the NHS Five Year
Forward View is now beginning to bear fruit,
providing practical experience of how to bring about
the changes set out in this Plan. Almost everything in
this Plan is already being implemented successfully
somewhere in the NHS.
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The NHS Long term Plan focuses on two main
issues:
8
• Connectivity
The first is how we intend to improve the connectivity of services to patients, which touches on issues such as integration of care, of access to care, and of developing new channels including digital solutions.
• Outcomes
The second is how the health system will deliver improved outcomes in the areas that are most responsible for ill health, including cancer, mental health, cardio vascular disease, and through prevention.
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Major practical changes over next 5 years
9
Boost out of hospital care
Redesign and reduce pressure on urgent care
Digitally enabled primary and Out-Patient (OP) care
Focus on population health through Integrated Care System (ICS)
Personalised care
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• Comprehensive Model of Personalised Care published January 2019
• At least one in five appointments with GPs are about issues that aren’t purely medical
• Social prescribing is offered alongside other medical treatment options for people who
have physical or mental health conditions
• Social prescribing link workers work in close partnership with pharmacy, social care,
community health and other health and care professionals
NHS LTP cross-cutting priority: Personalised care
Six evidenced-based interventions so personalised care can be implemented
at scale across the health system. Each defined by a standard set of
practices:
1. Shared decision making
2. Personalised care and support planning
3. Enabling choice, including legal rights to choice
4. Social prescribing and community-based support
5. Supported self-management
6. Personal health budgets and integrated personal budgets
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• Everyone who has to stay overnight in hospital is provided with help to stop
smoking
• Every pregnant woman is offered face-to-face support to help her stop smoking
• Help people using outpatient services for conditions that are made worse by
smoking to quit smoking
• More people able to access support to help control their diabetes
• More people to attend weight management services, especially those who are
obese and have another condition such as high blood pressure
• People admitted to hospital with alcohol related problems can be cared for by
specialist Alcohol Care Teams
• Continue to use antibiotics sensibly so that they are still available for future
generations
• Provide digital tools such as smartphone apps to enable more people to access
online NHS services and support self-management
LTP cross-cutting priority: Prevention of ill-health
New evidence-based NHS prevention programmes will be developed that
focus on reducing smoking, obesity and alcohol intake:
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Through Integrated Care
Systems, commissioners will
make shared decisions with
providers on
• population health,
• service redesign
implementation
Triple integration of the NHS Long Term Plan
1.Primary and specialist
care
3. Health and social
care
2. Physical and mental
health
NHS Long
Term Plan
www.england.nhs.uk
Community Services and Long Term Plan
13
• Digital consultations
• Integrated teams of GPs, community health and social care staff.
• Expanded CHS teams to provide fast support to people in their own homes as an alternative to hospitalisation/ ramp up NHS support for people living in care homes.
• More NHS community and intermediate health care packages to support timely crisis care, to free up >one million hospital bed days.
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Pharmacy and Long Term Plan
14
The NHS Long Term Plan establishes an ambition to better utilise the skill set of pharmacy
• PCN clinical pharmacists in GP and care homes
• to deliver more services to help people stay well in the community and relieve pressure on other parts of the system.
• It also sets out an ambition for more joined-up and coordinated care
• support the overall transformation of pharmacy, through service initiatives funded by the Pharmacy integration Fund.
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LTP pharmacy ambitions
15
Urgent Care – pharmacy connection schemes
Referral to pharmacy from NHS 111 (DMIRs)
NHS Urgent Medicines Supply Advanced Service (NUMSAS)
Development of referral of minor illness from
• GP to pharmacy
• 111 online referral to pharmacy
• Urgent care to pharmacy
Underpinned by digital integration 111 DoS, NHS.net, SCR, WES, NHS mail
Prevention • Healthy Living Pharmacies,
• Public Health campaigns,
• Vaccination
• Case finding
• Early diagnosis
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LTP pharmacy ambitions
16
Medicines optimisation and safety
NSAIDS
prevention of asthma deaths
medicines safety report
risk and mitigations
LASA errors
Transfers of care around medicines (TCAM)
Medicines Safety Programme and QOF
Workforce development
Clinical pharmacists in GP and care homes
Prescribing
Accredited checking technicians
Leadership skills
IPMO
Quality Payments Scheme
Pharmacy
Integration Fund
www.england.nhs.uk
Pharmacy Integration
Fund NHS RightCare
Programme and AHSNs
Digital Medicines
Programme at NHS Digital
2,000 new clinical
pharmacist MO roles in GP practices
Workforce developme
nt in collaboration with HEE
Developing new care
models – for urgent care
and care homes
Quality Payments Scheme
Pharmacy Integration
Fund set up to enable
pharmacist and
pharmacy technician
integration in primary
care as part of new multi-
disciplinary healthcare
teams, making the most
of their clinical skills
To support system wide medicines optimisation, NHS England is enabling the
transformation of pharmacy practice to improve the quality and efficiency of services for the
public
The drivers for pharmacy integration
Up to 5% of fund used to
evaluate each project
Evaluation looks at
scalability and
sustainability
Pharmacy integration to support medicines
optimisation
www.england.nhs.uk
Proposed vision for the integrated clinical pharmacy team
• Clinical pharmacists and pharmacy technicians a central part of
multi-professional teams in PCNs
• Community pharmacy teams deliver consistent, high-quality minor
illness care and support the public to live healthier lives
• Community pharmacists have capacity to deliver more clinical
care
• Support and encourage pharmacy technicians to practise at
the top of their licence as new technologies transform
medicines dispensing and supply processes
• Hospital and mental health pharmacists continue to be part of
specialist teams and extend their practice into primary care,
including providing consultant pharmacist support
• CCG pharmacy teams leading on population health
• Consistent delivery of these goals will require clinical and
professional leadership across the health and care system, by
Regional Chief Pharmacists and proposed Clinical Directors of
Pharmacy and Medicines in each ICS
Next steps for 2019/20:
• Publish IPMO
framework
• Develop proposed
governance framework
for pharmacy and
medicines across an
ICS
• System wide metrics
for use of data
developed and
benchmarked
• Continue to be led by
Regional Chief
Pharmacists
• PCN recruitment of
clinical pharmacists
from July 2019
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Resources for
primary medical and
community services
will increase by over
£4.5 billion by
2023/24
19
20
• Published in January 2019 by NHS
England and the BMA General
Practitioners Committee in England
• Five year framework: 2019/20 GMS
Contract changes and joint proposals
for the four subsequent years
• The Framework sets direction for
primary care and seeks to address the
core challenges facing general
practice.
A five year framework for the GP
services contract Summary of agreement
• Addresses workload issues
• Brings a permanent solution to indemnity
costs and coverage
• Improves the Quality and Outcomes
Framework
• Introduces a new Network Contract DES
(DIRECTED ENHANCED CARE)
• Helps join-up urgent care services
• Enables practices and patients to benefit
from digital technologies
• Delivers new services to achieve NHS
Long Term Plan commitments
• Gives five-year funding clarity and
certainty for practices
• Tests future contract changes prior to
introduction
• QOF review (published July 2018)
15 indicators will be added or amended including blood
pressure, diabetes, mental health, COPD and cervical
screening
• QI modules – safer prescribing of NSAIDs, valproate, lithium
and other high risk medicines
• Reducing medicines harm using PINCER and other similar tools.
• Test beds
21
GP contract: Quality and Outcomes
www.england.nhs.uk
Primary Care Networks (PCNs): service delivery
units
• Small enough to give a sense of local ownership
• Big enough to have impact across a 30-50K population
• Groupings of clinicians and wider staff working together to improve the care of their population
• Service delivery units and a unifying platform across the country.
22
Domiciliary
Care
Person
Primary
care
Mental
Health
services
Nursing
Homes
Voluntary
Sector
Hospital
Care
Homes NHS 111
Informed and
enabled people
Practices as teams of teams
Personalisation and improved
outcomes
Integrated primary care
service
Digitally enabled working
Growing motivated and enabled staff
Aligned incentives
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• GP practices working together as the core of a PCN, partnered with other local
providers to deliver a more integrated service.
• Investment to reimburse 20,000 + staff as part of the new network contract
• Up to 6 WTE clinical pharmacists in post in PCN community multidisciplinary
teams by 2024 (also physios, physician assistants, social prescribing workers,
paramedics)
• New GP QOF covering prescribing safety in 2019/20
• Clinical pharmacists in PCNs will provide a focal point for collaborative working
across the different pharmacy sectors including hospital, mental health and
community pharmacy.
• Collaboration with non-GP providers, such as pharmacies, will be a
requirement for networks from 2020.
PCNs and pharmacy
23
www.england.nhs.uk
• In 2017, the World Health Organisation (WHO) launched
its third Global Patient Safety Challenge ‘Medication
Without Harm’, which aims to reduce the global burden
of severe and avoidable medication-related harm by
50% over five years.
• Research identified there are an estimated 237
million ‘medication errors’ per year in the NHS in
England,
• 66 million potentially clinically significant AND
‘definitely avoidable’ adverse drug reactions
• collectively costing £98.5 million annually,
• are directly responsible for, approximately 700
deaths per year
The National Medicines Safety Programme
24
Medication Without Harm
WHO Global Patient Safety Challenge
www.england.nhs.uk
• The National Medicine Safety Programme (MSP) addresses the most
important priorities through three lenses:
• high risk drugs
• high risk parts of the medicines use process
• patients with the highest vulnerabilities
• All aspects of medication use will be considered:
- safe packaging and labelling design;
- safer prescribing methods, including electronic prescribing;
- understanding of human-factor error;
- the use of metrics to drive a reduction in the risk of harm;
- changes to administration protocols.
The National Medicines Safety Programme
25
www.england.nhs.uk
UK 5-year AMR Strategy 2013-18:
Seven key areas for action
DH – UK High Level Steering Group
NHSE/NHSI/PHE
Human health DEFRA
Animal health DH
1) Better access to and use of surveillance data
2) Programme 1 - Improving infection prevention and control (SRO
Ruth May)
3) Programme 2 - Optimising prescribing practice (SRO Keith Ridge)
4) Programme 3 - Improved use of diagnostic tests (SRO Sue Hill)
5) Programme 4 – Improved use of antimicrobials, in animals,
agriculture and the environment (SRO Pete Borreillo)
6) Improving professional education, training and public engagement
7) Improving the evidence
base through research
8) Developing new drugs,
vaccines and other
diagnostics and
treatments
9) Strengthening UK and
international collaboration
UK AMR Portfolio Board
AMR NHS Agencies
Coordinating Group
Various working groups
2016 target: 50% reduction in
the number of inappropriate
antibiotic prescriptions by
2020
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• National Overprescribing Review Opening Symposium 15 May
2019
• 150 attendees across medicine, nursing and pharmacy, plus
representation from patients and charities, commissioners and
ALBs
• Over 60 submissions received of work going on nationally in
reducing overprescribing
• First event, but there will be opportunities for all to input as the
review continues
• Setting the vision for overprescribing and identifying the key
areas for further investigation alongside an in depth review of the
available evidence
• From the symposium a SLWG will take forward the themes
identified
• Polypharmacy recommendations for the Secretary of State
National Overprescribing Review
and polypharmacy
NHS England and NHS
Improvement
• Short Life Working
Group appointed
and will meet
during 2019
• NIHR review of
research
• Report published in
2020
www.england.nhs.uk
Summary
28
• Increased funding for Community
Health Services and Primary care
• Utilising the skills/services of CHS
pharmacists
• Next 5 years – more integrated
roles with other healthcare
providers
• Focus on care of the elderly,
TCAM, health prevention, health
and wellbeing,
• Community based and integrated
health care approach
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What’s the national approach?
‘The frail Elderly’ ‘An Older Person
living with frailty’ A long-term condition
Hospital-based
episodic care
Disruptive & disjointed
Late
Crisis presentation
Fall, delirium, immobility
Timely identification
preventative, proactive care
supported self management
& personalised care
planning
Community based
person centred &
coordinated Health + Social
+Voluntary+ Mental Health
+ Community assets
FROM THIS TO THIS
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Any questions?
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