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NHS Brighton and Hove’s

Transforming Community Equipment services

Feasibility Study

Project Ref. B&H-ICES-FS-07

Project name

Transforming Community Equipment Services

Release Draft: V 07

Date: 24th September 2010

Author:

Raj Vaithamanithi

Owner:

Kathy Caley

Client:

NHS Brighton and Hove

Document Number:

B&H-ICES-FS-M-B-07

Brighton and Hove

79

Raj Vaithamanithi of 23

Document History

Document Location

This document is only valid on the day it was printed. The source of the document will be found in the Control section of the Project File.

Revision date

Previous revision date

Summary of Changes Changes marked

22/06/2010 First Draft by Raj Vaithamanithi RV

27/07/2010 Finance and process details are added RV

03/08/2010 Amended to incorporate Kathy’s comments

RV

17/08/2010 Executive Summary section, key activities, criteria and cost details are added and project definition section is removed

RV

20/08/2010 Format was changed to incorporate Kathy’s comments

RV

03/09/2010 Further details were added to section 7 RV

24/09/2010 incorporated Kathy’s comments and added east Lancaster’s national retail model implementation

RV

Approvals This document requires the following approvals.

Signed approval forms are filed in the project files.

Name Signature Title Date of Issue

Version

Kathy Caley Commissioner for independence and long term conditions - Commissioning & Performance

07

Distribution This document has been distributed to:

Name Title Date of Issue

Version Purpose

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Purpose

To provide a full and firm foundation for the initiation of the project.

Contents The ICES feasibility study contains the following topics:

1 EXECUTIVE SUMMARY 4

2. NATIONAL RETAIL MODEL 6

3. EARLY ADAPTOR DETAILS 9

4. SUSSEX POSITION ON COMMUNITY EQUIPMENT SERVICE 11

5. NHS BRIGHTON AND HOVE SERVICE BACKGROUND 11

6. POSSIBILITIES AVAILABLE TO BRIGHTON AND HOVE 12

7. NATIONAL RETAIL MODEL IMPLEMENTATION ACTIVITIES 16

7.1 Project Start Up 16

7.2 Project Initiation 16

7.3 Project Implementation 17

7.3.1 Change Management Activities 17

7.3.2 Operational Activities 18

7.3.3 Market Development and Retailer Accreditation Activities 18

7.3.4 Prescription Payment Solution Activities 20

8. SUCCESS CRITERIA TO IMPLEMENT NATIONAL RETAIL MODEL 20

9. RISKS AND ISSUES 21

10. CONCLUSION 22

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1 Executive Summary Community equipment falls into two categories; simple aids to daily living (SADL) such as eating/drinking utensils, grab rails and raised toilet seats, and more complex aids to daily living (CADL) such as beds, hoists and lifts. Provision of both types of equipment helps people to remain independent. Transforming Community Equipment Service (TCES) Programme was initiated in 2006, to review existing community equipment services in England and to develop and implement a collaborative model for a new service that put users and carers at the heart. The TCES Programme recommended a model to separate supply chains for simple and complex equipment and proposed a national retail model to deliver simple equipment services to the local population. As this programme is a national initiative, Brighton and Hove must now make a decision on whether to move forward with the provision of community equipment. Hence the joint commissioning board has decided to review the current Integrated Community Equipment Service (ICES) provided by South Downs Health (SDH), to identify if any efficiencies and improvements are possible and to undertake a local feasibility study of the national retail model to consider whether the model can be implemented in Brighton and Hove. The objectives of this feasibility study are to carry out analysis on the national retail model implementation and to propose the possible implementation options and timescale to transform community simple equipment services, which would enable Brighton and Hove public / patients to exercise their choice and control while purchasing simple community equipments.

The following assumptions are made in preparing this feasibility study:

• The data provided by SDH’s community equipment service is accurate

• information and tools provided by care service efficiency delivery and department of health are accurate to enough to estimate the implementation cost and timescale

The study looks at the localities which have implemented or considered implementing the national retail model both locally and nationally. It also explains the processes involved in issuing and delivering simple equipment to individuals and the next set of activities to be carried out if the recommendation is to implement the national retail model. .

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2. National Retail Model On 22nd June 2006, the then Prime Minister Tony Blair launched the Transforming Community Equipment Service (TCES) Programme which was tasked with undertaking a comprehensive review of existing community equipment services in England and developing a collaborative model for a new service that put users and carers at the heart. The TCES programme was asked to deliver a collaborative model for new service delivery that puts users and carers at the heart of the service leverages the strengths of the third and private sectors. The model was designed to

• Improve quality and put users and carers at the heart of the service

• Empower local services to focus on users with more complex conditions

• Maximise the skills of professionally qualified staff The TCES Programme is overseen by Parliamentary under Secretary of State for Care Services and sponsored by the Department of Health’s Older People and Disability Division. The Programme is part of the Care Services Efficiency Delivery (CSED) Programme. The model proposed by TCES Programme recommends to separate supply chains for simple and complex equipment, which is illustrated in the following figure.

Exchange

Prescription

for equipment

(Top up

option)

Market place(Private Sector,

Third Sector, etc)

Apply to

become

accredited

Normal Consumer

Contract between

User & Retailer

Return fulfilled

prescriptions

Arrange Retailer

Payments

Local

Authority &

NHS

partnersIssues prescription

Equipment owned by

User

Equipment loaned to

User

Complex Aids to Daily

Living Home

Delivery Service

Simple Aids to Daily

Living

Users

Complex

equipment options for regional or

cluster solutions between

LA/NHS partners

National Catalogue

& Tariff

*Contracts for Prescription

Clearing Service. Fee per

prescription

Includes Retailer Fee

per prescription paid

by the state

Information

National standard

of information

available for all

Accredits

retailers

Prescription

Clearing Solution

üTrusted Provider

ofAids to Daily Living

<Insert LA Logo> <Insert NHS Logo>

üTrusted Provider



Exchange

Prescription

for equipment

(Top up

option)


Third Sector, etc)

Apply to

become

accredited

Normal Consumer

Contract between

User & Retailer

Return fulfilled

prescriptions

Arrange Retailer

Payments

Local

Authority &

NHS


Equipment owned by

User

Equipment loaned to

User


Living Home

Delivery Service


Living

Users

Complex



LA/NHS partners

National Catalogue

& Tariff



prescription



by the state

Information

National standard

of information

available for all

Accredits

retailers

Prescription

Clearing Solution

Exchange

Prescription

for equipment

(Top up

option)


Third Sector, etc)

Apply to

become

accredited

Normal Consumer

Contract between

User & Retailer

Return fulfilled

prescriptions

Arrange Retailer

Payments

Local

Authority &

NHS


Equipment owned by

User

Equipment loaned to

User


Living Home

Delivery Service


Living

Users


Living Home

Delivery Service


Living

Users

Complex



LA/NHS partners

National Catalogue

& Tariff



prescription



by the state

Information

National standard

of information

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Accredits

retailers

Prescription

Clearing Solution

üTrusted Provider



üTrusted Provider



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The national TCES team encouraged health and local authorities to conduct their own local research to understand existing businesses and local community needs. The team recommends local and health authorities to consider third sector organisations like British Red Cross, Assist UK and Age Concern while developing the market place. The team also offered the documents and templates to conduct retailer events. TCES has prepared a national catalogue and tariff of Simple Aids to Daily Living (SADLs).The catalogue includes the most common items of equipment issued through community equipment stores in England. Generic specifications that meet clinical need have been developed to ensure the widest ranges of equipment items are available in the retail marketplace. The national product catalogue and tariff will be reviewed and updated regularly to incorporate additional items as necessary and to align with changing market conditions. The national TCES team designed an accreditation scheme to ensure that users of equipment receive a quality service at all stages of the process and advise local and health authorities to accredit the local retailers as part of national retail model implementation. An important aspect of accreditation process is the retailer’s competent demonstration on ability to offer home delivery and offer advice on suitability of products to users. The national team also states that it is important to monitor accredited retailers just to ensure that retailers are meeting accreditation standards. A local team will be required to do this. In the national retail model suggested by national TCES team, users have to collect equipments from the accredited retailers by exchanging the issued prescription. This process raises a need for a mechanism to pay the retailers for the equipment they issue to users. The national TCES team has identified the following three possible ways to process prescription and pay the retailers:

• Establish an prepaid electronic prescription clearing solution to which local and health authorities could subscribe

• Expand the existing back office arrangements of each individual authority to process and pay retailers directly

• Provide money to service users for equipment purchase in alignment with the vision of individual budgets

The national TCES team suggests that they prefer the establishment of a common electronic solution for clearing prescription and developed a prescription clearing solution with the help of Citibank. It is understood that this citi solution is implemented only at London Borough of Havering and the discussion is going on with other 15 local authorities to roll out this solution.

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The National retail model was implemented at Lancashire County Council including Blackburn with Darwen Borough Council, Dorset localities and 8 sites in London borough with the support of national Transforming community equipment service programme team. The following figure shows national implementation plan.

National TCES team provided support to these early adaptors in implementing national retail model by providing document templates and support to develop market place, accredit retailers and also to develop back office processes for payment solution to retailers. As the national TCES team will be disbanded after September 2010, it was holding a series of 'shared learning' events in London. These events are designed to equip local sites with the knowledge and understanding of how to implement the retail model without further direct support from the national TCES team. They aim to ensure local authorities and their health partners have full access to the tools and methodologies, which will enable them to lead their own implementation plans. There is now no longer ongoing support from the national team. Since March 2009 UK's leading pharmacy-led health and beauty retailer, Boots UK, has explored the feasibility of participating in the new service for dispensing community equipment to the public. It has worked with the Department of Health, Local Authority teams, suppliers and other interested organisations and piloted national retail model service in a number of stores. As a consequence of this work, Boots UK realised that the market for community equipment is significantly smaller than forecast. They also discovered that the variation of the service caused by specific local

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requirements, expectations and market conditions would make it difficult to operate it consistently across the entire chain. Hence Boots UK has decided not to participate in national retail model service any further and withdraw it at a date to be agreed with already engaged local authorities. 3. Early Adaptor Details National retail model was implemented by the following early adaptors:

• Lancashire County Council including Blackburn with Darwen Borough Council

• Dorset local authority

• 8 local authorities in London borough Dorset and Lancaster local authorities have decided to implement national retail model as they realised that transformation would enable them to achieve the identified smart benefits and the efficiency savings. Lancashire County Council including Blackburn with Darwen Borough Council has decided to implement Transforming community equipment service in phases across the region as the health service is led by NHS East Lancashire, NHS North Lancashire and NHS Central Lancashire. The Transforming community equipment service project was initiated in East Lancashire region as a pilot in July 2008 and fully implemented in 2009. Mobility stores were engaged using retailer events and interested retailers were identified and nine retailers were accredited to provide the simple equipments to service users. The number of simple equipments loaned through loan store managed by NHS East Lancashire is reduced. It is understood that the transforming community equipment service project will be completed by end of 2010/11 in central and north Lancashire region. East Lancashire has 65 items in its local catalogue. Out of those only 13 items have to be delivered and fitted and the remaining items only have to be delivered. All products on their local catalogue are priced at the Department of Health’s national tariff. East Lancashire pays £12.50 to deliver the items and £15 to deliver and fit the items as specified in the national tariff. East Lancashire has delivered 65,000 simple and complex equipments before implementing national retail model and delivers only 23,000 complex equipments currently after the national retail model is implemented. East Lancashire has decided to deliver equipments to the household people if they can’t collect equipments and it will be agreed with clinical staff during the assessment. In East Lancshire, it is anticipated to achieve total projected saving of £484,020 on the SADLs Service and represents a 7.2% efficiency saving. These savings would

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only be achieved if the Loan Service is downsized, with a 57% reduction in Loan Store running costs, or developed to expand the CADLs Service. Hence Lancashire local authority is considering the solutions to deliver complex equipments to users and know that savings will be realised fully only when the existing four loan stores, which are run between primary care trust and local authority, are downsized to only one loan stone. The retailers are getting paid within seven to fourteen days from the date the invoice being sent. In October 2009, East Lancashire piloted prescription clearing solution using Collective Enterprises Ltd back end system and PityArka’s PISCES front end system. They may use PityArka as a front end system and Citi solution as a back end system. It looks like that it may cost £2.50 per prescription to use this system in clearing the prescriptions. The transformation of London community equipment services is following a phased approach; the initial phase, to which this funded programme relates, is to move away from a state provided supply chain for simple aids to daily living (SADLs) to the prescription model served by the retail market place. At a later stage, a proposal will be presented to support the development and implementation of more efficient supply chains for complex aids to daily living (CADLs). Capital Ambition, London’s Improvement and Efficiency partnership, has awarded the programme funding of £1.9M to exploit smarter working opportunities. The Joint Improvement Partnership (JIP) team working in partnership with Care Services Efficiency Delivery (CSED) are planning to deliver regional roll out of the retail solution for simple aids to daily living (SADLs) in 33 local authorities and health partners across the London region within 2 years. The London TCES programme’s target is to assign LA/NHS Partners within London into five waves with a new wave launched every four months. It is anticipated that it would take two years to totally transform all sites within the London region. It is learnt from London Transforming Community Equipment Services team that national retail model is now live and prescriptions are being issued in Camden, Barking and Dagenham, Harrow, Havering, Lambeth and Southwark. Richmond, Hounslow, Brent, Bromley & Ealing are planning to go-live by October 2010 and Islington, Westminster, Greenwich, Merton & Sutton are planning to go-live by January 2011. Citibank’s electronic prescription clearing solution was implemented only at London borough of Havering. It can be seen from the above that many areas are still in the pilot stage of rolling out the National Retail Model.

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4. Sussex position on Community Equipment Service Nottingham Rehab Centre (NRC) provides Integrated Community Equipment Service to East and West Sussex Region. East Sussex population is around 500,000. East Sussex Community Services are in a pooled budget arrangement which is hosted by ESCC. It is understood that their contract will come to an end in September 2011. The contract value is around 3.5 million. In East Sussex, 70 per cent of activity in community equipment service is about providing simple equipments to service users. East Sussex has reviewed options to provide community equipment services to users and found that cost to implement national retail model might be marginally cheaper compared to the current provider. But East Sussex wanted to achieve efficiency savings around twenty to twenty five per cent approximately. As national retail model won’t absorb the savings what they intend to achieve, East Sussex doesn’t want to implement national retail model. It is also understood that they arranged a meeting with retailers and only 5 or 6 retailers attended the event and some of the retailers are not in the regions where there is a need for service. Because of this East Sussex health and local authority may prefer to use central buying consortia (CBC) than implementing national retail model. East Sussex local authority’s purchasing department may become a member of CBC and prefer to use CBC to purchase community equipments as it will allow them to reduce the equipment costs. It may commission another service to deliver and collect equipments back from users. This model has the following drawbacks:

• The service may have to manage the contracts with different organizations to buy, deliver and recollect equipments from users

• The service users may not get any choice while purchasing simple equipments

In future, East Sussex is planning to reduce logistics and procurement cost by entering into agreement with central buying consortia. West Sussex have also opted not to implement the national retail model. Instead, they are likely to undertake a procurement exercise for the provision of both simple and complex equipment. West Sussex’s contract with NRC expires in March 2012. It is interesting to note that West Sussex local and health services are using Nottingham Rehab Centre for community equipment services. It is understood that they are a member of central buying consortia (CBC) and has not used them to procure community equipment services. 5. NHS Brighton and Hove Service Background

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In Brighton and Hove, community equipment is provided by South Downs Health (SDH) to local users under a section 75 agreement since 2004. South Downs health has 2 stores and 1 workshop. The main store is located at Belgrave Centre in Portslade, with a satellite store based at Brighton General Hospital (BGH). The service supplies equipment and fittings to people in their own homes and within intermediate settings with the aim of reducing admissions, supporting timely discharge and maintaining independence within the community. Occupational Therapists, District Nurses and trained assessors send referrals to ICES by email or fax. Trained assessors are those who have undertaken accredited training to enable them to carry out assessments and improve the fitting of prescribed equipment to improve the efficiency and quality of the service provided. Each person referred must meet the FACS (Fair Access to Care) criteria. Once a referral is accepted, the equipment will be delivered or fitted within the 7 day national target.

6. Possibilities Available to Brighton and Hove Brighton and Hove has the following two possibilities in transforming the community equipment service:

• Do Nothing – Keep current service and see where improvements can be made

• Implement the National Retail Model for Simple Equipment and have a separate service for the provision of complex aids

Do Nothing – keep current service and see where improvements can be made

For both simple (less than £100) and complex items of equipment (more than £100) and bespoke/specials, the service can continue to provide equipment from the existing store and provide an in-house delivery / fit / installation / repairs and maintenance service.

Advantages

• Current service can be continued as service has local knowledge of community and service users

• Continuity of service

• Positive feedback from both service users and prescribers

• Efficiencies may be possible

Disadvantages

• Existing service does not align with changing government policy around better patient outcome, personalisation and choice

• Existing service does not add value to the money and is not offering choice to users

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National Retail Model Implementation for Simple Equipment and separate service for provision of Complex Equipment Brighton and Hove can implement the national retail model using the to-be process specified below: Practitioners will issue a prescription that all Brighton and Hove users for all simple items of equipment (less than £100). State funded users can redeem at an accredited retailer who can provide equipment as requested and fit and/or installation services can be prescribed as needed. A separate service will be required for the issuing of all complex items of equipment (more than £100) and bespoke/specials including delivery / fit / installation / repairs and maintenance service. Advantages

• Easy for the users to collect simple equipments whenever and wherever required as this model provides wider choice to the users

• Stimulates local market and creates local economy

• Creates opportunity to reconfigure existing services and also to negotiate for better terms with new suppliers

• Aligns with changing government policy around better patient outcome, personalisation and choice

Disadvantages

• It is not clear if efficiency savings will be realised

• It may be difficult to engage retailers as the retail model may not add value for the money to the retailers

Time Scale for implementation of national retail model The following stages are required:

• Project Start up

• Project Initiation

• Design and Build SADL

• Implementation

• Post Go-Live Support

The detailed activities and optimal timeline to implement national retail model in Brighton and Hove region is mentioned below:

1. Stage I – Initial Preparation:

v Get approval from JCB v Engage partners, develop detailed business case and secure

funding if decides to roll out national retail model across Sussex.

It may take approximately 8-12 weeks to develop business case and to secure the funding to initiate transforming community service programme.

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2. Stage II – Project Initiation:

v Produce Project Brief to implement national retail model v Agree the project objectives v Produce Project Initiation Document (PID) along with Project

Plan to implement national retail model

It may take 6-8 weeks to complete the PID and also to get the approval from project executive and the board

3. Stage III – Design and Build SADL

v Identify work streams v Agree the roles and responsibilities v Carry out process mapping activities

It may take approximately 16-20 weeks to agree the processes and policies to implement ICES as required.

4. Stage IV – Implementation: v Develop market place by conducting retailer engagement event

and giving accreditation to retailers v Establish back office processes to redeem prescriptions and to

complete the payment process v Provide training to retailers v Implement retail model

It may take approximately 8-12 weeks to undertake these steps.

5. Stage V – Post Go-Live

v Ramp-up SADL across Brighton and Hove locality v Decommission existing services if possible v Evaluate project success by realising the identified benefits

It may take approximately 8 weeks to complete the national retail model project activities for the locality. In total, it looks like that it may take 10 to 12 months to complete SADL project activities in Brighton and Hove locality. Joint programme have to be initiated to start CADL project activities across the region. It may take another 6 to 8 months to design and build CADL.

Implementation Resources and Cost Since the previous work on possible implementation of the national retail mode was undertaken in 2008, it is learnt from Lancashire and London

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implementation, the following resources are required to implement national retail model:

Project Implementation Resources Duration

Project Management Full Time (37.5 hours)

Business Change Manager Full Time (37.5 hours)

Occupational Therapist , Physiotherapist

Part Time (10 hours)

Finance - Back Office Part Time (5 hours)

The estimated cost to implement national retail model is specified in the below table:

Resource / Activity Cost

Project Management £40,000

Business Change Manager £40,000

Occupational Therapist, Physiotherapist

£10,000

Finance - Back Office Resource £5,000

Retailer Event £10,000

Prepaid prescription clearing solution £10,000

Total £115,000

In total, it is understood that the project implementation may cost £115,000 to implement national retail model including resource and back office process cost. This is a higher cost of implementation that previously indicated. Original figures indicated that the cost of project management support would be £40k for two years. As it would still take the same amount of time to implement the new model, but the costs of this have increased considerably, there will be an impact on the overall savings likely. Estimated Savings in Implementing National Retail Model Previous work indicated that there was potential to save approximately £500k if the national retail model for simple equipment was implemented alongside a procurement exercise for the provision on complex equipment. Savings attributed to simple aid provision was just over £200k, with just under £300k attributed to the procurement of a separate complex equipment service. Financial working indicated that savings would only be seen for simple aids by year two of implementation, with savings for complex aids seen by year three of implementation. These sums included the assumption that project management costs would be £40K per year for two years. Now that costs have increased to £115k per year for two years, there would be an impact on the possible savings. It should also be noted that the need to sustain the accreditation team, and provide ongoing support for fee reimbursement, will also have an impact on the potential future savings. It is very difficult to model the potential savings for implementing the national retail model and setting up a separate service for complex aids. This is partly

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because the early adaptor sites are still in roll out stage, and have not been able to report on actual savings compared to predicted savings. Modelling work also assumes that there are local retailers who are interested in being involved in provision of simple pieces of equipment. The fact that Boots the Pharmacy has pulled out of providing the service nationally could indicate a general reluctance on the part of providers to become involved. Fewer providers could have an impact on the overall efficiencies of the service and therefore any savings. It is difficult to model this in to savings work. In conclusion, it is possible that some degree of savings may be realised, but the strength of evidence is not yet available to support a more accurate prediction.

7. National Retail Model Implementation Activities

If Brighton and Hove joint commissioning board (JCB) would decide to implement national retail model, the following activities have to be carried out as part of project start up, initiation and implementation: 7.1 Project Start Up

• Establish below proposed project organization structure and its governance process

• Design and build the work streams required to deliver the products as expected and agree the roles and responsibilities

• Agree the project approach, processes and the standards required to

o identify and accredit the retailers o Conduct service readiness assessment to implement national

retail model o Decommission the existing service and to produce

contracting arrangements with the retailers. o Commission the retailers and develop service specifications

and key performance indicators. o Redeem prescriptions o Establish the prescription payment solution

• The detailed business case has to be developed to assess the viability of transforming community equipment service project and to initiate community equipment service transformation programme locally.

Before initiating the project, JCB has to ensure that whether the improvement programme funding has to be secured. 7.2 Project Initiation

The Project will be initiated once the project initiation document is reviewed and approved by the project board. The PID will act as the primary gateway

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for formal initiation of the project. Until the PID is approved, project activities will not be formally started beyond the appointment of project manager and the team. The project initiation document (PID) is a formal document that indicates commitment in providing resources to implement national retail model. It outlines the approaches to be followed in delivering the project and provides commitment to proceed. The PID aims to:

• Formally initiate the project

• Demonstrate that the project has a sound overall basis from which to proceed

• List the agreed objectives, scope and assumptions

• Show the agreed resources that are required to deliver the project successfully

• Act as a base document against which the Project Board and the Project Manager can monitor progress

• Agree and document the responsibilities and authority of the parties involved in the project

• Show the project stages, tasks, milestones and deliverables supplemented with a upload plan

• Act as a base document against which the benefits identified by the trust will be realised by users after the implementation

Once PID is signed off by the project board, the project will move into implementation stage. PID will be reviewed and updated to reflect the changes which may happen during this stage, 7.3 Project Implementation

Following key activities have to be carried out to implement national retail model in Brighton and Hove region

7.3.1 Change Management Activities The implementation of the Retail Model results in a significant cultural change, particularly for the prescribing community. In order for successful implementation of the model, the change must be effectively managed to engage stakeholders. A Change Management Strategy has to be developed that specifies the overarching approach to managing the people-related change as a result of implementing the Retail Model. The purpose of the Change Management Strategy is to:

• Describe the vision for where we want to be in the future with regards to community equipment and the wider personalisation agenda

• Highlight key changes that are required to successfully introduce the Retail Model and transition to the vision

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• Outline the recommended approach and activities required to manage the people-related change

• Identify the outcomes that can be expected from having an effective change management process as an integrated part of the project.

The Business Change Manager will apply the change strategy and change activities throughout the life of the project to progress towards achieving the vision. Business Change Manager has to design AS-IS and TO-BE process mappings by reviewing current system functionalities and the national retail model functionalities and carry out other change management activities such as stakeholder analysis and benefit realisation with the support of project team members and service users. These change management activities will enable the service to understand the changes which may happen, to understand and engage the stakeholders, identify required documents and reports and also to realise the benefits once the retail model is implemented.

7.3.2 Operational Activities Operational work group has to be developed to deliver the following activities:

• Local Catalogue Review Activities

• Clinical assessment and Prescription Issue Activities

Local Catalogue Review Activities A National Catalogue and retail tariff was developed by incorporating the most common items of equipment issued through community equipment stores in England with the help of Occupational Therapists and specialist nurses. NHS Brighton and Hove Local Authority and Health partnership has to tailor the Catalogue to reflect the range of products which are being provided locally. So the project team has to understand Brighton and Hove’s service user needs, prescribing environment and ensure that products specified in the current local catalogue are covered in the national catalogue. It is also worth to understand the fast moving equipments and expected volumes of simple equipments to be prescribed as it will help to engage the retailers by providing the required details at the time of market development. If the identified product does not exist in the national catalogue, the item has to be included in the national catalogue by agreeing with the national catalogue team. Clinical Assessment and Prescription Issue Activities The relevant clinical and social care staffs have to be engaged and the current processes in issuing equipments have to be reviewed and the way forward to assess and prescribe equipments have to be agreed. The following activities have to be carried out by the operational team:

• Review and agree the processes to issue the prescriptions

• Develop and agree the prescription issue form

• Agree the training plan and deliver training to prescribers 7.3.3 Market Development and Retailer Accreditation Activities

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Retail working group has to carry out market development and retailer accreditation activities. It may be the responsibility of retail working group to specify and agree the method to provide equipment specific training to retailers when required. The national TCES team suggests that, market development and retailer accreditation activities can be carried out by project manager, prescribers (OTs, district nurses, physiotherapists) and local contracts team. Market research will help the project team to understand the service user needs, the number of prescriptions being issued to local community and the location of existing retail businesses and to develop the retail units where it is required. It is learnt from the national TCES team that at least 2 retailer events within Brighton and Hove region to explain the national retail model, share the local catalogue with the interested retailers, explain the accreditation process and to engage the possible retailers and identify the interested retailers, would be required. Brighton and Hove project team has to design an accreditation scheme to ensure the marketplace behaves in a way that reflects the needs of users and their carers and reassures practitioners to ‘let go’ of their traditional ways of working. Accreditation is the process by which retailers are evaluated, measured and scrutinised against a set of agreed standards in order to be certified as an Accredited Retailer. An Accredited Retailer is one who met all the Accreditation Standards and is given express authority to redeem prescriptions on behalf of the State. The following are the National Accreditation Standards: It is the responsibility of project team to apply the National Accreditation Standards locally to ensure retailers in the marketplace are accredited. The local accreditation process will certify retailers wishing to redeem prescriptions

Physical Criteria:Physical Criteria: Competency Criteria:Competency Criteria:

1. Fulfilment of prescriptions face to face at a physical retail premises (i.e. not internet shopping or mail order)

2. Ability to display and demonstrate equipment in a form convenient to the business

3. Premises open at normal retail hours including weekend opening to suit the individual business requirements

4. Ability to offer qualified home delivery, and fit as a chargeable service (optional)

5. The existence of customer-facing staff, trained to a minimum level of competence, who are capable of:

– Communicating effectively with Users

– Offering advice on suitability of products to the User

– Supporting decision making

1. Fulfilment of prescriptions face to face at a physical retail premises (i.e. not internet shopping or mail order)

2. Ability to display and demonstrate equipment in a form convenient to the business

3. Premises open at normal retail hours including weekend opening to suit the individual business requirements

4. Ability to offer qualified home delivery, and fit as a chargeable service (optional)

5. The existence of customer-facing staff, trained to a minimum level of competence, who are capable of:

– Communicating effectively with Users

– Offering advice on suitability of products to the User

– Supporting decision making

1. At least 3 years experience in the disability /

mobility / health retail sector, with proof that

they have received equipment specific

training

2. 6 months in the disability / mobility / health

retail sector plus professional training (i.e.

Occupational Therapist, Physiotherapist,

Doctor, Pharmacist, Community Nurse etc)

with evidence of equipment specific training

3. Already be accredited

4. Commitment to attend appropriate

accreditation training within 6 months

1. At least 3 years experience in the disability /

mobility / health retail sector, with proof that

they have received equipment specific

training

2. 6 months in the disability / mobility / health

retail sector plus professional training (i.e.

Occupational Therapist, Physiotherapist,

Doctor, Pharmacist, Community Nurse etc)

with evidence of equipment specific training

3. Already be accredited

4. Commitment to attend appropriate

accreditation training within 6 months

Customer facing staff will need to

demonstrate competency in Assistive

Technology gained from one of the

following:

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have met a national standard of competency aimed at assuring the integrity and quality of the service users will receive. Once accredited, retailers are allowed to act on behalf of local authorities and PCT partners and to issue prescribed simple equipments. Retailers must continually demonstrate adherence to standards and criteria in order to maintain their certified status.

7.3.4 Prescription Payment Solution Activities

Retailers have to redeem processed prescriptions if the national retail model is implemented. This raises a need for a process to pay the retailers for the equipment they issue to users. Nationally Department of Health has agreed that retailers will get the handling fee of £1.50 for each prescription. Brighton and Hove has to consider any of the following options suggested by the national TCES team to process prescription and pay the retailers and choose an option to pay the retailers:

• Establish an prepaid electronic prescription clearing solution (PCS) to which local and health authorities could subscribe

• Expand the existing back office arrangements of each individual authority to process and pay retailers directly

• Provide Money to service users for equipment purchase in alignment with the vision of individual budgets

The national TCES team suggests that they prefer the establishment of a common electronic solution for clearing prescription and developed a prescription clearing solution with the help of Citibank because of the following factors:

• Payment is made at the point of sale thereby removing the need for a back office arrangement and resource

• The need for complex invoicing and recharging arrangements are eliminated

• The solution supports personalization agenda and the technology is proven on a global bases

• Better management of budget and cash management

• Better control on the way funds are spent It is understood that this citi solution is implemented only at London Borough of Havering and the discussion is going on with other 15 local authorities to roll out this solution. 8. Success Criteria to implement National Retail Model

It is learnt from the early adaptors that the following factors have to be considered in implementing national retail model in Brighton and Hove:

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• Sponsorship and support required from the senior management team has to be attained and their roles and responsibilities in the project board have to be agreed

• Detailed Business case has to be evaluated and adequate funding has to be secured before initiating the project

• Resources like Business Change Manager, Project Manager, and Occupational Therapist have to be appointed to carry out change management, project management and assessment activities

• Required work streams such as assessment team, retail team, back office team and communication team have to be in place and suitable team leads and staff have to be identified, engaged and their roles and responsibilities have to be agreed

• Adequate retailer events have to be arranged in the late evenings to engage local and national retailers and explain the benefits and payment process details

• Retailer Accreditation and Prescription issue process has to be clearly agreed and the activities have to be carried out by the identified resources as required

• Existing service catalogue has to be reviewed against the national catalogue and the national tariff for the equipments have to be agreed

• Clear guidance and training has to be provided to assessors, users and retailers about issuing prescriptions, collecting and installing equipments

• The processes and timescale to ramp down the existing services have to be agreed with the current users

• Various stakeholders, their interests and the way to engage them have to be identified while the project is initiated.

• The benefits to be realised have to be identified and agreed when the project initiation document was approved and the benefit owners have to understand their accountability to realise those identified smart benefits

9. Risks and Issues

The major risks in implementing national retail model are listed below:

• Local and national retailers may not be interested in providing simple equipments using their channels as the market for community equipment is significantly smaller than expected

• It may be difficult to find and release the resources required to implement national retail model

• Quality of service to users may be compromised due to lack of training, local knowledge and financial pressure

• Services may not be available during transition

• It may be difficult to realise the benefits if complex equipment model can’t be agreed between the neighbourhood localities and set up

• It may be difficult to engage prescribers as the prescription process may change

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• It may be difficult to engage current equipment service provider as some of their store staff might be made redundant if the national retail model is implemented

• The initial and ongoing costs of accrediting local retailers

• The initial and ongoing costs of accrediting local retailers

• It is difficult to predict what likely savings may be

10. Conclusion When the national retail model was initially introduced in 2006 there was strong support from the national team to implement the service locally. Brighton and Hove spent a considerable amount of time looking at whether it could work locally, and worked with SDH to collect information to outline potential savings for the future. Nationally, uptake of the retail model has been minimal. As set out in this study, a small number of areas have begun pilot implementation, and are generally taking a phased approach to this. Due to this it is difficult to secure accurate information outlining whether predicted savings have been realised. Locally, both East and West Sussex have opted not to implement the national retail model. Since the initial scoping work was undertaken in Brighton and Hove, there have been some substantial changes to the work programme. Firstly, the national support team have been disbanded. This means that intensive support to implement changes is no longer available. Secondly, the UK’s largest Pharmacy chain have withdrawn from participating in the national retail model, citing complexities and a lack of business opportunity. Finally, the ongoing requirements for any area implementing the model have grown. The need for a process and team to undertake ongoing accreditation of retailers could be costly. As could the need for a system for reimbursing retailers for dispensing fee and cost of equipment. A number of possibilities for this are suggested by the national team, but there is no national solution currently available. The Citi Bank solution is in very early stages, and discussions are taking place with one area about using the system. Therefore it is still an area for development. Instead it would be necessary to develop a ‘back office’ function in the local authority to undertake this work, which would add to the cost of running the service. If Brighton and Hove were to look to implement the national retail model for the provision of simple equipment, it would take approximately 12 months to undertake all necessary work. Funding would need to be secured in advance of this to support the implementation. It would also be necessary to give consideration to how complex pieces of equipment are provided going forward. This would require additional support work, and an additional time period.

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Based on earlier discussions, potential savings were identified as being in the region of £500k, by year three, if both the national retail model was implemented for simple aids, and a service commissioned for the provision of complex aids. Since this figure was calculated there have been changes to the support needs of the national retail model. Rather than looking at £40k per year project management costs for two years, £115k would be required, with ongoing costs for accreditation and fee reimbursement. It has not been possible to learn from pilot sites regarding predicted to actual savings figures, as they are still rolling out the model in a phased approach. Therefore we can not accurately predict the anticipated level of savings.

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