planning template for patient and public engagement 2016-17...1 planning template for patient and...

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Planning template for patient and public engagement 2016-17

Programme / commissioning area: Promoting self-care – proposals for over the counter medicines, malaria chemoprophylaxis and travel vaccines

Responsible Commissioner: Kate Moriarty-Baker

Programme / commissioning objective: Proposed changes to GP prescribing guidelines for malaria prevention medicines, travel vaccinations and over the counter medicines. medicines

Date completed: May 2017

Engagement objectives

1. To share proposals under consideration for

Reviewing the current arrangements for provision of over the counter medicines for acute, self-limiting conditions by GPs on NHS prescription

no longer offering malaria prophylaxis (prevention) medicines for travel on an NHS prescription

Ensuring specific vaccinations for travel are not provided on an NHS prescription in line with national policy

2. To seek people’s views on

the principle of restricting routine NHS prescription of over the counter medicines

how far they agree or disagree with the three specific proposals

any specific concerns about the proposals

suggested mitigating actions for concerns expressed

optimum channels for communication with Southwark people on the proposed and final decision

Proposals for change

There are three proposals that relate to treatments provided on NHS prescription for Southwark residents. We are revising our guidance for prescribing and propose that in the future

1. NHS prescriptions will not routinely be provided for treatment of a range of acute, self-limiting conditions and minor ailments for which self-care remedies can be purchased over the counter – see appendix A

2. To stop offering NHS prescriptions for malaria chemoprophylaxis (prevention) for travel and align with national policy

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3. To more robustly encourage adherence to implementation of national policy which does not support the provision of the following selected vaccines for travel purposes on an FP10 NHS prescription:

Hepatitis B (single agent vaccine)

Meningitis vaccine

Yellow Fever

Japanese B encephalitis

Tick-borne encephalitis

Rabies vaccine

If adopted these changes will

Promote self-care

Align NHS Southwark CCG guidance with national guidance

Provide clarity of guidance and policy and reduce unwarranted variation in practice across the health economy

Release NHS resource for funding other areas

*NB proposals do not remove the primacy of clinical judgement, and clinicians would use their judgement when considering whether it is acceptable to recommend that patient should purchase their medication

Rationale

Taken together, these proposals will support the CCG to contain the costs of medicines on the local NHS budget, and will contribute to the medicines related QIPP. For 17/18 that total savings are estimated at £375K based on implementation from October 2017. This estimate is based on a full year saving of £150k for travel vaccines and antimalarial prophylaxis and £600k for the OTC proposal. The proposals for over the counter medicines further support the CCG’s agenda to promote self-care and the self-management of minor and self-limiting conditions, and to reduce unnecessary demand on GP time, including out of hours services. This will free up clinician time for people who have more complex healthcare needs and who need more active support in managing their health. Proposal for withdrawing current arrangements that encourage prescription of malaria prophylaxis (prevention)

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medicines on NHS prescription for travel. The proposal has been supported by public health specialists and is being taken forward across Lambeth, Southwark and Lewisham. The proposals bring policy in Lambeth, Southwark and Lewisham back in line with national policy and follow a review of evidence that has shown that the number of cases of malaria across these three boroughs has fallen significantly from levels 20 years ago when the current arrangements were introduced by the Lambeth, Southwark and Lewisham Health Authority. Lambeth, Southwark and Lewisham are the only three areas nationally offering malaria prophylaxis through the NHS. Proposal to more robustly encourage adherence to implementation of national policy which does not support the provision of selected vaccines for travel purposes on an FP10 NHS prescription. The proposal has been developed in consultation with public health colleagues across Lambeth, Southwark and Lewisham and aims to standardise local provision of the specific travel vaccines that may be provided under the NHS or a private service. These proposals are part of Southwark plans within the community-based care workstream of the South-east London Sustainability and Transformation Plan. Similar discussions are taking place in each area within the SEL STP footprint, as well as in many other areas of the country.

What stage are proposals at? What are

Discussions have taken place with NHS Southwark Clinical Commissioning Group meeting in February 2017 and how other SEL boroughs are managing this initiative at the Area Prescribing Committee 30 March 2017 and

the Southwark Medicines Management Committee 25 April (this is a committee where clinicians, providers and commissioners work together to ensure that patients have safe and consistent access to medicines in the context of care pathways which cross multiple provider; it also enables local NHS stakeholders and clinicians to exert a population approach to the prioritisation, improvement and development of healthcare delivery related to medicines). Consultation is planned from 26 June 2017 to 18 August (8 weeks)

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timescales for decision and implementation?

The proposed timeline is below: 1 October 2017 Implementation 14 September 17 Governing Body decision 7 September 17 September Commissioning Strategy Committee discussion on outcomes of consultation and recommendations to GB 1 September 17 send out CSC papers 21 – 31 August 17 analysis of consultation findings and drafting committee papers 20 August 2017 end of consultation 27 July 2017 locality meeting discussions with GPs as part of consultation 11 July 2017 information stall as part of the OHSEL/STP engagement event 4 July 2017 South Locality PPG discussion as part of consultation 29 June 17 onwards article in GP bulletin, linking to website and for duration of consultation 28 June 17 presentation and discussion at Healthy Communities sub committee 27 June 2017 presentation, discussion and information stall at Peckham and Nunhead Community Council meeting 26 June 2017 presentation, discussion and information stall at Borough, Bankside and Walworth Community Council meeting 26 June 16 Start of consultation: consultation document and survey on website, email to engagement mailing list, CCG partners (MPs, councillors, trusts etc.) hard copies sent to practices, pharmacies, community groups 22 June 2017 locality meeting discussions with GPs as part of pre consultation engagement 16 June 17 pre consultation engagement workshop with local PPG members and Healthwatch to discuss approach and test materials 1 June 2017 discussion on proposals and process start at June Commissioning Strategy Committee 25 May 2017 locality meeting discussions with GPs as part of pre consultation engagement and prior to CSC meeting 11 May 2017 agenda item at Engagement Advisory Group to advise on approach to engagement to include Healthwatch and council community participation team

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May 2017 CCG to discuss approach with OSC chair 5 May 2017 draft consultation plan sent to EAG 28 April 2017 Prescribing Improvement Scheme sent to practices highlighting proposals around the three areas with potential implementation dates of October 2017

Target groups for engagement

Patients registered at Southwark GP practices, particularly those which are high prescribers of anti-malarials (17 practices account for >70% of mefloquine prescribing and 15 practices account for >75% of atovaquone with proguanil and five practices are in both groups and with the majority of the mefloquine prescribing taking place in Peckham, Borough & Walworth areas)

Southwark CCG engagement mailing list

Groups representing Southwark patients (e.g. Healthwatch Southwark, practice and locality patient participation groups (PPGs)

Southwark residents who may be likely to travel to countries needing the selected vaccinations or malarial prevention medicines

Voluntary and community sector (VCS) organisations as representatives of particular groups who may be affected, including people on very low incomes and those who are entitled to free NHS prescriptions

Elected representatives (local councillors) of Southwark residents

Groups of people likely to be impacted by the proposals as identified in the equality analysis including but not limited to those from West Africa, Latin America, South Asia and those who are economically deprived.

Engagement approach

Pre-consultation plans include:

Clinical engagement at May and June locality meetings

Discussion with Health Communities Scrutiny Sub Committee chair in May to outline plans for consultation and answer any questions, based on trigger template and share draft engagement plan

Discussion at Engagement Advisory Group to advise on consultation to include Healthwatch and Council

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community participation team Consultation plans include:

Using our website to inform and invite comment – news articles, banner, get involved page

Using CCG Twitter presence to pull followers to CCG website content

Using the CCG’s engagement mailing list to invite people to look at proposals on CCG website

Article in Southwark News advertorial

Using established channels of communication (GP bulletin and July locality meetings) to engage with our GP membership and to encourage them to engage with patients through their patient participation group

Discussions at locality PPGs (south - 4 July)

Drafting news articles and messages for use by stakeholders including Healthwatch, Southwark Council, provider organisations and voluntary and community groups to promote as they see fit, both internally within their organisations and externally to reach a wider audience

Providing briefings for local authority elected members, in addition to Scrutiny chair

Briefing and informal meeting with Scrutiny chair and/or members

Presentations and discussions at Borough, Bankside and Walworth and Peckham & Nunhead community council meetings on 26 and 27 June

Staffed stand at Southwark STP civic engagement event (11 July)

Discussions at any practice PPG that meets during consultation period (focus on high prescribers)

Informing and inviting comment using leaflets distributed through all GPs, pharmacies, libraries

An online and paper survey

Postal returns

Tools and resources required

Trigger template for OSC

Consultation document

A5 patient / public leaflet

Survey – online and paper version

Content for ‘Get involved’ webpage

Short news piece for CCG website

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Article for Southwark News advertorial

Press articles for various audiences

FAQ document for website and for reference at patient/public events

Presentation for use at patient/public events (e.g. Community Council, PPG meetings and outreach to community groups)

MP briefing x 3

Agreed lines to support media enquiries

Potential risks

Likely to attract press interest Health inequalities

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Engagement Action Plan and rolling action log Stakeholder Engagement activity Channel/tool Actions – detail Who By when Completed

Clinicians –

Southwark GPs, CCG members

Highlight proposals Letter and PIS Draft letter. KMB to sign off MS/ADK 28 April Sent 28 April

Brief and seek views GP bulletin Ongoing through consultation

Brief and seek views Presentations at locality meetings

25 May and papers to go out 18 May. 27 July and papers to go out 20 July KMB to sign off

MS / ADK / RW SM

17 May 19 July

Presentation sent 19 May for meeting on 25 May

Community Pharmacists

Brief and seek views Letter Presentation

Draft letter and presentation ADK / MS / KMB

Letter sent by Rachel Doherty 30 June

GP federations Brief and seek views Letter with link to consultation documents once live

Draft letter MS / KR / 30 June Completed 29 June

Non-medical Prescribers – GSTT community services

Brief and seek views Letter with link to consultation documents once live

Draft letter MS / KR / 30 June Partially complete

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Hospital colleagues – GSTT, KCH, St Georges A&E Urgent Care Pharmacies


Draft letter MS / KR / 30 June Completed 29 June

OOH - SELDOC


Draft letter MS / KR / 30 June

London Ambulance Service

Brief Letter with link to consultation documents once live

Draft letter MS / KR / 30 June

Practice nurse forum

Presentation and discussion

Presentation and consultation documents and summary

Presentation as part of regular PN Forum meeting

KMB RM

28 June

Local Pharmaceutical Committee

Presentation and discussion

Consultation documents, summary leaflets

Presentation as part of regular LPC meeting

SM 6 July

Political stakeholders

OSC Brief and seek views of Scrutiny members

Trigger template Finalise & send trigger template for meeting in May

MS / KMB 5 May

Face-to-face briefing

Face to face meeting requested for May / June but not taken up

AB End of May

Presentation and discussion at OSC meeting

Presentation confirmed for OSC meeting by Julie Timbrell, OSC Officer, on 1 June. Julie since confirmed that they do not

KMB RW

28 June

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Stakeholder Engagement activity Channel/tool Actions – detail Who By when Completed require an agenda item.

Southwark councillors

Brief and engage Southwark elected members

Letter with link to consultation documents once live

Email letter to all Southwark ward councilors as part of consultation with link to page, FAQs and asking them to get in touch if any queries

Comms 30 June Completed 29 June

Southwark MPs

Letter & FAQs Briefing

Letter Briefing as part of any one to one meetings during consultation time period

Stakeholder letter sent Prepare briefing.

KR June / July Completed 29 June

Southwark patients and residents (and representatives)

Healthwatch Southwark

Brief Healthwatch and seek views from HW as patient representatives

Discussion as part of EAG

To advise on consultation plans RW

5 May 11 May

Discussion as part of CSC

To feedback views on proposals. Paper, equality impact assessment and consultation plan

ADK / MS / RW

25 May 25 May

Southwark residents - Healthwatch members and contacts

Use of Healthwatch mailings and channels to inform and seek feedback

Content for Healthwatch newsletter/ ebulletin

Draft article with link to CCG website for info and online survey

KR 26 June

Send to HW for publication deadline RW 28 June – RW forwarded email to database asking Jo if she could include in newsletters

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Stakeholder Engagement activity Channel/tool Actions – detail Who By when Completed PPGs – Presentation and

discussion for PPG meetings as part of d consultation

Presentation Workshop for locality PPG members to test consultation approach and materials

RW / KR / ADK

16 June 16 June

Presentation and discussion as part of consultation (4 July at South Southwark PPG)

RW Sent 27 June

4 July

PPGs - practices

Discussion at practice PPGs (GP practice-led)

GP bulletin article Attend any practice PPGs in consultation period:

Dr Aru – 26 June

RW / SM

26 June

Leaflets Presentation Discussion guide Printed survey and questions

Consultation documents, summary leaflets and paper surveys distributed to practices

KR/SJ 26 June

Southwark residents – general

Provide information, invite and respond to questions at open event

Stand at community council meetings; leaflets, paper surveys

Borough, Walworth and Bankside Community Council meeting 26 June – chair’s announcement and information stall Peckham and Nunhead Community Council meeting 27 June - 10 minute presentation and information stall

RW / SM

Chairs announcement & info stall for BBW confirmed 24 May, but can advertise in their newsletter and FB page

26 June 27 June

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Stakeholder Engagement activity Channel/tool Actions – detail Who By when Completed 10 min presentation & information stall confirmed 23 May

Use website to inform, provide background and how to give views

CCG website Prepare news, banner and information on consultation page for CCG website

SJ / KR 26 June

Mail out via practices and pharmacies, libraries

Postal mail out of A5 leaflet & full document

Content, design, print full document and A5 leaflet

Designers 23 June

Distribution

100 leaflets per practice and 5 full documents

50 leaflets per pharmacy

50 leaflets and 5 full documents per library

Other community outlets - CABx, Wellbeing Hub, UCC,, King’s

Distribution company

Week beginning 26 June

26 June

Virtual – online survey Survey Monkey – via CCG website

Design and launch online survey on CCG website

SJ / SC 23 June 26 June

Enable people to complete paper survey

Paper survey Designed, printed and distributed Designers 30 June

Article in Southwark News

Southwark News advertorial

Submit news article for inclusion in CCG’s full page advertorial. Two opportunities during consultation period.

Comms Deadline 23 June, for publication 29 June

June completed

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Stakeholder Engagement activity Channel/tool Actions – detail Who By when Completed Deadline 21 July for publication 27 July

Get involved list Virtual Newspiece/ emailing

News article send and promote to ‘Get involved’ list

SJ 29 June

NHS FT members (GSTT)

Via Trust coms channels/colleagues

News article Send news article for trust publications KR

NHS FT patient groups

Via Trust engagement channels/ colleagues

News article Send news article by email to engagement and comms leads at GSTT and KCH

KR / SJ Completed

People entitled to free prescriptions

Advising London, CABx, Southwark Legal Advice Network

Presentation at Southwark Legal Advice Network meeting Copies of consultation material distrusted to CABx Southwark Pensioners Centre have requested 30 copies

RW Comms

19 July

VCS forums Virtual – all channels Inform, provide background and how to give views

Engagement mailing list and article and offer outreach sessions

News article send and promote Community Southwark newsletter CCG stakeholder newsletter

KR

Travellers to countries requiring malaria prevention - targeting large Southwark

Send email with links to consultation page and survey and offer presentation and discussion at their group

Presentation, discussion with summary leaflets and paper surveys

Latin American Groups

Latin American group at Pembroke House, Elena Felices, Latin American Community Co-ordinator, Advising London

Latin American Working Rights Service / FULA, Nahir de la Silva

RW to contact RW Meds ops

18 July 21 July? Asking for another date

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Stakeholder Engagement activity Channel/tool Actions – detail Who By when Completed West African, and Latin American populations

Latin American Disabled People’s Project Jonh Marulanda-Garzon at [email protected]

African Groups

Sierra Leone Friendship Association

Nigerian Muslim Communities Asian Groups

Dulwich Milan Association

Dulwich Punjabi Association Refugees and Asylum Seekers

Southwark Day Centre for Asylum Seekers

Southwark Refugees Community Forum

RW RW & ADK

Email sent 6 July Email sent 6 July Email sent 6 July

10 Aug

Faith groups serving Black African and Muslim communities



Nigerian Muslim Communities

Calvary Christian Centre

Christ in the Ladder Ministries

Community Outreach Ministries

Email sent 6 July

Somali Send email with links to consultation page and survey and offer presentation and discussion at their group


Somali Women’s Group, Somali Integration and Development Association, Malike

RW & ADW Email to Cathy 27 June

12 July

mailto:[email protected]

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Stakeholder Engagement activity Channel/tool Actions – detail Who By when Completed People with Diabetes



Diabetes Forum RW 28 June 28 June

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Appendix 1 Proposed therapeutic areas/groups of medicines to be considered for inclusion in the self-care medicine list for OTC purchase as part of NHS Southwark GP deprescribing initiative.

These are products that can be purchased over the counter without a prescription from a pharmacy. For the majority of healthy people many minor illnesses can be treated through self-care without the need to see a doctor. Most minor illnesses will get better with time and treatments only help to relieve symptoms. Symptoms of other minor illnesses can get better by purchasing a medicine over the counter from a pharmacy. A variety of over the counter medicines can be used to relieve symptoms such as headache and hay fever. Local community pharmacists can give professional advice on what else can be done for self care. If a problem is more serious and needs the attention of a GP, the pharmacist will advise the patient to see their GP as appropriate. Advice is also available from NHS Choices, Health Help Now at www.healthhelpnow-nhs.net and NHS 111. NHS Southwark is not proposing changes to long-term treatment with over the counter medicine such as regular pain medicine for osteoarthritis or where the product has an over the counter license restriction. NHS Southwark CCG runs a Pharmacy First service which allows community pharmacists to offer advice and treatment for a range of self-limiting conditions. This service gave advice to 4660 patients in the last 3 months. Some of the therapeutic areas from this scheme overlap with some of the areas of the proposed list below (those in italics and highlighted)

The aim of the initiative is to support self-care. Under the current proposal, the Pharmacy First Scheme will continue to run and there are plans for both initiatives to be monitored with a review after 12 months of both initiatives running concurrently.

http://www.healthhelpnow-nhs.net/

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The areas this proposal covers includes:

Analgesics (painkillers) for short-term use

Anti-diarrhoeal medication for short term use (up to 72 hours)

Antifungal treatment for short term minor ailments

Antiperspirants Cold sore treatment

Colic treatment Cough and cold remedies Ear wax removers

Eye infection treatments

Eye lubricating products Head lice treatment and scabies treatment

Haemorrhoidal preparations for short term use (5-7 days)

Herbal and complementary supplements Indigestion remedies

Laxatives for short term use (up to 72 hours)

Mouth wash Mouth ulcers treatment

Nappy rash treatment

Hay fever medicines

Threadworm tablets

Topical acne treatment which is available over the counter Topical steroids for short term use (up to 1 week) for bites, stings or mild dermatitis

Vitamins and minerals

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Warts and verruca treatment

Proposed general inclusion for OTC self care medicines

Minor ailments that are self-limiting and will clear up without the need for a medicine e.g. cough and cold.

Treatments that can be purchased without a prescription (OTC): o General Sales List (GSL) items can be purchased from any retailer, Supermarket and discount stores and are more cost effective

than pharmacies. o Pharmacy only (P) items can only be purchased from retail pharmacies. Buying ‘own brand’ or generic items are usually more cost

effective than originator brands. o Treatments

Treatments for self-limiting conditions or for relatively short-term use e.g. hayfever medicines

Proposed general exclusion for OTC self care medicines

Prescription Only Medicines (POM)

Off-label use, for example during pregnancy, or other OTC licence restrictions

Long-term (chronic) treatment e.g. paracetamol regularly four times daily in osteoarthritis

Where there are possible safeguarding concerns, including, but not limited to, children where there might be concerns that treatment might otherwise not be provided.

planning template for patient and public engagement 2016-17...1 planning template for patient and...

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