report of the launch event wednesday 27th april 2016 all nations
TRANSCRIPT
Report of the Launch Event
Wednesday 27th April 2016
All Nations Centre
CARDIFF
Opening
Pharmacisits arrived and networked with
all delegates at the All Nations centre
before taking a seat.
Delegates were welcomed by Andrew
Evans, Principal Pharmacist, Welsh
Government. Mr Evans started providing
background to why everyone has been
invited and touching on the story of the
origins of the Community of Practice
(CoP).
He then introduced Paul Gimson, the lead for improvement in Primary
care & Matt Wyatt, Improvement Advisor at 1000 Lives Wales.
What’s a Community of Practice?
Matt Wyatt provided a plenary
presentation on the concepts and methods that underpin the
development of a community of practice. He described the origin of the
concept, the defining features and how a CoP can do things that other types of
group can’t.
Matt outlined the participatory and organic development of the relationships; highlighting the experiences that participants could expect.
It has to be immersive, to understand it; you have to be surrounded by the experience.
The right focus for a Community of Practice? Paul Gimson gave a presentation exploring what
the focus of the CoP should be. He covered the
primary care plan, discussed what the role of a
“cluster pharmacist” is and asked delegates to
consider their experiences across clusters, their
integration, services and planning.
He asked what we need to do as a CoP to make
these experiences better? He concluded the presentation with a closing
remark that it’s up to the CoP to decide which, if not all, are the right
focuses for this CoP.
Mind mapping
Matt asked the participants in groups of 2-3 to ‘mind map’ the influences on the role of the “cluster pharmacist”. This issue caused fantastic
discussion on the tables which is necessary for a CoP. The mind maps
expanded to capture all thoughts and opinions around cluster pharmacy. There was a huge volume of feedback, some are displayed on the next
few pages, the others are found in the appendix.
Mind Maps
What are cluster pharmacists dealing with?
The level of feedback from this session suggests that this topic could form
the basis of a more detailed and dedicated session within a future meeting of the CoP. It was noted that several areas amongst the mind
maps were repeated numerous times which may require further exploration of service and development needs. It was evident that sharing
common experiences from pharmacists could be a powerful and integral component to shaping the future of the profession.
Some of the themes are below. The mind maps themselves still supply of
a wealth of information –
Development needs – CPD, role extension, training needs. Recognition – identity, clinical expertise.
Communication – feedback, networking, isolation. Support – admin tasks.
Time – Work life balance. Pressure to report drug switches, cost
savings, activity spreadsheets. Scope of practice – utility, current skill sets.
Quality of care – variation within a cluster. Resources – IT
A pharmacist operating in unknown
territory
Paul introduced Rob Liddington, a pharmacist
formerly of the British Army discussed some
of the challenges he has faced when trying to
improve medicines optimisation in difficult
circumstances with limited resource. These
included snake bites, methanol poisoning and
difficult decision making .His most poignant
message to fellow pharmacists were to be
inventive and adventurous.
Delights and Dilemma’s
Working on their tables, participants were asked to create two lists. These
Wordles illustrate the feedback with the largest words appearing most often.
List 1: Things that annoyed you in your work, this week:
List 2: Things that annoy you in your work, permanently:
Participants were then asked to consider what made work meaningful for
them, what aspect of their work, provided them personally with a sense of delight. The room then self-organised into complementary groups
based on the themes that arose. The delights are in the wordle below.
The groups were then provided with a challenge:
1. To add up the total years experience on a table. 2. To list every initiative, programme or event they had come across in
their professional career. 3. In their groups to then write a list to capture work the CoP could do
in the future. They were encouraged to discuss some of the issues and problems that have arisen throughout the day.
The result:
1. The total experience of the 75 attendees in the room was 1234
years. 2. The list of events are below, a total of 68 different pieces of work.
List of programmes, initiatives and policies
111 Mid staffs
1000 Lives Minor Ailments scheme
Agenda for change MMIS
AWMSG 2003 MUR
Blacklist MURs 2004
Clusters NHS direct
Common Ailments 2013 NICE (late 90's)
CPD NWIS
Community pharmacy contract 2005 Pathlinks
Degree course (up 3 to 4) 1997 PGDs
Devolution 2001 Pharmacist mandatory CPD 2207/8
Different health ministers Polypharmacy
List of programmes, initiatives and policies
DMEs 3010 POM's to Ps
DMR Post grad diplomas
Electronic prescriptions Pre reg exams 1992
Emails Prescribing data
Enhanced services Prudent Healthcare 2014/2015
Facility Pharmacists QoF
Fallow year 2001 Registered / Checking technicians
Fund holding 90's Responsible Pharmacist
GMS 2004 contract Robotic dispensing
GP contract 2008 RPS / GPHC
HA to Trusts to UHBS 2010 NHS reorganisation RPSGB to GPHC 2010/11
Healthcare inspectorate Wales Schools of pharmacy 2010
Improving Health 2014 Setting the direction
Independant / Supplementary Prescribers Shipman
Internet - patient googling Smoking cessation / banned indoors
Just in case boxes Spoonful of sugar
Kings Fund Supplementary Independant prescribing 2004
LHB reorganisations 2009 & others Together for Health 2000's
LHG to LHB 2000 / 2001 Trusted to care, Berwick report
MECC TTC 2002
Medicines act WCCG 2012
Medicines Reconciliation WES - hosted computers
3. The work we could do in the future was sorted by themes which are:
Improving Relationships Training and Development
Sharing Best Practice Measurement
Finance Governance
At the risk of being lists of tables, the idea is so that the whole CoP has a record of what was recorded. They are included to create discussion at
future events. Duplication has been removed or combined.
Improving relationships
Advice forum - in between meetings - share resource for problem solving
Communication
Decrease the isolation
Directory of COP
Educate colleagues i.e. GP
Education of healthcare team
Education of patients
Education required for GP's to explain purpose of role - clarify different pharmacist roles
Improving relationships
Email list
Embedded in practice
Encourage GP attendance (funding / locum cover)
Engagement
Engagement with GPs and rest of team
Expectations and clarification of the role (Pharmacists, GPs, practice, HB and WG)
Feedback from surgery's - how getting along
Forum
Good to have more practice managers involved
GP expectations integration into GP team
Greater influence in primary care
Integration - community pharmacy its role integrating into the cluster world
Minor ailment training
Multidisciplinary working
Networking
PR ( improving relationships)
Professional networking - blogs, email, electronic forum
Promote pharmacists resource i.e. What we can do for patient
Promotion of role
Public awareness - patient opinion, patient education
Public Health / health promotion - empowering patients
Publication of role
Regular contact
Relationship with team
Support
Sustaining role of cluster practice pharmacists
Time for COP to shine while GP community decline
Understanding of others about the role
USP of a cluster pharmacist
Visibility in practice
Training / Development
Medication review - tools available to help
? Cluster tech's
Adopt additional skills? - phlebotomy, foot assessments, monitoring conditions
Advocacy / mental capacity e.g. In care homes (Shine)
Chronic disease management
Clinical element and teaching - monitoring i.e. Bloods etc, introduction, clinically identity areas go towards (?) Clinical systems training (master classes)
Consultation skills
Education - skills - what and how? Standardised?
Education and training - patient assessment, consultation skills, deprescribing, TA relevant, cardiology, resp, T2DM [Relevant to primary care] Expert speakers - 1 hour clinical session added to COP
Getting the most of a cluster pharmacist
Importance of IP qualification
Induction checklist / plan for cluster pharmacist (based on experience of pharmacist)
Interpreting bloods (in context of CDM)
Interpreting test results
Training / Development
IT training
IT/ colleague roles
Optional training
Peer review / Mentoring / Hot review / Clinical Supervision
Professional development - maintenance / building competency
Protective time
Research / Evaluation
Specific cluster pharmacist tasks, applicable across all surgeries.
Training (specific)
Training needs, support needs and resources of pharmacists
Training on GPs and how they operate - funding, QoF, GMS contract.
Training package
Undergraduate - incorporate into course. Pre reg - split between primary and secondary care
Sharing best practice
Benefits of cluster pharmacists to practice & patient
England - 3 year postgrad qualification (facility + iPek (sic?) is this better
Glossary of best practice examples
Inhaler technique (AW note - Powys project)
Learning from good model of practice
Polypharmacy / de prescribing
Prescribing Process
Quick wins - care homes, polypharmacy, enteral nutrition, asthmatics (inhalers), gaining confidence, relationships with GPs/ DN's.
Reorganisation - delivering value
Share and evaluate best practice - GP one.
Sharing good idea / practice
Sharing ideas across cluster practices
Sharing of skills / expertise / learning / case studies
Sustaining GP Practices
Measurement
? Increase number of pharmacists per surgery rather than cluster
Impact of pharmacists on improving patient care
Improve DNA rates
Increase number of pharmacists i.e. One per surgery
Meaningful data
Repeat dispensing
Showing 'value', outcome measures - quality, quantity time saved, financial save
Waste / batch prescribing
Finance
Batch prescribing - savings vs safety
Business cases writing
Finance
Financial return to practices / LHB - value to struggling partnerships and LHB
Funding / Business cases
MUR funding - Clusters instead for COP
Potential threats to general practice business from community pharmacy e.g. Dispensing, flu, drums, asthma checks etc - these sayings will not attract new GP partners
Governance
Antibiotic governance
Centralised uniform evaluation
Clear direction to be set by - Cluster ? LHB? WAG? Patients? GPs?
Clinical coding (contribution to QoF / LES)
RGD ( Service evaluation - Pincer study) - KPI, outcomes , IT support
Evaluation This programme of work is being evaluated by Cardiff University
(supported by a grant from the Health Foundation). Alison Bullock introduced the research team and the evaluative element of the
programme. She outlined what the evaluation would entail and the contributions of those involved.
Three things will happen to support the production of a final evaluation report in 2017:
• Observation of the CoP meetings • Focus group discussion and individual
interviews
• Your reports about your QI practice
(submitted on a short structured online form)
• Short structured online reports about
your QI practice.
Purpose
To learn about how a Community of Practice might help you use your quality improvement skills (Bronze IQT training) for better service outcomes.
Does a CoP support the habits of an improver and develop technical, soft and learning skills?
Closing Keynote
The closing keynote was presented by Dr. Richard Lewis, the National
Professional Lead for Primary Care in Wales.
He shared his early reflections of
being in post.
He recognised the formidable
challenges facing GPs, and primary care in Wales and across the UK.
He was pleased to have encountered unexpected levels of
enthusiasm, examples of
innovation and novel ways of trying to overcome what are difficult times for health services.
He advocated that primary care can offer the means of a solution to the
challenges currently facing health systems the world over and that the National Primary Care Plan for Wales is an unequivocal commitment to
put primary care front and centre.
He promoted that new approaches have to be found – if we are to
maintain sustainable health and social care services.
He covered the significant evidence of initiatives involving the valuable
use of health professionals in practice and in the community across all
specialities and more through cluster working in Wales.
There is evidence emerging on their impact from all these areas on
increasing capacity and helping to manage workload.
He put questions to the group and there was light discussion over what
problems are being faced and the way forward within a CoP.
Richard closed the keynote with a message to the CoP ‘we can predict
clusters should make waves of change…once they are having a
measurable impact, I think clusters too have the potential to change
everything.’
Forming the Community of Practice
Margaret Allan, Director of WCPPE
closed the first Community of
Practice for Cluster Pharmacists.
Margaret recapped on the day’s
events and reiterated that the CoP
is what the group wants out of it,
and that it can only truly form if
we keep the momentum going.
She thanked everyone for their
time and commitment,
contributing to the mind maps,
dilemmas and discussions. She
hoped that others felt the sense of purpose created in the room and that
this was an opportunity for ongoing networking and communication for
the pharmacists in the community.
On behalf of 1000 Lives Wales, Paul Gimson and Matt Wyatt quickly thanked everyone for their attendance and reminded them of the
upcoming meetings, overleaf.
Next Time
Tuesday 12th July 2016
Thursday 13th October 2016 Wednesday 25th January 2017
For further information contact:
Paul Gimson Public Health Wales Mail: Innovations House, Llanharan CF72 9RP Email: [email protected]
Phone: 01443 233233
APPENDIX
Attendee list
First name Last name Job title Organisation
Margaret Allan Director-WCPPE Cardiff University
Mark Allen Clinical Pharmacist Cardiff & Vale UHB
K Louise Allen Policy and planning manager, Wales
Company Chemists Association
Victoria Allum North Wales Regional Coordinator
Wales Centre for Pharmacy Professional Education
Claire Arthur Pharmacist prescribing advisor
Abertawe Bro Morgannwg UHB
Thomas Banning Practice Support Pharmacist
Brecon Medical Group Practice
Carl Barrett Cluster Pharmacist Cwm Taf UHB
Rachel Beckett
Practice Based Pharmacist - Monmouthshire South Aneurin Bevan UHB
Ian Bevan
Practice Manager - Bridgend North Network Lead
Abertawe Bro Morgannwg UHB
Sarah Bevan Cluster pharmacist Hywel Dda UHB
Ann Brown Practice Manager
General Practice (The Health Centre Abercynon)
Alison Bullock Professor Cardiff University
Sarah Bush Prescribing Adviser Taf Ely Cluster Cwm Taf UHB
Mike Curson Senior Primary Care Pharmacist Aneurin Bevan UHB
Manjinder Dahel Prescribing advisor Abertawe Bro Morgannwg UHB
Lowri Davies
Frailty and Chronic Conditions Cluster Pharmacist Hywel Dda UHB
Ian Dodd Practice Manager Cwm Taf UHB
Allan Donnithorne Cluster Pharmacist Cardiff & Vale UHB
Rowena Duffield Practice Based Clinical Pharmacist Aneurin Bevan UHB
Bethan Edwards Cluster Pharmacist Abertawe Bro Morgannwg UHB
Sian Evans
Consultant in Pharmaceutical Public Health Public Health Wales
Samantha Fisher Head of Pharmacy Affairs, Lloyds Pharmacy
Community Pharmacy Wales
Paul Gimson Programme Manager for Primary Care
1000 Lives Improvement Service
First name Last name Job title Organisation
Anthony Hall Practice pharmacist Aneurin Bevan UHB
Lloyd Hambridge
Practice Based Clinical Pharmacist Caerphilly East Neighbourhood Care Network Aneurin Bevan UHB
Paul Harris Healthcare Partnerships Manager Boots UK
Daniel Hay Taff Ely cluster pharmacist Cwm Taf UHB
Jamie Hayes Dirctor Cardiff and Vale
Lucy Higgins
Practice Based Pharmacist-Monmouthshire North NCN Aneurin Bevan UHB
Claire Hill
Practice-Based Clinical Pharmacist, Newport North NCN Aneurin Bevan UHB
Charlotte Hill GP cluster Pharmacist Cwm Taf UHB
Kath Hodgson head of programme delivery
Wales Centre for Pharmacy Professional Education
Gareth Holyfield Principal Pharmacist in Public Health Public Health Wales
Caroline James pharmacist Cwm Taf UHB
Kirsty James Receptionist Cwm Taf UHB
Tracey James GP , DSMP for IP pharmacist at Newport Aneurin Bevan UHB
Hayley James neightbour care network pharmacist Aneurin Bevan UHB
Kate Jenkins Cluster Pharmacist Cardiff & Vale UHB
Marian Jones Cluster Pharmacist Cardiff & Vale UHB
Viv Kent Practice Manager Aneurin Bevan UHB
Non Lewis Prescribing Advisor Advanced Pharmacist Cwm Taf UHB
Christina Lewis GP Cluster Pharmacist Abertawe Bro Morgannwg UHB
Robert Liddington Pharmacist Specialist Care quality commission
Sarah Long cluster pharmacist Abertawe Bro Morgannwg UHB
Paul Mayberry Community Pharmacy Lead Aneurin Bevan UHB
Haydn Mayo Community Director Cardiff & Vale UHB
Ruth Mitchell Pharmacist Boots
Moira Moore Practice Business Manager Ashgrove Surgery
Sarah Moore Practice manager Parc Canol group practice
Melissa Morgan practice based pharmacist Aneurin Bevan UHB
First name Last name Job title Organisation
Gethin Morgan Cluster Pharmacist Cardiff & Vale UHB
Kirsty Morris Prescribing advisor Abertawe Bro Morgannwg UHB
Vanessa Morton Advanced Practice Pharmacist
Abertawe Bro Morgannwg UHB
Rachel Murphy Cluster Pharmacists - West Network Bridgend
Abertawe Bro Morgannwg UHB
Emma Nurse Cluster Pharmacist Hywel Dda UHB
Carl Peacock Practice based clinical pharmacist Aneurin Bevan UHB
Lorna Phillips Respiratory Pharmacist Cwm Taf UHB
Lia Popa Pharmacist Betsi Cadwaladr UHB
Lisa Pottenger practice based pharmacist Aneurin Bevan UHB
Carolyn Poulter Regional Co-ordinator
Wales Centre for Pharmacy Professional Education
Nerys Rees Practice Nurse Cwm Taf UHB
Lisa Riley Pharmacist Aneurin Bevan UHB
Debra Roberts Head of Programme Development
Wales Centre for Pharmacy Professional Education
Elaine Russ Research Centre Manager Cardiff University
Has Shah GP Cwm Taf UHB
Kate Spittle Practice Pharmacist Cwm Taf UHB
Anne Sprackling Senior Primary Care Pharmacist Aneurin Bevan UHB
Neil Sugden Pharmacist Prescribing Adviser
Abertawe Bro Morgannwg UHB
Jayne Taylor-Lloyd Practice business manager Cwm Taf UHB
Elly Thomas Practice Pharmacist Ashgrove Surgery
Helen Thomas Pharmacist Davies Chemist Ltd
Jane Thomas Senior Primary Care Pharmacist Aneurin Bevan UHB
Avril Tucker Primary Care Antimicrobial Pharmacist
Abertawe Bro Morgannwg UHB
Christine Vining Primary Care/Practice Pharmacist
GP practices in Cwm Taf and Cwm Taf UHB
Sheree Vyas pharmacist
Wales Centre for Pharmacy Professional Education
Jonathan Walker Locality Pharmacist Betsi Cadwaladr UHB
Andrew Ware Service Improvement and Development Manager
1000 Lives Improvement Service
Katie Webb Researcher Cardiff University
James Wermig practice pharmacist Aneurin Bevan UHB
First name Last name Job title Organisation
Helen Wigley Cluster Pharmacist Cardiff & Vale UHB
Don Wilkes Practice Pharmacist Argyle Medical Group
Rory Wilkinson Locality Lead Pharmacist Betsi Cadwaladr UHB
Anna Williams Prescribing Support Pharmacist Hywel Dda UHB
Nerys Williams locum practice pharmacist Parc Canol surgery
Michael Williams Practice Pharmacist Aman Tawe Partnership Medical Practice
Ivana Wong cluster pharmacist Cardiff & Vale UHB
Bev Woods Pharmacist Team Leader - Primary Care Cwm Taf UHB
Mind Maps
01/05/2016
1
Pharmacists in Practice
All Wales Community of Practice
09:30 Registration & Refreshments
10:00 How did we get here? Andrew Evans
10:20 What’s a Community of Practice Matt Wyatt
11:00 The Right Focus For a COP Paul Gimson
12:00 A Pharmacist in Unknown Territory Rob Liddington
12:30 Lunch & Networking
13:30 Delights and Dilemmas Matt & Paul
14:30 Evaluation Alison Bullock
14:45 Closing Keynote Richard Lewis
15:00 Forming the Community of Practice Margaret Allan
15:30 Close
HOW DID WE GET HERE?
Andrew Evans
WHAT IS A COP?
Matt Wyatt
Apologising …
• Improvement Advisor at Public Health Wales
• Why am I here?
• Complex Need
• Creating Space
• Apologising
Mechanistic Answer
Best Practice Rational
Risk Averse Deductive Structure
Targets Projects
Facts Unilateral
End Points Instructed
Planned Taught
Delivered To
Supervised Manufactured
Consultation Process
Universal Standardised
Similarity Supply
Designed Information
Organised Teams
Intelligence Inform
Regulated Negotiated
Probable Show
Invent Leadership
Organic Context Good Practice Holistic Risk Wise Political Network Outcomes Experiments Ideas Together Connections Advocated Responded Learned Achieved With Accountable Grown Participation People Individual Tailored Diversity Equip Evolved Communication Understood Groups Wisdom Discuss Appreciated Mediated Possible Guide Innovate Relationship
01/05/2016
2
TQM BPE CIC PDSA L6σ & PBMA …
The Process Fallacy
Processes are defined by a very highly specified, predetermined end point and they are very, very useful.
Things that are not processes:
• Retrospective Coherence
• Lists drawn into shapes
End
Step 2
Step 1
Start
It must be your fault ...
Extravert v Introvert Sensing v Intuition Thinking v Feeling
Judgement v Perception
Leadershippers on tour ...
• Culture
• Vision
• Values
• Strategies
• Objectives
• Missions
• Champions
• Frontlines
• Processes (again)
Integrated Modernisation Pathway
Seamless Linkage Facility
Proactive Context Pyramid
Optimal Resource Framework
Stable Client Model Inclusive Downsizing Market
Special Polynomial Network
Focused Consensus Vision
Strategic Engagement Transformation Instinctive Fallback Solution
Virtual Empowerment Mechanism
Mutual Appreciative Flow
Elemental Scoping Principal Established Cartesian Exercise
Participative Tertiary Approach
Innovative Learning Forum
Organic Stakeholder Cascade
Evolutionary Leadership Cycle
Narrative Pooling Inquiry
Robust Re-engineering Tree
Collaborative Centred Challenge
Eclectic Regional Partnership
01/05/2016
3
13 www.inc.com 14
Altogether in practice …
“Your trained in a silo, employed in a silo and then someone says, now all go and work together … it’ll be fine!”
Communities of Practice ...
1991: Institute for Research on Learning in Palo Alto, California - Etienne Wenger and Jean Lave coined the term Community of Practice The term was first used in their study of apprenticeship and has since been applied to government, education, social service providers, and various professional organizations. A lot has happened since!
The basics …
A community of practice is a network of people who share a specific area of knowledge and are willing to work and learn together over a period of time to develop and share that knowledge
• a shared domain of interest
• a membership who meet to share their experience
• and a common practice
Fluffy bunnies …
“… it is recognised that some of the most creative and sustainable work comes from facilitating passionate and committed practitioners to share experiences and knowledge, in order to bring about change in their own practice.”
01/05/2016
4
Over the last 10 years ... • Care Planning
• Unified Assessment
• Chronic Conditions
• Passing the Baton
• Discharge Nurses
• Intermediate Care
• Challenging Behaviour
• Falls Collaborative
• Complex Care Forum
• PMLD
• Pharmacists in Practice
Practice in Practice …
• It’s a living thing not a machine, it lives & dies!
• Groundwork, a few rules & a sense of direction
• Fine tuning the rhythm & wisdom of the crowd
• Enthusiasts, the six hour rule & a tipping point
• Participative, fun and intellectually stimulating
A shift in perspective ...
How to create the conditions that enable people to feel good, have space to think, get together, take a risk, do a couple of experiments and nurture their intrinsic motivations ... all at the same time?
24 The Fundamental Attribution Error www.thesun.co.uk
01/05/2016
5
25 static.panoramio.com Unconditional Positive Regard
Leveraging the Diversity ...
Crowd Error = Average Error – Diversity
THE RIGHT FOCUS
Paul Gimson
01/05/2016
6
Current roles within the pharmacy team
• Practice Based Pharmacist
• Primary Care Pharmacist
• Prescribing Advisor
• Community Pharmacist
• Intermediate Care Pharmacist
• Hospital Pharmacist
• Prescribing Pharmacist
• etc
Cluster Pharmacists...
Follow the money... Primary Care Plan
• A primary care service made up of a wide range of professionals working as a coordinated and integrated team of GPs, nurses, pharmacists, midwives, health visitors, dentists, optometrists, physiotherapists, podiatrists, healthcare support workers, social workers and others.
• Will become the mainstay of the NHS: tackling the root causes of ill health, preventing people from being admitted to hospital unnecessarily, helping those who have been admitted to get home quickly with the right support; motivating and supporting people with chronic conditions and long-term illnesses to manage their health at home.
• The new primary care service for Wales will help to reshape the NHS, developing and increasing the primary care workforce to provide the majority of care close to people’s homes, accelerating the transfer of services from the hospital to the community and improving the way people can access services.
Primary Care Plan
• A primary care service made up of a wide range of professionals working as a coordinated and integrated team of GPs, nurses, pharmacists, midwives, health visitors, dentists, optometrists, physiotherapists, podiatrists, healthcare support workers, social workers and others.
• Will become the mainstay of the NHS: tackling the root causes of ill health, preventing people from being admitted to hospital unnecessarily, helping those who have been admitted to get home quickly with the right support; motivating and supporting people with chronic conditions and long-term illnesses to manage their health at home.
• The new primary care service for Wales will help to reshape the NHS, developing and increasing the primary care workforce to provide the majority of care close to people’s homes, accelerating the transfer of services from the hospital to the community and improving the way people can access services.
Primary Care Plan
PRINCIPLES UNDERPINNING THE PLAN
• Prevention • Co-ordinated care • Co-Production • Planning services at a
community level of 25,000-100,000 people
• Primary Care Clusters • Prudent healthcare.
“No GP should
routinely be
undertaking any
activity which could,
just as appropriately
be, undertaken by an
advanced nurse, a
clinical pharmacist or
an advanced
practioner paramedic”
01/05/2016
7
So what...?
...is your experience?
• Of working ACROSS the cluster?
• Of INTEGRATION with the wider primary care team?
• Of the provision of CLINICAL PHARMACY SERVICES
• Of PLANNING services on a population level
...do we need to do? • To improve working
ACROSS the cluster? • To INTEGRATE the role of
cluster pharmacist with the rest of the primary care team
• To deliver CLINICAL PHARMACY SERVICES based on the identified NEEDS of your local population
Pick a subject you think is important
mind-mapping.co.uk
UNKNOWN TERRITORY
Rob Liddington
RECONVENE @ 13:30
Lunch & Networking
DELIGHTS AND DILEMMAS
Matt & Paul
01/05/2016
8
Dilemmas ... Delights ...
Create list with dates, of all the policies, strategies, projects
reorganisations and big ideas that you’ve been involved in (or subjected to) throughout
your career, that have effected how you practice.
www.despair.com
Milking the assets you’ve already got
Optimising assets by moving them around
Adapting assets with continuous feedback
Exapting assets to a new greater utility
Discovering any potential assets
Stretch participants to explore opportunities and innovate in unpredictable environments
Stretch participants to analyse problems and embed evidence in predictable environments
Expert led case study, measurable precedent
and working tools
Participative method, creative facilitation and
immersive exercises
Learning sessions begin and end by reflecting on
the participants own experience of life back
in the real world
Some Participants will feel more comfortable in exploration others in analysis: the model is a
synthesis to leverage the collective diversity
Time scale is fractal over a session, a day and the life of the programme
Re
al W
orl
d
Co
nce
ptu
al
Co
nce
ptu
al
Time
01/05/2016
9
EVALUATION
Alison Bullock
Evaluation Helping GP practice-based pharmacists to
implement their improvement skills:
Assessing the value of a community of practice model
Working in collaboration with Margaret Allan Andrew Evans Matt Wyatt Paul Gimson
Purpose
To learn about how a Community of Practice might help you use your quality improvement skills (Bronze IQT training) for better service outcomes. Does a CoP support the habits of an improver and develop technical, soft and learning skills?
Guinea pigs………….. Our approach 1.Develop an ‘official’ theory (logic
model) to describe the conditions or context (C) under which the mechanisms (M) operate to produce desired outcomes (O).
2.Undertake a CoP case study, observing meetings, interviewing participants
3.Present a ‘real’ theory which describes the features required for optimising the contribution of a CoP and implementation of QI skills.
01/05/2016
10
What will happen?
• You participate in CoP meetings which we observe
• Focus group discussion and individual interviews
• Short structured online reports about your QI practice.
This project has been reviewed and approved by a research ethics committee at Cardiff University.
02920 875403
www.cardiff.ac.uk/curemede
Thank you
for listening
KEYNOTE
Richard Lewis
Corporate slide master With guidelines for corporate presentations
Dr. Richard Lewis National Professional Lead for Primary Care in Wales
NHS Wales/Welsh Government
Pharmacists in Practice 27 April 2016
All Nations Centre, Cardiff
01/05/2016
11
The Primary Care Plan
• Primary Care Front and Centre
– Planning care locally
– Improving access and quality
– Equitable access
– A skilled local workforce
– Strong leadership.
1978
Alma Ata 1978 Alma Mata Declaration 1978
• Government Commitment
• Clusters
• Public Health Initiatives (PHW & Legislation)
• Community Referral
• Personal Responsibility
• Integrated Whole System Approach/Planned & Unscheduled Care, OOH, Social Care
• Multidisciplinary Primary Health Care Teams
Real Challenges Real Needs
• An ageing population
• High levels of chronic disease
• Health inequalities
• Lifestyle choices
• and other
OECD Report
01/05/2016
12
Primary and Community Care Teams Re-Inventing the Primary Healthcare Team
• Clinical pharmacists
• Improving access to Community Pharmacy
• Improving access to optometry
• Improving access to audiology
• Improving access to dentistry
• Extended practice nurse role
• Advanced & specialist nurse practitioners
• Physiotherapists
• Paramedic practitioners
• Occupational therapists
• Physicians Associates
Let’s Journey Together
FORMING THE COP
Margaret Allan