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TRANSCRIPT
Thursday 10 March 2016
Your pharmacy, your future: surviving and thriving in the
future landscape
Satyan Kotecha, Chair, Local Pharmacy Network, West Midlands
Welcome and introduction
Agenda7pm Welcome and introduction: Satyan Kotecha, Chair, Local Pharmacy Network, West Midlands
7.10pm Keynote speech: Claire Ward, Pharmacy Voice
7.40pm The NHS England perspective: Alison Tennant, Deputy Director Nursing and Quality/CDAO, NHS England
7.55pm A new model of community pharmacy delivery: Mark Koziol, Chair, Pharmacists' Defence Association and chief fundraiser for the YPG Pharmacy Project in Dudley
8.20pm Apprentice placements in pharmacies: Sarah Appleby, Assistant Practitioner Programme Lead and Apprenticeship Champion, Health Education England, working across the West Midlands
8.35pm An introduction to research and development tax relief – case studies: Gary Johnson, RD Tax Solutions and Satyan Kotecha
9.10pm National Pharmacy Association – Check 34: Andrew Lane, NPA Board Member
9.30pm Summary and closing remarks: Satyan Kotecha
Threats£170 million efficiency savings
Circa £25k per pharmacy
Falsified Medicines Directive
National living wage
Auto enrolment
Apprenticeship levy (0.5%)
OpportunitiesNew models of working
Reduce ‘cost’ not quality?
Clinically focused role
Build on existing foundation
Invest for our future
Claire Ward, Chair, Pharmacy Voice
Keynote speech
Community pharmacy in 2016/17 and beyond…
Claire Ward, Chair, Pharmacy Voice
Agenda
• The context: what we were saying back in October
• The challenge arrives – the December 17 letter
• What’s happened and happening?
• What is Pharmacy Voice doing?
• Some final thoughts
8
Pharmacy Voice who we are and what we do
• An association of trade associations – NPA, AIMp and CCA
• Board of 12 plus non-executive independent Chair
• Professional team with experience of healthcare and pharmacy
• To strengthen the voice of community pharmacy
• Policy: what do we want, why do we want it, why what we want is good for patients (and pharmacy)
• Representation – government, NHSE, PHE, HEE, LGA, APPG
• Uniting for common interests
• Influencing stakeholders
The case for pharmacy (October 2015)
• Demand for change in delivery of services in NHS
• Simon Stevens – Five Year Forward View (5YFV)
• Need to save £22 billion – what’s pharmacy’s contribution?
• New models of care
• Pressures of primary care – need to work smarter
• If the question is how to do things better – the answer is pharmacy
Context in England
Achievement of significant improvements in key areas – cancer survival, avoidable deaths, waiting times, etc. but:
• Still not performing as well as comparable countries for some conditions
• Ageing population: number of people >80 set to x2 by 2030
• Rise in LTC: diabetes set to rise by 29% to >4 million by 2025
• Increasing patient expectation/exercise of preferences
• Unprecedented focus on patient safety and patient experience (Francis effect)
• Unprecedented resource constraints (projected £30bn gap in NHS funding and £4.3bn gap in social care funding by 2020)
Financial context in England
NHS and local government coped well with austerity in last Parliament, but both now seriously struggling:
• NHS expected to have overspent its budget by more than £800m in 2014/15, despite £250m additional Treasury funding and an extra £650m from transferred planned capital investment (King’s Fund, 2015)
• Local authorities tightening eligibility thresholds and anticipating scaling back social services from 2015/16. For every £1 of council tax collected by councils in 2019/20, 60p will be spent on caring for the elderly, vulnerable adults, and vulnerable children (up from 41p in 2010/11)
(LGA/ADASS, 2014)
Five Year Forward View
October 2014 – shared vision from national NHS bodies
Set out need to address three potentially widening gaps in:
• Health and wellbeing
• Care and quality
• Funding and efficiency
PV “5YFV Opportunities for Community Pharmacy”
1. Support national bodies and local commissioners implement new preventative health programmes and tackle our major public health priorities
2. Contribute to new models of care delivery:
• lead the development of new ways of supporting people with long term conditions by enabling independence, self-management and shared decision making
• help increase public awareness and utilisation of alternatives to A&E and general practice for dealing with common conditions and monitor ailments
3. Provide opportunities for research, development and deployment of new diagnostic and analytical devices, treatment options and communications tools
4. Contribute to developing sustainable, cohesive and vibrant communities as trusted commercial and social partners.
Challenges
• Public awareness and confidence
• Knowledge and awareness of policy-makers
• Resource constraints
• Practical barriers (IT systems)
• Complexity of current change processes
• Contract and funding mechanisms
• Need for cultural and behaviour change within the sector
To note: the writing on the wall?
• Chief Pharmaceutical Officers’ Vision (RPS Conference, September 2015)
• Future of pharmacy is as a clinical profession
• Need to think seriously about the use of technology, robotics, hub and spoke
Initial work:
• Understand the implications
• Make technology work for pharmacists and patients (protect the pharmacist/patient interaction)
• Recognise the challenge, and the determination
• Focus on solutions and link to big (NHS) picture
Are we really making the most of medicines?
➢Only 16% of patients prescribed a new medicine take it as prescribed, experience no problems and receive as much information as they need
➢ Ten days after starting a medicine, almost a third of patients are already non-adherent
➢ A study conducted in care homes found that over two thirds of residents were exposed to one or more medication errors
➢ An estimated 1.7million serious prescribing errors occurred in 2010
➢ In primary care around £300 million of medicines are wasted every year, of which £150 million is avoidable
➢ At least 6% of emergency re-admissions are caused by avoidable adverse reactions to medicines
Patient partnership
People differ in their…
1. Desire to be involved in treatment decisions
2. Perceptions of medicines
3. Information needs
4. Capacity and resources to adhere to treatment
We need to
1. Identify individual needs and preferences
2. TAILOR interventions to address:
- misconceptions, concerns and information needs
- practical problems reducing patients’ ability to adhere to medicines
How might it look in practice?
Solutions
In excess of £450million per annum
➢ Asthma £90million
➢ Statins for prevention of cardiovascular disease £75million
➢ Type 2 diabetes over £100million
➢ Hypertension over £100million
➢ Schizophrenia £113million
Cost savings per year that could be realised by increasing the proportion of patients who are compliant with their medicines to 80%
98% of respondents to the on-line Pharmacy survey reported
strong evidence of skills enhancement as a result of the project
since the project, the number of MURs related to inhaler technique has continued to increase
over 4,500 Asthma Control Test (Medicine Use Reviews)
MURs, 600 follow-up Asthma Control Test MURs and 828 COPD Assessment Test pre- and post MURs 40%
of asthma patients showed better asthma control over
the time period
55%of COPD patients showed
an improvement in symptom management
positive association between the introduction of the project and changes in hospital emergency admissions
use of ‘second intervention’ MURs enabled participants to see the impact of the intervention very quickly, maintaining motivation
Inhaler Technique Improvement Programme
➢
➢
➢
➢
➢
Community Pharmacy Future Project
£139min reduced use of NHS and
social services resources,
societal costs and increased
uptake of flu vaccinations
£86m in disease-related
cost savings from
supporting people to
stop smoking
Customers
identified by
pharmacies
Customer
completes risk
assessment
Higher
risk?
Micro-
spirometry
Refer to GPPublic health
advice given
No Yes
• Regular smokers• Purchasing cough mixture
regularly• On medicines for chest
exacerbations• Self-referral
Significant improvements in ➢ patient-reported adherence
➢ access and utilisation of
rescue packs
➢ quality of life
➢ reduction in routine GP
visits
Smoking quit rate of
13.85%
Community pharmacy supporting patients using high-risk medicines
Audit carried out in 2,773 pharmacies, of 48,000 patients using methotrexate, warfarin and lithium
Over 13,000 people said they did not have a record book
Nearly 14% of patients were not having regular blood tests
to check they are receiving the correct dose
425 patients exhibited some signs of toxicity and
were referred to their prescriber
➢
➢
➢
2012-13 Practice-based Audit
Context – the December letter
26
What the Government states it wants The offer within community pharmacy
Integrate community pharmacy more
closely within the NHS, optimising
medicines use and delivering better
services to patients and the public.
Highly trained healthcare professionals using their
expertise in medicines to deliver clinical services,
help people stay well and self-care, liase with and
signpost to other providers, and facilitate seamless
patient pathways
Modernise the system for patients and
the public
High levels of choice and convenience in where and
how to access pharmacy services, including online;
responsive to changes in service-user demand
Ensure the system is efficient and
delivers value for money for the
taxpayer
Innovative solutions to reduce costs and improve
efficiency across the whole healthcare system
Maintain good public access to
pharmacies and pharmacists in
England.
The most accessible options for face-to-face contact
with a healthcare professional: community-based,
with long opening hours and no appointments
necessary
Support cohesive local communities
and a vibrant business and enterprise
culture
A vital contribution to healthy highstreets; a central
hub for public health services; significant private
investment and thousands of employment and
training opportunitiesMaking sudden, arbitrary cuts in funding to the sector is inconsistent
with stated Government policy
Are we really making the most of medicines?
➢Only 16% of patients prescribed a new medicine take it as prescribed, experience no problems and receive as much information as they need
➢ Ten days after starting a medicine, almost a third of patients are already non-adherent
➢ A study conducted in care homes found that over two thirds of residents were exposed to one or more medication errors
➢ An estimated 1.7million serious prescribing errors occurred in 2010
➢ In primary care around £300 million of medicines are wasted every year, of which £150 million is avoidable
➢ At least 6% of emergency re-admissions are caused by avoidable adverse reactions to medicines
Context - efficiency
Context – effectiveness
28
• Patients want to be involved in treatment decisions
• Behavioural medicines insights: perceptions and adherence
• Moving adherence to 80% in five named conditions will release £450m a year.
• 40% of people with asthma and 55% of those with COPD improve with an inhaler device check
• Community pharmacists prevent severe harm and save lives, and pay particular attention to high risk medicines
What’s happened and happening
29
• Working together
– Steering Group
– Communications
– The new narrative
• The double loop process
Consultation approach
30
A FLAWED CONSULTATION PROCESS
• Initiated out of the blue
• Very little detail
• No explanations
• No impact assessment
• No evidence base
• No route for public comment
• Unfounded assumptions about the current efficiency of community
pharmacy
• No acknowledgement of changes required in other parts of the system
The opportunity for constructive, informed policy engagement has been severely undermined by this approach
A FLAWED CONSULTATION PROCESS
• Initiated out of the blue
• Very little detail
• No explanations
• No impact assessment
• No evidence base
• No route for public comment
• Unfounded assumptions about the current efficiency of community
pharmacy
• No acknowledgement of changes required in other parts of the system
The opportunity for constructive, informed policy engagement has been severely undermined by this approach
What we can deliver
Our 2011 Blueprint for Better Health said:
“Our ambition is for a community based pharmacy service that works collaboratively with other primary care professionals, and that makes the most of the considerable skills and knowledge of pharmacists and the pharmacy team. It will help control costs, improving the effectiveness of prescribing through optimising the use of medicines and preventing ill health, benefitting the public, patients and the NHS alike… “
Since then, our ambition has grown. We are working with members and partners to articulate this renewed ambition and vision, so there is a clear and common understanding of community pharmacy’s role within a modern health and care system
31
What we need
The following commitments in return for the investment of resources, effort, expertise and time that the sector is willing to put into delivering the Government’s stated vision and our ambition for the sector
32
FIVE COMMITMENTS TO ENABLE COMMUNITY PHARMACY TO BE FULLY
INTEGRATED WITHIN A MODERN, EFFICIENT AND ACCESSIBLE HEALTH AND
CARE SYSTEM
1. Stop the planned disinvestment in community pharmacy in 2016/17
2. Agree a sustainable long-term settlement with the sector
3. Invest in service transformation in the same way as for other parts of the
NHS
4. Put in place a joint, coordinated approach to planning investment and
implementing change, in partnership with national community pharmacy
bodies
5. Deliver the reforms that are required in other parts of the system, and in
legislation, to enable community pharmacy to play its full role
An alternative approach
We recognise the need to change. The right way to manage change is to capitalise on the existing network and the investment it represents and take a planned approach designed to avoid unintended consequences. Change must be built on the foundations of a clear future funding settlement that supports the development of a sustainable forward view for the sector.
33
Change must occur in the right way, for the right reasons and be guaranteed to improve patient experience and outcomes
We ask the Government to commit to an approach to change that starts with a shared vision of the future for community pharmacy as a fully
integrated part of the NHS
What we want in return…
Commitment from NHS England and the Department of Health to:• Take action to ensure local commissioning of community pharmacy services is
managed effectively, in line with standard national frameworks, evidence and best practice; and addressing conflicts of interest within GP-led commissioning of primary care
• Enable and enforce the use of EPS (including for CDs) and electronic repeat dispensing within general practice
• Secure a firm commitment from Public Health England and Local Government to invest in the public health services offered by community pharmacy
• Give community pharmacy professionals full read/write access to shared care records
• Implement original pack dispensing• Change regulations to allow community pharmacy professionals to deliver
advanced services outside the pharmacy• Allow generic substitution• Remove the bureaucratic burdens of administrating prescription charges • Stamp out prescription direction
34
Prescription duration
• Medicines optimisation should start with patients. The goal must be to improve patient safety, experience and outcomes
• We support efforts to identify and manage appropriate (longer and shorter) prescription duration for individuals. We believe this is best achieved through partnership between patients and pharmacists
• People with long-term conditions require different levels of support to manage their health and medicines; some value very regular monitoring. You must enable community pharmacy teams to use their expertise to help patients make decisions about what is right for them
• A national programme of work on medicines optimisation should be supported through the Pharmacy Integration Fund, building on MUR and NMS and using the experience from initiatives such as the Community Pharmacy Future work
35
A blanket approach to increasing prescription duration risks dramatically increasing the £300m pa bill for medicines waste
Pharmacy Integration Fund
We see the proposed Pharmacy Integration Fund as an opportunity to build, test, refine, grow and embed innovative approaches to making better use of the network.
36
RECOMMENDATIONS FOR BEST USE OF THE PHARMACY INTEGRATION FUND
• Enable implementation of the requirements we have set out in this submission
• Enhance the fund, including through access to other national and local
transformation funds, and ensure it is used only to support community pharmacy
development and integration
• It must not be used for developments that already have a funding stream, such as
the creation of roles for pharmacists working in general practice. Using it in this
way would severely damage efforts to engage community pharmacy teams in
service transformation
• Change must be implemented at scale to deliver long-term and sustainable
improvement in quality and efficiency. For this reason, national control and
oversight of the Fund must be retained. Local engagement and implementation is
clearly necessary, but decision-making on the use of the fund should not be fully
devolvedWe look forward to discussing the proposals for the PIF with NHS England. We need a commitment that NHS England will work with the sector in a meaningful way to agree how the fund is allocated and accessed
Next steps
• There is a way to do things differently, and a route through the turmoil that has been created by the sudden announcement of cuts and the jumble of ideas included in the December 17th letter and stakeholder briefing
• Trade associations bring together sector experts to create solutions. Used effectively, we can help our members do things differently.
• We can also help NHS England and the Department of Health identify and remove the barriers that stop pharmacy teams doing the right thing more often. But first, there must be a commitment to do so.
• The Government must agree a roadmap for change with the national community pharmacy bodies, building on the best features of the service now and using the Pharmacy Integration Fund as one of the mechanisms for change
• This is the only way community pharmacy can be properly integrated into the health and care system and established as the front door to the NHS.
37
Any questions
Alison Tennant, Deputy Director Nursing and Quality/CDAO, NHS England
The NHS England perspective
Community pharmacy –where do you want to be in five years’ time?
Alison Tennant NHS England
www.england.nhs.uk
• 6% reduction in contract value
• Increasing number of prescriptions
• Increasing complexity of patients
• Fragmented system
Challenges
41
www.england.nhs.uk
• 6% reduction in contract value
• Increasing number of prescriptions
• Increasing complexity of patients
• Fragmented system
Opportunities
42
www.england.nhs.uk
• Hospital Pharmacists
• CGG Pharmacists
• Specialist Pharmacists
• Community Pharmacists
43
What value does the rest of
healthcare think Pharmacy add?
LOTS
?
www.england.nhs.uk
• Open and accessible
• Supportive
• Informative
BUT
• Do they speak to the
counter assistant more
than the pharmacist?
44
What value do patients think
community pharmacy add?
www.england.nhs.uk
Jeremy Holmes
“Pharmacists need to stop looking
down at the dashboard and look
up through the windscreen”
www.england.nhs.uk 46
www.england.nhs.uk
• It is a curve!
• Need to change mindset and attitudes
• Need to build personal relationships – challenges of
perception of competition and poor behaviour of some
pharmacists
• Challenge coming from other bodies – NHS England
and local authorities
47
Managing change
www.england.nhs.uk
• Optometrists have formed alliances that mean the
CCGs only deal with one body when rolling out
services instead of multiple contracts
• GP Federations are looking to pharmacies to support
their new models of working e.g. Jhoots with
Wolverhampton GP Federation
• Worcestershire Acute Trust looking to use community
pharmacies to help with discharges
48
Practical examples
www.england.nhs.uk
• With each other
• With your LPC
• With provider pharamcists
• With your local GP
• With CCGs
• With Local Authorities
• With the Third Sector
49
Improve collaborative working
www.england.nhs.uk
Get out from
behind the
dispensing
counter
Mark Koziol, Chair, Pharmacists' Defence Association and chief fundraiser for the YPG
Pharmacy Project in Dudley
A new model of community pharmacy delivery
Snowballs and Sledgehammers
The YPG Pharmacy Initiative
A new model of Community Pharmacy
Delivery
The YPG Pharmacy Initiative
• The first few tentative steps
• Initial discussions held
• How funds were raised
• The Custodians
• The Senior Advisory Board
• Not for Profit Social Enterprise
• Publicity created interest.
Why the Priory Estate opportunity was ideal
• Created the ideal conditions
• Was in need of healthcare facility – previous
pharmacy failure
• Was a distinctive geographical location
• Had an active, enthusiastic and demanding
community
• Had a supportive Primary Care
Organisation
• Supportive of an ‘outside of the box’ approach.
Why the Priory Estate opportunity was ideal
• Created the ideal conditions
• Local community input into the PNA
• Created an LPS contract based on
the PNA.
How we got going - Snowballs
• The lads at the Priory ‘Test’
• The PCT facility
• The need to secure the next door building.
The tendering process
• Pressure testing a voluntary exercise
• Up against professional operations
• Pressures of cost vs service
• Tensions between supply and services
• THE PRIZE - A CONTRACT FOR SERVICES.
Refurbishing the building - Sledgehammers
• The trials and tribulations with the extension
Refurbishing the building - Sledgehammers
• The trials and tribulations with the extension
• The reaction from the local community.
Setting up the Social Enterprise
• The steering group meetings
• The community input
• The iterative process
• The wider service to the community
• Within the facility
• Out with the wider facility
• Success measured in terms of Social Capital.
Insert the pics here
The Priory Community Pharmacy In
Dudley
The YPG Philosophy
• To operate as a Social Enterprise not for
profit
• To engage with the local community to ensure that
pharmacy can find new and innovative ways of working
so as to support its continuously developing needs.
• A healthy living pharmacy passionate about the provision
of pharmacy services.
• Pharmacy in the wider community
• Outreach to Colleges, town centres, libraries,
shopping centres, work places etc.
The YPG Philosophy
• Supporting Pharmacy’s significant role in the NHS,
moving from reactive to pro-active.
• Tackling health issues before they occur
• Primarily through a public health approach(e.g. Slip and Trip to prevent falls).
• Underpinning undergraduate training
• Enabling practice research
• Re-investing in the profession.
Organisational links – Developing partnerships
• Dudley public health community improvement team- Alcohol outreach, Skin cancer awareness
• Charity links ; health trainer initiative.
• Industry
• Training and development or in provision of the services
• Pfizer & McNeil- Training and support on smoking cessation
• Alphega pharmacy UK. Pharmacy business awards
• Local Church, The Office of the Mayor
• Dudley College, Dudley Libraries.
Our Services- LPS specificationOur LPS service specification requires us to
provide the following services:
• Smoking cessation
• EHC provision
• Needle exchange
• Minor ailment scheme
• Blood pressure check
• Diabetes screening
• Room booking for NHS
• Medicines use review
NO SMOKING DAY-TESCO SUPERMARKET
Sexual Health Services- Non LPS -£2,000 income
Social Enterprise and not for profit status ensures that surplus made is invested in new services.
• HIV testing
• Condom demonstration and distribution
• Chlamydia screening and treatment
• Distributed 146 Chlamydia tests to under 25s over a 6 month period.
• Health promotion outreaches once a week in Dudley colleges.
Alcohol IBA- Non LPS - £8,000 income generated
• Reached out to over 1000 residents of the local
community resulting in 365 alcohol interventions to
people with increasing risk of alcohol in six month period.
Weight management- Non LPS
Skin Cancer Awareness- Non LPS £9,000 income
generated• Distributed 800 free
sun cream samples from Bolton healthcare (Uvistat).
• Reaching 1,201 people within a 6 month period.• Introducing this
campaign to other healthy living pharmacies in the borough.
Slip and Trip- falls prevention campaign – Non LPS
• 607 interventions, 107 referrals for balance classes/ home improvements
• Free Slippers distributed
Other services
• Flu Vaccination: NHS+ Private PGD
221 people vaccinated last year
• NHS Health check
• New medicine service
• Funded Minor Ailments scheme• Pregnancy testing
• Allergy testing £1,000 Alphega
• Safe place
• Community Information point
• COPD and Asthma outreach - TEVA £4,000
Annual Health Fayre
Charity event with Proceeds donated to Mayor of
Dudley chosen charity
Supporting training and development
• Wolverhampton University
Work placement opportunities for the students
Visiting lecturer public health
• Colleges in the borough
• St Thomas Network
• The Prince’s Trust
• Pre Registration training
Three so far- Brighton, Aston and Wolverhampton universities
Not just a pharmacy
• Meeting rooms- Quarterly Priory community pharmacy
stakeholder’s meeting which includes Pharmacy users
• Health Exchange
• Drug Rehabilitation clinics
• Dudley and Walsall mental health
• Labour councillors every Friday
• Dudley Member of European parliament once a month
Mystery shopper results
Our awards
Our awards Cont’d
…. and a two page mention in the independent
community pharmacy magazine
Vision for the future • Creating a Community centre.
• Develop links with voluntary sector.
• Develop more outreach educational events such as talks
on osteoporosis, sexual health, substance misuse etc.
• Support other pharmacies in locality; Scaling up the
achievements.
• Creating the anchor for the provision of health/ Well
being services in the community.
Conclusions
• Suitable for a distinctive Geographical location
• Need a supportive CCG
• Secure local community input into the PNA
• Create an LPS contract based on the PNA
• Establish a Social Enterprise
• ensure community input via a steering board
• Take a Public Health Approach
• Develop partnerships
• Deliver Pharmacy in the wider community- outreach services
• Go Beyond the contractual requirements.
Sarah Appleby, Assistant Practitioner Programme Lead and Apprenticeship Champion, Health Education England,
working across the West Midlands
Apprentice placements in pharmacies
Apprenticeships: Good for BusinessSarah Appleby
Health Education England working across the West Midlands
Welcome
Apprenticeships: Setting the Scene
• In current format apprenticeships have been around
for 17 years
• 2.2 million apprenticeships in UK since 2010
• Government’s commitment to create 3 million
apprenticeships by 2020 will be enshrined in law
• Current commitment to deliver 3 million more by 2020
• Apprenticeships to be given equal legal treatment as
degrees
• Public sector bodies such as NHS will be given
targets to help reach 3 million
@NHS_HealthEdEng #Apprent_PC
Health Education England: Priorities
Get in
Get on
Go further
@NHS_HealthEdEng #Apprent_PC
Apprenticeship Activity
0
500
1000
1500
2000
2500
2011/12 2012/13 2013/14 2014/15 2015/16
No. of New Apprenticeship Starts in West Midlands
No. of NewApprenticeship Starts
What is an Apprenticeship?
• A framework of nationally recognised qualifications
that combine work-based training and formal
education.
• Apprentices working ‘hands-one’ alongside
experienced staff
• Previously developed by Sectors Council
• New employer led trailblazer standards
• Apprentices “Learn and Earn”:
– Min apprenticeship wage £3.30 per hour(*This rate is for apprentices aged 16 to 18 and those aged 19 or over who are in their
first year. All other apprentices are entitled to the National Minimum Wage for their age).
@NHS_HealthEdEng #Apprent_PC
Levels of Apprenticeships
Different Levels of Apprenticeship
Levels 4 – 7
• 24 months +
• Foundation
Degree +
Level 3
• 18-24 months
• Equivalent to
2 A levels
Level 2
• 12-18 months
• Equivalent to
5 GCSEs
A*-C
Plus knowledge, confidence and employability skills
Intermediate
Apprenticeship
Advanced
Apprenticeship
Higher
Apprenticeships
Apprenticeship Benefits
Learn, Achieve, Progress Fully
qualified flexible
workforce
Access to high quality
education and training
Company Loyalty
Motivate, Leadership
Opportunities
Upskilling staff
Attract Fresh Talent
STAFF
Your Customers
Corporate Social Responsibility
Customer Satisfaction
Customers choose companies with
apprentices
Able to access diverse range
of services
Benefits to your Business
Return on Investment
Innovate new
role/services
Recruitment of the Right
People
Improved Productivity
Improved Quality
Funding available
Employer Responsibilities• Induction into their role and provide on-the job training
• Paying apprentice’s wages and issuing their contract of
employment (direct employment of apprentices)
• As an employee, the apprentice receives the same benefits as
other employees
• An apprenticeship is not a work experience programme and is
linked to a job
• Employers have a legal responsibility to ensure appropriate
supervision at all times
• Where an Apprenticeship Training Agency (ATA) services are
used to source, arrange and find a host for an apprenticeship,
the Agency is the apprentice’s employer
As an employer you are able to source apprenticeships:
• Through local/regional training providers
• Employer in House: Some employers choose to take responsibility
for all elements of apprenticeship delivery
• Employer Academies: Employer utilise sector specific
apprenticeship academies e.g. National Skills Academy for Health
As an employer you are able to utilise apprenticeships:
• Directly recruiting apprentices under company employment contract
• Current Staff Development
• Agency Training Agreement Apprentices (ATA)
Apprenticeship Approaches
Apprenticeship Funding: NowSkills Funding Agency
• Contribution varies depending on the sector and
candidates age
• Higher apprenticeship funding – dual awards (foundation
degree and higher apprenticeship) for roles such as
Assistant Practitioners
Apprenticeship Employer Grant (AGE)
• For employers with <50 employees
• Up to 5 grants of £1500 - apprentices aged 16-24 years
• Up until 31st March 2016 to be reviewed April 2016
Apprenticeship Funding: HEE
• A contribution of up to £500 is available to
NHS employers/providers of NHS services for
every reported new apprentice start
2015/2016
• Recommendation to continue for 2016/2017
@NHS_HealthEdEng #insertcampaignhashtag
@NHS_HealthEdEng #insertcampaignhashtag
Funding: The Future
• Levy will be payable on pay bill in excess of £3
million per year at 0.5%
• All employers will receive an allowance of £15,000
to offset against payment of the levy
• The levy will be payable through Pay As You Earn
(PAYE)
• Employers will be given digital accounts
• Where employers choose not to use the funds in
their digital accounts, these will be redistributed
Potential Opportunities• Potential of using an approach for a collective
response/action i.e. funding from the levy paying for
apprenticeships within primary care employers
• Stimulate further interest in development of Higher
Apprenticeships
• Align with Career Development Programmes
• Use of any local procurement to drive up
apprenticeships
Want to find out more?
• Primary Care Apprenticeships Event
4th May 2016, 1-3 pm,
University College Birmingham
• 18th March 2016, Webinar, National Skills Academy for
Health
• Apprenticeship Toolkit – May 2016 launch
• CPEN Stakeholder Engagement Event – 28th April 2016
Any Questions
Sarah Appleby – MHI LETC Assistant Practitioner Programme Lead
and Apprenticeship Ambassador
Gary Johnson, RD Tax Solutions and SatyanKotecha
An introduction to research and development tax relief –
case studies
An Introduction to Research & Development Tax Relief
Gary Johnson
Objectives
- To enhance your understanding of Research & Development Tax Relief
- To give an outline of R&D qualifying areas and qualifying criteria
- To establish whether this form of tax relief can enable your business to grow
Agenda
- What is R&D Tax Relief?- The Justification for R&D Tax Relief- R&D Tax Relief - Qualifying Guidelines- R&D Tax Relief - Eligibility to Claim- Qualifying Sectors- Case Studies- The Process- Q&A- Summary
What is Research & Development Tax Relief?
SMETurnover – Up to £84,000,000Balance Sheet – Under £72,240,0001-500 Staff
The Justification for Research & Development Tax Relief
HMRC Market Analysis
120,000 ClaimsSince 2000 SME
33,800
£14.3bn Claimed Expenditure in 2013 / 2014SME Claims up 23%SME`s realised £800m benefit in the year
HM Revenue & Customs defines R&D tax qualifying areas through the following guidelines :
- Scientific Advantage - Technological Advantage
- Overall Knowledge & Capacity - Appreciable Improvement
Research & Development Tax Relief -
Qualifying Guidelines
Research & Development Tax Relief -
Eligibility to Claim
- The tax relief is only available for Limited
companies
- To qualify, a company must have been trading for over 12 months
- There must be a minimum of 5 staff, or Turnover >£750,000
- There must be evidence of at least 1 R&D related project
Qualifying Sectors
Manufacturing
Mining & Quarrying
Other Services Activities
Professional, Scientific & Technical
Public Admin, Defence & Social Services
Real Estate
Transport & Storage
Water, Sewerage and Waste
Wholesale & Retail Trade, Repairs
Accommodation & Food
Admin & Support Services
Agriculture, Forestry, Fishing
Arts, Entertainment & Recreation
Construction
Education
Electricity, Gas, Steam & Air
Conditioning
Financial & Insurance
Health & Social Work
Information & Communication
R& D Claimable Work
Streams
Care Homes
• Training costs due to new certifications
• Management systems
• Research into specialised fields such as patients
with mental health
Pharmacies
• Improvement in accuracy of results during
clinical trials
• Improving the speed of available results
• Creation/development of software
platforms
• Monitoring of patients
• Implementation of new machines as
training staff
Training companies/Consultancies
• Merging standalone systems with other systems
• Putting into place a training metrics
• Specialising in a specific sector (i.e. IT)
• Development of courses
• Outsourcing instructors
• Online training videos
• Analysis to demographics for products or course
material
• Planning of courses which don’t yet exist
• Course creation for Social Communication
Example – K&K Healthcare
K&K’s qualifying R&D expenditure:• Incorporation of digital technology • Creation and development of a software platform • Pharmacy staff have been trained to measure patient serum uric acid• Implementation of machines
2013: R&D Qualifying Costs: £97,413
2013: Corporation Tax Rebate: £10,823
2014: R&D Qualifying Costs: £91,332
2014: Corporation Tax Rebate: £10,148
Q&A
Thank you for your time.
t: 07469 851567
www.rdtaxsolutions.com
Andrew Lane, NPA Board Member
National Pharmacy Association – Check 34
Background
• How well do you know your numbers?
• Is your Schedule of Payment (FP34) data being analysed to help with your business performance?
– Reviewing SOP’s and dispensing performance
– Using local and national comparators
• Contractors not always well informed about prescription reimbursement
Check34 can help
• Two thirds of NPA members have now signed up – why don’t you?
• It can help you gain more control over your business –by using 14 key performance indicators – including the number of items dispensed per month, script switches and fees lost
• It can save you time – by automating the analysis and turning raw data into business knowledge
• It has the potential to improve your bottom line – by giving you a clearer view of payments made to you and the trends underlying your dispensing business
Key performance indicators (KPIs) Easy to use dashboards:
Show how your pharmacy is performing for each of the key performance indicators
Rank your pharmacies for each of the key performance indicators
Easy to use graphs show how you’re trending vs. the national and local averages
Sign upIt’s easy to register
Just go to www.npa.co.uk/check34 and fill in the simple registration form
It’s easy to use
Simply sign in with your bespoke username and password and all your information is there ready for you to start using
Coming Soon......
CheckRX – the companion tool which provides Prescription item analysis
Satyan Kotecha
Summary and closing remarks
Thank you!