Download NLG(15)489 Annual Medicines Management Report 2014-15

MEDICINES OPTIMISATION STRATEGY
ANNUAL REPORT
2014/15
Mike Urwin
Chief Pharmacist & Clinical Lead Medicines Management
September 2015
Introduction
This year’s report has a new title following a national switch of focus from ’Medicines
Management’ to ‘Medicines Optimisation’. In March 2015 NICE published the guideline
“Medicines optimisation: the safe and effective use of medicines to enable the best possible
outcomes”.
Medicines optimisation is defined as a person centred approach to safe and effective medicines
use, to ensure people obtain the best possible outcomes from their medicines.
Medicines management has primarily been led by pharmacy teams and is an important enabler
of medicines optimisation. The definition of 'optimise' is to 'make the best or most effective use
of (a situation or resource)'. Medicines optimisation focuses on actions taken by all health and
social care practitioners and requires greater patient engagement and professional collaboration
across health and social care settings.
The Royal Pharmaceutical Society produced a guide ‘Medicines optimisation: helping patients
make the most of medicines’ (2013) to support the medicines optimisation agenda. This guide
suggests four guiding principles for medicines optimisation, aiming to lead to improved patient
outcomes:

Aim to understand the patient's experience

Evidence based choice of medicines

Ensure medicines use is as safe as possible

Make medicines optimisation part of routine practice
Medicines management standards are no longer separately described in CQC’s new
fundamental standards, but the principles of good medicines management /medicines
optimisation practice are unchanged.
Medicines optimisation is a strategic issue fundamental to the way that hospitals work and to
the quality of patient care. It is the responsibility of every healthcare professional who handles
medicines. The consequences of failing to deliver effective medicines management are
significant and include:

Exposure of patients to unnecessary risk and harm

Unnecessary expenditure and other avoidable costs

Poor patient experience, patient dissatisfaction and loss of reputation
It is easy to see how good Medicines Management practice has an impact on patient care and
the measures used to benchmark Trust performance.
This report describes the continuing improvement to medicines optimisation practice within the
Trust in the last 12 months
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1. Medicines Reconciliation
Medicines reconciliation is the process that ensures all medicines that a patient was taking prior
to admission are prescribed on the inpatient chart, unless it has been decided to stop or change
the prescription.
Pharmacy led medicines reconciliation for all hospital admissions is a requirement of
NICE/NPSA guidance and is specifically mentioned in the CQC registration requirements for
healthcare providers.
Medicines reconciliation continues to be effective in identifying omitted prescriptions,
discrepancies and errors.
Each year all activity related to pharmacy ward activity including medicines reconciliation is
collected. The results are shown in table 1.
Table 1
Number patient who had medicines
reconciled by Pharmacy staff
Omissions - The number of medicines
accidently not prescribed by doctor on
admission
Discrepancies - The number of
discrepancies found when reconciling
patient’s medicines. A discrepancy is
where the drug has been prescribed but
the dose or frequency is incorrect.
Prescribing errors - the number of new
medicines prescribed on admission
where there is an error in the prescription
Estimated
Full year
effect
2013
Estimated
Full year
effect
2014
Estimated
Estimated
Full year effect Full year effect
2015
Saturday &
Sunday
31925
32110
34008
5885
21913
34515
34320
6587
14104
16926
22672
4169
5425
3367
6448
589
The effectiveness of Pharmacy led medicines reconciliation was evaluated by Dr Beer when it
was initially implemented. He concluded that the was a moderate to high risk there would be a
clinical consequence for 1 in 6 patients who did not receive pharmacy led medicines
reconciliation.
The differences in data from last year (large increase in number of omissions found and more
discrepancies) suggest that doctors now even more rely on pharmacy led medicines
reconciliation to identify patients’ current prescription on admission. This also reinforces the
need for a 7 day pharmacy medicines reconciliation service, which is discussed later in this
report.
The original NICE/NPSA guidance on medicines reconciliation has been superseded and is now
incorporated into the new NICE guidance on medicines optimisation. The new guidance
expands the scope of medicines reconciliation in hospitals. During the next 12 months we will
work towards updating trust policy and procedures to incorporate medicines reconciliation when
patients move settings within the hospital. We expect to be able to do this within existing
resources. The pharmacy will also scope the requirement of medicines reconciliation at
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discharge, which we expect to require extra resources to achieve. These proposals will be
presented to the Trust next year.
2. Pharmacy 7 day working
In autumn 2014 Pharmacy were asked to consult with staff so that the service could be
extended to cover Saturdays & Sundays.
Drivers for change
•
•
•
•
•
Current provision - Dispensary only service Saturday 9-12, then pharmacist emergency
duty service
Patients admitted at weekend discharged without seeing a pharmacist
Medication incidents at weekends identified on Monday morning
Difficult for Pharmacy teams to catch up on Mondays
Keogh recommendations on 7 day NHS
Proposed service & costs
The aim of the weekend service was to reconcile the medicines of all patients that were
admitted on a Saturday and Sunday, to review any newly prescribed medicines and to supply
medicines if required. This would be delivered on each site by 2 pharmacists, 4 technicians and
2 Pharmacy Support Workers (+1 at SGH Store).
A budget of £284k was provided and this was used to recruit 2 Pharmacists and 4 technicians
into the Pharmacy team and to pay the enhancements for the staff who work at weekends.
Implementation
An extensive consultation process that included 23 group meetings and 63 1:1 meetings took
place. Pharmacy staff engaged with the process and the resulting final response to the
consultation described staff working arrangements that had not been included in the original
paper and were the result of true collaboration of the whole Pharmacy team.
The 7 day service began immediately after Easter 2015.
Outcomes
Data collected by the teams over the first 6 weeks of the service show that on average 115
patients have their medicines reconciled each weekend, which is equivalent to approximately
6,000 patients per year who will benefit from the new 7 day service. Using Dr. Beer’s evaluation
of medicines reconciliation, this equates to preventing avoidable harm of approximately 1,000
patients per year.
The data also shows that the weekend service will identify 6,500 prescriptions per annum that
were accidently omitted from the patients inpatient prescription when they were admitted; a
further 4,000 prescriptions where there was a discrepancy in the medication prescribed on
admission and what the patient was actually taking; and a further 600 prescribing errors in new
prescriptions.
The dispensary is also supply medicines over the weekend and is projecting to supply 16,000
medicines per annum on a Saturday and Sunday.
Prior to Pharmacy 7 day working, some patients admitted over the weekend were admitted and
discharged without seeing a member of the pharmacy team. Some were seen on a Monday
when the Pharmacy service resumed after a weekend, but many patients will have gone without
critical medicines prescribed during that period.
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3. Medication Safety Officer
The new role of Medication Safety Officer (MSO) was created in autumn 2014, in response to
NHS England’s Patient safety Alert ‘to improve reporting and learning of medication and
medical devices incidents’. Accountable to the Chief Pharmacist & Clinical Lead Medicines
Management. The role is integral to improving medication error incident reporting and learning
within the Trust. Responsibilities & duties of the post include:






to be an active member of the National Medication Safety Network
improving reporting and learning of medication error incidents in the Trust
managing medication incident reporting in the Trust. This may entail reviewing all
medication incident reports to ensure data quality for local and national learning and
where necessary to investigate and find additional information from reporters. Also, to
authorise the release of medication error reports to the NRLS each week
receiving and responding to requests for more information about medication error
incident reports from the Patient Safety Doman in NHS England and the MHRA
work as a member of the medication safety committee to provide the Trust with
assurance that:
o Medication error reporting and learning systems are operating effectively
o the quality of incident reports supports learning is appropriate,
o important patient safety issues identified by these systems are adequately
addressed locally
o incident reports are submitted in a timely fashion for national learning
supporting the dissemination of medication safety communications from NHS England
and the MHRA throughout the Trust
4. Safer Medication Group
This multidisciplinary group is chaired by the Chief Pharmacist & Clinical Lead for Medicines
Management and is focused on promoting and supporting safer medication practice. Alternate
meetings are devoted to reviewing incidents involving medicines.
Following on from last year, the group’s work programme continued and included:

Developing strategies to reduce the number of medication incidents involving older
patients and their compliance, promoting our self medication scheme (SAMPOD)
 Developing strategies to reduce the number of incidents of omitted medicines
 Developing strategies across the primary & secondary care interface
 Safe & Secure Medicines
 Second checking of medicines prior to administration
In addition the committee also




Monitored actions and progress against patient safety alerts
Reviewed medication incidents
Reviewed medication incidents involving controlled drugs to support the Accountable
Officer Controlled Drugs in preparing the Occurrence Report which is submitted to the
Local Intelligence Network on a quarterly basis.
Reviewed and approved policies/procedures
o Medicines Code Parts 1, 3 & 4
o Management of Suspected Illicit Substances
o Medicines Reconciliation Policy and Form
o Guidance for Compliance Aids and form
o Insulin Passport Policy
o Unlicensed Medicines Policy
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
Reviewed the outcomes and agreed action plans of the following audits

o Inpatient Prescribing Audit
o Outpatient Prescription Audit
o Omitted and Delayed Doses (2010/RRR009) Audit
o Safe & Secure storage of medicines Audit
Discussed
o
o
o
o
o
o
o
o
o
NICE CG79 Medicines Adherence
Pharmacy Drop Off Units
Medicines Security
Safer Medications Newsletters
Preventing harm from oral oxycodone
Risk of misuse Pregabalin & Gabapentin
Medicine Related Admissions
Reviewed Medication Incidents by Drug Location & Grade
Improving Medication Safety Newsletters
4.1
Medicines Security
Since the first audit in March 2012, medicines security continues to be an area where we are
improving practice. The fifth audit took place early 2015 and improvements have been
demonstrated in each audit. Pharmacists are now part of the Ward review system and
medicines security is also one of the areas they consider as part of that process.
Since 2013 the Trust invested £220k in a new electronic/mechanical locking system (Abloy Cliq)
for medicine cupboards on 60 wards. Safer Medication Group approved the new policy for using
the system in 2013/4. The system is very effective. Audits continue to show wards which have
the system always have locked medicines cupboards. The system is also popular with nursing
staff and each ward is saving significant nursing time (equivalent to half a nurse every day) not
looking for the single set of drug cupboard keys. The return on investment (ROI) is over 600% in
the first 12 months. We are the first Trust in the country to use the system on a large scale and
the initiative was shortlisted in the HSJ/Nursing Times Patient Safety & Care Awards in 2014
and in the HSJ Value Awards 2015.
4.2
Omitted medicines
The NPSA required Trust to perform an annual audit on omitted critical medicines. Critical
medicines (as defined by (NPSA/2010/RRR09) are medicines where delays in administration or
omissions can cause serious harm or death. The Trust’s Medicines & Therapeutics Committee
has identified the medicines which are considered to be critical in this context and these are
published on the Trust’s intranet.
The 2015 audit collected data on omitted medicines from approximately 50% of occupied beds,
across the three hospitals. 389 prescription charts were examined, and 104 critical medicines
were identified as omitted. The omissions affected 79 patients, which equates to 20% of the
population which was audited.
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2. Patient could
not take dose
3. Patient refused
4. Dose not
available
5. Omitted at
nurses discretion
6. Dr requested
omission
9. No IV Access
No Code Given
No. Patients
with
omitted
critical
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No. Critical
Medicines
omitted
No. with no
follow up
recorded
% Critical
Medicines
omitted
% with no
follow up
recorded
5
% Patients
with
omitted
critical
7.3%
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10.6%
45%
11
14
13
18
5
7
13.4%
17.1%
12.5%
17.3%
38%
39%
10
10
7
12.2%
9.6%
70%
9
9
1
11.0%
8.7%
11%
2
30
82
2
41
104
2.4%
36.6%
1.9%
39.4%
0%
5%
26%
2
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The reasons for omissions were examined
18% of omission occurred because the doctor (8.7%) or the nurse (9.6%) made the decision to
omit based on the patient’s condition. Follow up action was recorded for 11% of doctor
requested omissions and 70% of omissions at nurse’s discretion.
A further 12.5% of omissions occurred because the patient refused to take the medicine, with
38% of these instances having a follow up action recorded.
10.6% of omissions were recorded where the patient could not take the dose. 45% of these had
follow up action recorded on the prescription sheet.
17.3% (18 prescriptions) of omissions occurred because the medicines were unavailable. There
was follow up action recorded for 39% of these omissions. The auditors found in 1 instance the
medicine was dispensed and on the ward, 5 instances the medicine had been ordered and was
being dispensed at that time, and 8 were identified before the daily pharmacy visit to the ward
and had not been ordered by ward staff. There were also 4 instances where the medicine had
been dispensed but was not on the ward
There were 41 times when no code was recorded against the omission.
These results do not show significant improvement from the previous year’s audit. The action
plan for the audit will focus on ensuring all omitted medicines having the reason code recorded
on the prescription and the follow up action being recorded on page 6 of the prescription.
The report will include some new draft audit standards with the associated data collection and
results. These will be discussed by Safer Medication Group with the intention to report against
the new audit standards next year.
Pharmacy has developed a toolkit for their staff to assist them in the management of omitted
doses which they identify during their ward visits. It is hoped this will reduce the number of
omitted doses of critical medicines and educate nurses and doctors in the correct action when
they encounter omitted doses or potential omitted doses.
Omitted doses have also been incorporated into the monthly inpatient prescription audit and a
dashboard is being developed to further enhance our monitoring of omitted critical medicines.
Safer Medication Group will continue to focus on omitted medicines and its potential impact on
mortality rates.
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4.3
Patient Safety Alerts
The Safer Medication Group ensured the following Patient Safety Alerts were actioned:
 Patient safety alert – risk of death or severe harm due to inadvertent injection of skin
preparation solution.
 Patient safety alert – Managing risks during the transition period to new ISO connectors
for medical devices
 Patient safety alert – Risk of death from asphyxiation by accidental ingestion of fluid/food
thickening powder
 Patient safety alert – Harm from using Low Molecular Weight Heparins when
contraindicated
 Patient safety alert – Risk of death or serious harm from accidental ingestion of
potassium permanganate preparations
 Patient safety alert – risk of distress and death from inappropriate doses of naloxone in
patients on long-term opioid or opiate treatment
 Patient safety alert – resources to support the prompt recognition of sepsis and the rapid
initiation of treatment
 Patient safety alert on residual anaesthetic drugs in cannulae and intravenous lines
 Patient safety alert on minimising risks of omitted and delayed medicines for patients
receiving homecare services
4.4
Compliance with medicines related mandatory training
The committee continued to monitor uptake of medicines related mandatory training, and
suggest strategies to improve compliance rates. Since the last report there have been
improvements in compliance rates in each of the 3 mandatory training topics. At the end of
August 2015 the compliance rates were:



Medicines Management
Medical Gases
Safe use of insulin
90%
79%
66%
4.5
Lead Nurses Medicines Management
Promoting all aspects of medicines management, the Lead Nurses Medicines Management
make a significant impact on improving medicines management/optimisation practice within the
Trust. Working with the Chief Pharmacist and Heads of Nursing they engage with pharmacy
and nursing staff at all levels, supporting local and national medicine management initiatives,
bridging the gap between pharmacy and nursing services.
In 2015 both the long standing post holders moved to new roles in the Trust. Their commitment
and passion to the safe use of medicines was exceptional. This report acknowledges their role
in making a substantial and long lasting contribution to improving safe practice in the use of
medicines during their years in post.
4.6
Next 12 months
In the coming year Safer Medication Group will continue to focus on the risks associated with
medicines use. The Medicines Code will be reviewed and updated as necessary.
5. Electronic prescribing
In 2012 Executive Team agreed to the proposal to use Ascribe as the Trusts system for
electronic prescribing, allowing NLAG to be an early adopter of ePrescribing and Medicines
Administration (ePMA). In summer 2013 the system went live on wards B7 & B6 and DPOW.
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Evaluations by system users identified a number of issues that should be resolved to make the
system easier to use before further roll out. The issues can be split into three categories –
hardware, the ePrescribing software and other issues. While these issues were being
addressed the system was withdrawn from B6. These issues were fully described in last year’s
report.
In summer 2014 the Trust appointed a new assistant chief pharmacist who is now leading the
implementation of ePMA. She led the introduction of an ePMA system to the hospitals in
Liverpool and brings a new perspective and impetus to our project.
Many of the software issues identified by the Trust have been address by the software supplier.
Ascribe (now called EMIS Health to reflect the ownership of the company by one of the largest
health IT companies in the country) have put significant investment into the development of the
system, and improvements are being delivered in each release of the software.
The new project lead has engaged senior clinicians, nurses and managers and has their
support for the roll out of the system at Grimsby. IT hardware on the wards is still a major risk to
the success of the project. Clinicians do not like using Toughbooks for electronic prescribing,
preferring devices with a keyboard and mouse. To reduce this risk we believe most wards would
require (on average) two additional laptops. However discussions with future users the assistant
chief pharmacist indicate that the wards would accept new hardware cannot be purchased in
the current financial climate and are prepared to implement they system without additional
hardware.
Implementation plans have been developed that look at rolling out the system across the Trust.
Options for different rates of rollout have been included in these plans.
The Trust has also investigated the possibility of developing and in-house ePMA system by the
Web-V team.
A decision on the implementation of ePMA is expected to be made in autumn 2015.
6. Area Prescribing Committee
The Trust with our primary care partners in North Lincolnshire and North East Lincolnshire
formed the Northern Lincolnshire Area Prescribing Committee (APC) in 2012 The purpose of
the committee is to manage the introduction of medicines into clinical practice and maintain a
single formulary to be used by all three organisations.
Since its formation in September 2012 the APC has agreed the single formulary for both
primary and secondary care and addressed the Department of Health’s directive that all
treatments with a positive NICE Technology Appraisal are included on the formulary.
The committee continues to be effective in providing a single forum for clinicians in primary and
secondary care discuss local policy on the clinical use of medicines to treat patients across
Northern Lincolnshire.
7. Antimicrobials
Promoting optimal antimicrobials stewardship is the primary role of the Consultant Pharmacist,
Antimicrobials.
The prevention of the development antimicrobial resistant micro-organisms is of key importance
locally, nationally and internationally, with relevant guidance being issued by organisations such
as NICE and Public Health England this year. Good antimicrobials stewardship is key to slowing
this development and poor utilisation of antibiotics is one factor which may contribute to higher
numbers of health care acquired infections, such as Clostridium difficile, MRSA bacteraemias
and Carbapenemase Producing Enterobacteriaceae infections.
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The Trust’s Morbidity and Mortality Action Plan continues to concentrate on the treatment of
sepsis as one of its key targets to reduce morbidity and mortality and the rapid deployment of
the most appropriate antibiotics is a crucial aspect of ensuring optimal patient outcomes.
The Consultant Pharmacist, Antimicrobials has contributed to the development of a
Management of Infection poster distributed to all clinical areas Trust-wide to ensure the
appropriate choice of antibiotics for the treatment of infections in all body systems. Additionally,
antibiotic stocks in therapeutic areas have been reviewed in order to ensure rapid availability of
critical antibiotics when needed and this information publicised so that clinicians may rapidly
access appropriate antibiotics quickly, as needed.
The sustainability of the Antimicrobials Steering Group has been achieved by incorporating it as
a subgroup of the Trust’s Medicines and Therapeutics Committee so that antimicrobials issues
are considered and discussed monthly by a range of Trust clinicians including the Consultant
Pharmacist, Antimicrobials and a Consultant Microbiologist.
In order to improve compliance with good antimicrobial prescribing standards, the Consultant
Pharmacist, Antimicrobials has led the development of a modified Trust prescription sheet, with
dedicated antibiotic prescribing sections incorporated. This will encourage prescribers to include
indications, course durations and 48-hour review of all antibiotics, as per local and national
standards.
The Consultant Pharmacist, Antimicrobials continues to develop and deliver antibiotic education
and training on the prudent use of antimicrobials to doctors, nursing and pharmacy staff within
NLAG, to Bradford post-graduate clinical pharmacy diploma students and HYMS medical
students.
The Consultant Pharmacist, Antimicrobials continues to contribute to the review and develop
the Antibiotic Formulary and Prescribing Advice for Adult and Paediatric Patients meet on a 6monthly basis and the Path Links Antimicrobials formulary Committee is also exploring the
incorporation of these publications into an application to be made available on mobile devices
and desktop computers to improve availability and access and planned to be delivered within
the 2015/16 year.
All members of the Clinical Pharmacy teams work to intervene where necessary in the
prescribing of antimicrobials to ensure optimum drug choice, course-length, prescribing
standards and advise on therapeutic drug monitoring, as necessary.
8. Controlled drugs
The Chief Pharmacist & Clinical Lead Medicines Management is the Accountable Officer for
Controlled Drugs for the Trust. The Local Intelligence Network (LIN) is now hosted by North
Yorkshire and Humber CSU and meets four times a year to consider and share concerns with
CD use. Within the Trust systems have been set up to inform Chief Pharmacist & Clinical Lead
Medicines Management of any incident involving a CD which is reported on Datix, which are
then investigated by a member of the pharmacy team. These arrangements have been
strengthened and are now routinely managed by the Medication Safety Officer. All CD incidents
are reviewed by the Safer Medication Group and this forms the basis for the occurrence report
that is submitted to the Local Intelligence Network each quarter. There is a rolling audit of
controlled drug storage on wards and departments, with each area being checked by pharmacy
staff every 3 months.
The Trust uses CQC’s self-assessment tool to monitor the effectiveness of it management of
controlled drugs.
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9. Outsourcing Outpatient Dispensing
Since January 2013 LloydsPharmacy has been contracted by the Trust to dispense all
outpatient prescriptions written by our clinicians at SGH and DPOW. The service is provided
from premises located very close to the existing hospital pharmacies at SGH and DPOW. This
contract does not change the inpatient services provided by the hospital pharmacy, nor the
existing outpatient dispensing service provided by Lloyds Pharmacy at Goole. Medicines
required for inpatients and at discharge are still supplied from the hospital pharmacy.
LloydsPharmacy apply the same governance standards as the hospital pharmacy, challenging
non-formulary prescribing and ensuring length of treatment does not exceed the Trust’s agreed
supply quantities.
The performance of the contract is regularly and routinely managed through the monitoring of
agreed key performance indicators and regular meetings with the contractor. The service from
LloydsPharmacy is well managed and meets the key performance indicators set out in the
contract.
Financially the contract performs well. Lloydspharmacy dispensed over £4.9m of drugs on
behalf of the Trust in 2014/15. This delivered a net saving of £0.55m, an increase of £120k from
2013/14. It is estimated that over the life of the contract Lloyds will dispense outpatient
medicines to the value of £42m, which will generate savings of approximately £4.2m over the 7
year life of the contract.
During 2015 a new innovative service has been introduced in which LloydsPharmacy dispense
and deliver specific treatments to patients homes, replacing a service which was previously
supplied by a homecare provider. The new service will improve the patient experience, reduce
the known risks from homecare services (these were a national serious concern in 2013/14 and
resulted in NHS England issuing a patient safety alert) and will deliver significant savings on
drug expenditure; approximately £100k in 2015/16, with a full year effect of approximately
£200k.
The Trust has had a successful relationship with LloydsPharmacy for the last 5 years at Goole
where they dispense hospital outpatient prescriptions and provide an inpatient clinical pharmacy
service. Review of the contract with Lloyds continues to show that the service has delivered
both financial and governance benefits for the Trust, by ensuring compliance of prescribing with
the Trust formulary, mandating generic substitution and ensuring length of treatment is in tariff
prices. None of these factors were achievable using FP10 (HP) prescriptions. Pharmacist input
to the wards has been welcomed by staff on the wards at Goole. The contract is now in the
second of the two optional one year extensions.
During 2015 this contract came to an end. Following a formal tendering process Lloyds have
been awarded the contract for a further 5 years.
10. Drug Expenditure
In last year’s report the reasons for year on year increases in drug expenditure was explored,
along with the strategies we use to reduce drug expenditure. During 2014/15 Pharmacy
implemented systems to reduce medicines wastage on wards through more efficient use of
patients own medicines. Discussions with primary care based on the recommendations in the
DoH report “Improving the use of medicines for better outcomes and reduced waste - An Action
Plan” (http://www.dh.gov.uk/health/2012/12/medicines-reduced-waste/ December 2012.) were
unsuccessful in changing local policy on the supply of medicines by the Trust where the patients
already get regular repeat prescriptions of those medicines from their GP.
In the last 12 months we have developed a number of schemes to reduce drug expenditure.
The scheme described in section 9 where we have developed a new service with
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LloydsPharmacy which uses the VAT advantages of the outsourced outpatient but keeps those
savings within the Trust is typical of our current plans.
Another scheme to reduce drug expenditure being developed and implemented this year is the
switching of patients to biosimilar products where these exist. Biosimilars are a type of generic
medicine but applied to very large molecules that are derived from living systems rather than
chemical synthesis. NICE have produced supporting information to assist clinicians in this type
of switch.
Drug savings considered and monitored in Trust’s ‘Procurement & Non-Pay Delivery Group’.
The target for savings in 2015/6 is approximately £370k. Current plans should deliver savings
exceeding that target.
11. Homecare
In 2011DoH commissioned a review of homecare arrangements and its future for the best value
for patients, the NHS and the provider market (“Homecare Medicines — Towards a Vision for
the Future”). The follow up report (“Towards a Vision for the Future – Taking Forward the
Recommendations”) was published in 2014.
These reports make recommendations that NHS Trusts strengthen governance frameworks of
homecare medicine. The Trust Chief Pharmacist should become the ‘Responsible Officer’ for all
homecare medicine and be accountable for them to the Trust Chief Executive Officer. The
involvement of the Trust’s Medical and Nurse Directors needs to improve around the design,
operation and control of homecare medicine. Homecare medicine needs to be set in the context
of a strategy for chronic and stable conditions for patients who are best managed at home and
should be part of integrated planning between Trusts and their commissioning agencies. As
such a strategy for homecare medicine should be developed with the local drugs and
therapeutics committee and an annual plan which the Trust Chief Pharmacist then has to
deliver.
Homecare is defined as a service that delivers on-going medicine supplies and associated care,
direct to a patient’s choice of location, with their consent. There are potentially four different
categories of home care service which include simple delivery, dispensing, nurse administration
and aseptic preparation.
During 2014/15 it was agreed that a homecare committee would be set up as a sub-committee
of the Trust’s Medicines & Therapeutics Committee. In 2015/16 the committee will set up, agree
its terms of reference and then meet regularly to provide the required governance.
The Trust is also looking at ways to take patients out of the homecare systems into services
which can be delivered via our outsourced outpatient dispensing contractor. In June 2015 we
switched 279 patients a ‘dispense and deliver’ service from LloydsPharmacy. The new service
has already received positive patient feedback and reduces the previous risks encounter with
homecare providers because we have a much closer working relationship with LloydsPharmacy
than we do with the homecare industry. We will be looking for further opportunities for similar
switches.
12. Benchmarking Pharmacy Services
During spring 2015 the Trust participated in the NHS Benchmarking Network’s ‘Pharmacy &
Medicines Optimisation Provider Project’.
The aim of the project was to compare pharmacy services across the country over a number of
indicators. The final report available at
http://www.nhsbenchmarking.nhs.uk/CubeCore/.uploads/MemberFiles/NHSBNPharmacyReport
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2015.pdf and gives a summary of the national findings. There is a toolkit available for Trusts to
look at their own results.
Our Trust’s results indicate we manage the procurement of drugs efficiently showing us to have
a very low pharmacy stock value per £10m annual drug spend.
Our Pharmacist pay costs per £10m annual drug spend is well below average (see graph
below). This supports our statements from previous years based on data from within Yorkshire
and Humber which shows we have fewer pharmacists than similar sized trusts.
Graphs similar to this one for Pharmacy technicians’ shows we have average pay costs for this
group, and above average pay costs for pharmacy support workers. We believe this
demonstrates good skill mix. Previously we have reported that the Trust has a low pay cost per
wte of pharmacy staff, which we also believed indicated good use of skill mix. The graph below
maps our skill mix against the national average.
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Our major variances from the national averages are in the Pharmacist and other staff
categories, where we are shown to have significantly fewer pharmacists than the national
average, and significantly more ‘other staff’ than the national average. We believe the difference
in the ‘other staff’ category is due to the extensive use of apprentices in training posts for
pharmacy support workers and pharmacy technicians.
Despite our lower than average number of pharmacists, they manage to see above the national
average number of patients on wards per day per 100 beds (see graph below).
However, because of our lower than average number of pharmacists our average number of
hours spent on wards per week per 100 beds is low.
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Our percentage of prescribers who are active pharmacist prescribers is more than twice the
national average.
The benchmarking report covers more indicators than it is possible to describe here. The
pharmacy management team has used the report to help them identify areas for future
development of the service.
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