Building PBC capacity through Community Pharmacy as an alternative service provider

1
Building PBC capacity through Community Pharmacy
as an alternative service provider

• Sue Taylor
• Chief Officer
• Devon LPC

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Why consider community pharmacy?

• Partnership approach adds value to planning and
  service improvement
• Local community setting
• Availability of highly skilled team
• Access
• Experts in medicines
• Public Health role

3
The perspective from Devon LPC the story so far

• PCTs and practices getting to grips with PBC
• Formation of consortia by practices
• Local needs assessments
• Data analysis
• Business case development
• Local service redesign
• Start of practice based provision

4
Challenges faced by the LPC

• Limited engagement between practice based
  commissioners and community pharmacy
• PBC groups not looking outside the box
• Lack of understanding
• Pharmacy contribution to care pathways
• How to utilise existing contractual framework
• No visible added value from community pharmacy
• Credibility of profession
• Limited access to data

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• We need to be better commissioners than the
  commissioners
• Gary Warner, Hampshire and IOW LPC, 2007

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A case study LPC development of a Business Case
for COPD

• Needs Assessment
• Evidence Research
• Service Outline
• Current service
• Proposed
• Cost / Benefit
• Patient
• Practice/PCT
• Measured Outcomes
• Challenges

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Needs Assessment

• What has the PCT identified as its priority
• What has the Practice identified as a priority
• What can be done by the Practice in the time
  available (practice based providing)
• What should be sub contracted (PBC)
• How will this be done (PBC)
• Who will do it? (PBC)

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Service Provision(Example COPD Current)
Current Provision
Case Managed
Respiratory Nurses Managed
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Service Provision(Example COPD Proposed)
Current Provision
Case Managed
Respiratory Nurses Managed
Proposed Provision
Pharmacy Zone
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Need

• Background
• Prevalence of COPD
• Approx. 900,000 sufferers (1.5 of UK population)
• Highest prevalence in Sunderland (2.93), Knowsley
  (2.8)
• Estimated that 75 of all cases are
  misdiagnosed/undiagnosed
• 50 of smokers may develop COPD

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Need

• Mortality and COPD
• Fifth most common cause of death in the UK
• Only major cause of death that is increasing
• Approx. 30,000 deaths/annum (5 of all deaths)
• UK death rate double the European average

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Need

• Economic burden of COPD
• One in eight acute medical admissions is due to
  COPD
• Accounts for over 1 million hospital bed days in
  England
• 500 million direct healthcare costs
• Loss of 27 million working days each year

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Evidence Research
Patients
Admissions
Cost
List Size
10,415
COPD register
112
High Risk Case
7
2
4,000
managed
1/3
Medium Risk
Respiratory Nurse
27
1
2,000
managed
No previous
99
27
12,000
2/3
admission Group
Source Dr W Bird Met Office
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COPD Hospitalisation
High Risk
No of Hospital Admissions
Medium Risk
Low Risk
Time
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Evidence Research
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Service Outline

• Accessing Services closer to the patients home
• Choice of provider (competition)
• Promoting Self care management (Improving Patient
  Care)
• Reaching new patients
• Value for Money
• Integrating Community Pharmacy into primary care
  (but not a community pharmacist working in
  primary care)
• Reducing Hospital Admission

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Service Outline

• Screening through spirometry
• Assessment of
• Dyspnoea scale
• Air Flow
• Smoking Status
• Exacerbations
• Sputum Testing/Repeat Dispensing
• Signposting

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Cost

• What was the actual cost in the previous year for
  hospital admissions for COPD within an area?
• Locality or PCT
• What is the cost of the Pharmacy COPD service?
• 4,500 (70 patients managed) (9,000 net saving)
• What are the set up costs?
• Approximately 3,000.00 (equipment and training)
• What is the break even point?
• Approximately 2 patients avoiding hospital (1 in
  30)
• Consider costs for increased prescribing

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Benefits

• Practice/PCT
• Identification of patients with COPD
• Spirometry completed
• Patient information collected
• Encourages patient self care
• Demonstrates meeting the SHA target to redesign
  pathways to reach patients with new services.
• 9000 saving

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Benefits

• Patients
• Understanding of condition
• Promotion of self care
• Prevention of admission
• Reduction of stress
• Improved concordance

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Challenges

• Practices are able to provide a COPD service
• Commissioning versus Provision
• Sub contracting work is out of practice control
• Change
• Proven track record

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Building PBC capacity through ASPs Summary

• Business Case Format
• Robust evidence
• Strong U.S.P
• Good working relationships communication
• Sub Contracting generates/saves

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Time Line
PBC commissioning group met and GP lead for PBC
agreed to commission
No Evidence, No money, other priorities need
addressing, lack of PBC understanding prevent
implementation
COPD care pathway group approved
2 GP practices agree to work with pharmacy
Initial Business proposal presented to East Devon
PCT May 20027
July 2007
April 2006
April 2007
December 2006
PCT to agree funding for pilot
PCT agreed this should be commissioned through
PBC (need)
Mid Devon, Exeter, Torbay, North Devon,
Teignbridge, South Hams West Devon Plymouth
PCTs all approached
Plymouth PCT said COPD care pathways group would
need to agree
COPD Stakeholder events for NSF attended
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Integrating Community Pharmacy with PBC

• Group Discussion
• What do we do already which could be integrated?
• 10 minutes

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Integrating community pharmacy making a
difference
Current Provision
Case Managed
Case Managed Disease/Care managed
Medicine Supply Medicines Management Concordance/C
ompliance Screening/Monitoring Healthy lifestyle
promotion Signposting Support for Self care
Pharmacy Zone
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Integrating Community Pharmacy making a
difference

• Targeted Medicines Use Reviews
• Asthma
• COPD
• Osteoporosis and at risk of falling
• Parkinson's Disease
• Diabetes
• Making MURs work for patients, GPs and CP

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Contact details

• Sue Taylor
• sue_at_devonlpc.org
• Jonathan Kerr
• jonathan_at_devonlpc.org