Local Enhanced Service Specification For

Local Enhanced Service Specification for

Weight Management Provision in Pharmacies

CONTENTS

INTRODUCTION PAGE 3

SERVICE OBJECTIVES AND INTENDED PAGE 3

HEALTH OUTCOMES

THE PROPOSAL & PAYMENTS PAGE 3 - 4

DURATION PAGE 4

GUIDELINES FOR WEIGHT MANAGEMENT PAGE 5

SERVICES IN PHARMACY

CLAIMS PROCESS CRITERIA PAGE 6

CRITERIA FOR THE PROVISION OF WEIGHT PAGE 7 - 8

MANAGEMENT SUPPORT IN PHARMACY

FEEDBACK TO PRACTICES PAGE 8

CONTACTS PAGE 9

APPENDIX A – TEMPLATE LETTER TO PATIENTS

APPENDIX C – Claim form for completing consenting paperwork (Follow Up) - Week 12

APPENDIX D –Weight Management by pharmacy signature form

APPENDIX E – ADULT OBESITY CARE PATHWAY

REFERENCES

Local Enhanced Service for

Weight Management Provision in PHARMACies

INTRODUCTION

NHS Walsall, in line with NICE guidelines[1], ‘Choosing Health’ priorities[2] and its own strategy for the prevention and treatment of overweight and obesity in Walsall[3], has developed a Local Enhanced Service (LES) to reimburse Pharmacies who provide weight management services to patients in Walsall. The scheme will propose a LES contract with Pharmacies in Walsall for an additional payment and is subject to a six month review to take account of future developments in service needs and of changes in the NHS regulations.

SERVICE OBJECTIVES AND INTENDED HEALTH OUTCOMES

·  To reduce the number of overweight patients who have a Body Mass Index (BMI) greater than 25 kg/m2 (22 kg/m2 for South Asian patients) and obese patients who have a BMI greater than 30 kg/m2 (27.5 kg/m2 for South Asian patients).

·  To improve patients’ diet and nutritional intake, increase levels of physical activity and promote sustained weight loss in overweight and obese patients.

·  To encourage and support healthcare professionals to enhance their management of overweight and obese patients.

·  To reduce BMI levels in areas where there are particularly high levels of health inequality.

·  To improve access to overweight and obesity management services in pharmacies.

·  To increase Walsall tPCT’s availability of patient information relating to how people could benefit from the services proposed and obtain more accurate information regarding overweight and obesity prevalence.

THE PROPOSAL & PAYMENTS

As from 01/08/2010 individual pharmacies who register as part of the LES can receive a maximum payment of £55 per patient supported through a structured weight management programme (as defined on page 5), provided by the pharmacy staff trained and accredited to provide weight management support by NHS Walsall.

All payments will be given after the patient has completed the 12 week programme and is structured in the following way:

·  Registration and signposting and providing information on physical activity - £15

·  Patient achieving 5% or more weight loss of their original weight by their last appointment- additional £40

A monitoring form must be completed for each patient and patient information entered onto the practice clinical software obesity template.

The number of monitoring forms, combined with system generated information regarding the patient’s visit on the fourth week, will verify the claim for the number of patients participating in the service, once received by the TPCT.

Payment will be made to pharmacy accounts and is non-superannuable. Payments will be made by BACS, separate from Quarterly Statement of Fees and Allowances payments.

DURATION

This LES will run from 01/09/2010 to 01/04/2011. These guidelines are subject to an on-going formal review and will inform the end of year (2011) service review which will be used to determine if the service is to be extended or decommissioned. Any variations will be discussed and agreed by both parties and will be included as additions to this local enhanced service agreement.

Guidelines for Weight Management Services in Pharmacies[1]

Walsall Weight Management Services

This intervention may be conducted by any member of the Pharmacy Team* who has trained with, and is accredited by, Walsall NHS to deliver weight management.

* Pharmacists

* Pharmacy Assistants

* Counter Assistants

Intervention (Week 1) – First Appointment (20 – 30 minutes- will be longer if groups are being delivered)
Initial assessment & setting target weight loss at 12 weeks
·  Assess motivation.
·  Discuss & agree individual plan including weight management record card. Realistic target weight in line with NICE Guidance is to lose 5% of their weight
·  Weigh and measure the patient providing information on BMI.
·  Discuss with patient suitable physical activities and refer to appropriate local services (e.g. Walsall Community Health or leisure services)
·  Measure Waist Circumference.
·  Complete monitoring information.
·  Arrange weekly follow up appointment
Intervention (Weeks 2 & 3) – (10 minutes- will be longer if groups are being delivered)
Progress review
·  Review progress against individual patient plan and towards goal.
·  Aiming for a maximum weekly weight loss of 0.5-1kg in line with NICE Guidance
·  Weigh and measure the patient providing information on BMI.
·  Discuss any problems and how these can be overcome.
·  Reinforce the importance of physical activity and the services available
Intervention (Week 4) – (10 minutes- will be longer if groups are being delivered)
Progress review
·  Assess progress against individual patient plan and towards goal.
·  Weigh and measure the patient providing information on BMI.
·  Record changes on system and complete monitoring form.
·  Discuss any problems and see how these can be overcome
·  Reinforce the importance of physical activity and the services available
·  Arrange follow up appointment fortnightly
Follow Up (Week 6, 8, 10) – (10 minutes- will be longer if groups are being delivered)
Progress review
·  Review progress.
·  Weigh and measure the patient providing information on BMI.
·  Discuss any problems and see how these can be overcome
·  Reinforce the importance of physical activity and the services available
·  Arrange final follow up appointment
Follow Up (Week 12) – (10 minutes- will be longer if groups are being delivered)
Target review
·  Review progress.
·  Weigh and measure the patient providing information on BMI.
·  Measure Waist Circumference
·  Record changes on system and complete monitoring form.
·  Congratulate if successful and offer self help materials to support weight maintenance or if unsuccessful refer to other services within the pathway.

This intervention and process is based on the existing evidence based smoking cessation model currently delivered in primary care across Walsall.

CLAIMS PROCESS CRITERIA

Payment will be subject to the following criteria and regulations:

·  Patients must be seen face to face by the trained and accredited pharmacy staff member and offered one to one or group support.

·  One monitoring form is to be completed for each patient supported through the weight management attempt. Note – A period of 6 months must elapse before a further weight loss attempt is made, unless relapse has been the result of exceptional circumstances.

·  The patient must sign the monitoring form.

·  All sections of the monitoring form and Patient Medical Record (PMR) must be completed.

·  The trained and accredited pharmacy staff member that provided the intervention should complete the monitoring form and input data onto the PMR.

·  Monitoring forms, with signed consent, must be returned attached to the claim form at the end of each month. Forms must be returned on time in order for payment to be issued.

·  The trained and accredited pharmacy staff member must sign the claim form.

·  Payment will only be issued when correctly completed monitoring forms and claim forms have been returned and verified by the Healthy Weight Team.

·  Incomplete monitoring forms will be returned to the accredited pharmacist staff member to be properly completed and payment will not be issued until the form is returned correctly.

·  Payment will be made to the Pharmacy..

·  Only pharmacies that have members of staff who have participated in the Walsall ‘Weights Over’ training course and who are therefore accredited service providers will be eligible to receive this payment.

Please note random checks will be made on the information supplied in the monitoring form and will be assessed as part of the Community Pharmacy Assurance Framework.

CRITERIA FOR THE PROVISION OF WEIGHT MANAGEMENT SUPPORT IN PHARMACY

As a payment will be made for support through the weight management programme, the payment is subject to the quality provision and standard level of support. The following are the minimum standards of service provision by which service providers must adhere. All providers will be issued support materials to assist ongoing quality provision of service.

·  The accredited pharmacy staff member providing the support must have been trained for their role.

·  Support should be offered for the full duration of the 12 week weight management programme. This will include a weigh in and discussion around the patient’s progress and issues they may have.

·  The initial consultation should last between 20 and 30 minutes (would be longer if holding group sessions) involving assessment of motivation and readiness to lose weight, and advice on diet and physical activity.

·  Only those who are motivated to lose weight should embark on the programme.

·  There must be an accurate assessment of each patient’s suitability for participating in the weight management programme.

·  Up-to-date records for each patient starting the programme must be kept. Reports containing aggregated data (not patient identifiable) from these records may be generated by the Weight Management Team to ensure this procedure is being adhered to.

·  The health professional that provided the initial intervention should, wherever possible, carry out all contacts including weekly for the first 4 weeks and fortnightly there after up to the 12th and final week.

Please note three attempts to contact the patient for any appointment must be made; two by phone and one in writing. If after these three attempts the patient cannot be contacted, the patient can be recorded as ‘being lost to follow-up’. A copy of the letter sent to the patient should be attached to the monitoring form and dates of phone calls should be recorded.

A standard letter for your use is attached in Appendix A.

·  All patients must be weighed using the appropriate measuring device. It is the responsibility of the accredited pharmacy staff member to ensure they are weighed and that the weighing equipment is calibrated and in working order.

·  In the event of the patient not losing weight or for maintaining weight, they should be referred into another service within the obesity pathway, on 01922 605432, and a range of further options will be proposed. For further information see the pathway shown in Appendix D.

·  Service providers should attend weight management update training when required.

·  The Healthy Weight Team must be informed about any changes to staff and or the provision of weight management services within the pharmacy immediately. Please note that The Healthy Weight Team should also be informed if a weight management service within the pharmacy is to be postponed or suspended.

·  Important – The provision of weight management support in pharmacy will also be monitored through the clinical governance agenda.

FEEDBACK TO PATIENTS

Patient views on their experiences and satisfaction levels will need to be measured through an on-going, systematic process to test whether the service is engaging with patients in a way that supports them. Patient satisfaction surveys will be carried out in order to establish this information.

CONTACTS

Contacts

Susie Gill

Healthy Weight Programme Manager – NHS Walsall

Public Health

Jubilee House

Bloxwich Lane,

Walsall,

WS2 7JL

01922 619958

Finance

Jane Sutton

Management Accountant

Walsall tPCT

01922 618368

APPENDIX A – TEMPLATE LETTER TO PATIENTS

PHARMACY HEADED PAPER

(Patients Name)

(Patients Address)

(Patients Address)

(Patients Address)

(Patients Post Code) Date,

Dear XXXXXX

I am contacting you regarding your weight loss follow-up appointment. As you were unable to attend the appointment scheduled for XXXXXXX I am interested to know how you are getting on.

If you would like to make another appointment please contact the pharmacy on XXXXX XXX to arrange an appointment with myself. However, if you are unable to attend in person please call me on the telephone to discuss your progress.

Yours Sincerely

(Accredited Pharmacy Weight Management Adviser)

APPENDIX C - Claim form for completing consenting paperwork (Follow Up) – Week 12

Month ………………… Walsall Weight Management Service

Name of Accredited

Pharmacy staff member

(Please Print):

Name of Pharmacy

(Please print or

Stamp):

Total number of monitoring

forms attached to this claim:

Number of patients registered & referred to

local physical activity services:

Number of patients achieving 5 % weight loss

at last appointment:

Signed: Pharmacy staff member

Signed: Pharmacy Manager

Monitoring forms must be attached to this claim to be verified and paid.

The claim & monitoring forms must be returned at the end of every month.

Please return to The Primary Care Development Team NHS Walsall, Jubilee House, Bloxwich Lane, WS2 7JL

I declare that I am entitled to claim the payment shown above and that the information I have given on this form is correct and complete, I understand that if it is not, appropriate action may be taken. For the purposes of verification of this claim for NHS funds and the prevention and detection of fraud, I consent to the disclosure of relevant information from this form to and by the Primary Care Trust and the NHS counter Fraud and Security Management Service.

APPENDIX D – Weight Management by Pharmacy- signature form

This document constitutes the agreement between the pharmacy and the PCT in regards to this enhanced service.

I confirm that this Pharmacy wishes to engage with the PCT during 1st September 2010 to 31st March 2011 as per the attached specification.