Wrightington, Wigan and Leigh NHSFT HPTP Plan

  1. Executive Summary

During the last 10 years, we have modified and restructured our pharmacy services at Wrightington, Wigan and Leigh so that many of Lord Carters aspirations have already been met or will be met well before the deadlines set. This will be supported by the newly formed GM Devomanc HPTP collaborative which will support transformation across Greater Manchester in a way that individual trusts could not. It is anticipated that the combined programme of local change and GM transformation will yield a modernised and efficient service for patients which is safe, caring and effective.

  1. Carter Metrics and Model Hospital benchmarks
    Unfortunately the data from the NHSI productivity website was that belonging to Warrington NHS FT. This is being corrected but direct comparators are therefore impossible at present time though we do believe that previous benchmarking data in 2014 showed us to have lower staff numbers than peers running multi-site pharmacy services.

In the past five years we have already re-provided our pharmacies at Leigh infirmary, our pharmacy store, our aseptic services and are currently re-providing our pharmacy service at Thomas Linacre OPD. We thus have a strong history of transformational change delivering efficiency to the local Health Economy.

4 years ago we also restructured our clinical and infrastructure service to provide 7 day services well before the political clamour to do so. We now run a 7 day clinical pharmacy and supply service across 4 sites. We have full clinical services on the acute site 7 days a week with all admission wards on that site having a visit every day. Our medical admissions areas benefit from 12- 15 hours per day pharmacist and technician time each, mirroring the weekday services.
At weekends we support all new admissions, see patients with new medication requests and any follow up patients identified by our colleagues. Our weekend staffing has been increased to match demand from a mixture of investment and further skill mix reviews. This review continues as hospital services increasingly transform to provide 7 day services.

In the past month we have commenced a service in to A&E to support the trusts performance metrics, more effective medicines management and improved compliance with clinical metrics such as Sepsis 6.

We had prior to implementation of Electronic Prescribing, one of the highest Medicines Reconciliation figures in the North West with monthly totals in excess of 90%. We were early adopters of SCR and MIG ( a different form of SCR ) and these are routinely and extensively used by our pharmacy teams to support effective medicines reconciliation. Data post EP is awaited for evaluation.

We have increased our incident reporting for medicines related events so that we are the best reporting trust pro –rata to beds in the GM patch. This has been transformational in the way we deal with adverse events and how we prevent them in future, sometimes sharing learning on sentinel events with NHSE.

We have agreement to set in place a Bio-similar switch programme for Rheumatology and Gastroenterology. New patients are being commenced on the agents now and existing patients will be transferred, with clinical supervision, commencing in early 2017. Biosimilars for cancer care will be adopted in due course and dose banded chemotherapy will be implemented by the agreed schedule.

Electronic prescribing is embedded in the trust for inpatient activity and discharges. The trust anticipates that full electronic prescribing for the remaining cancer patients and outpatients will be delivered in 2017 as agreed schedules are met.
We are about to restructure to provide a dedicated manager for high cost drugs, working seamlessly with our Divisions, finance teams, Business Intelligence and our commissioning colleagues. This will ensure we deliver Hackett compliance with all necessary governance arrangements.

We have a strong focus on Antimicrobials in the organisation, working with Infection Control consultants and CCG Medicines Management teams to reduce the number of C Diff infections and ensure an effective anti-microbial formulary that reflects local resistance patterns. Our DDD figures continue to fall as evidenced in Define / Refine reports. This work is embedded into the organisations Infection Control and Medicines Management Strategy Board meetings.

We have committed to ensure all pharmacists above band 6 can be prescribers and continue to support all Medicines Management Technicians to become accredited checkers thereby improving efficiency and patient outcomes.

Staff sickness, training and appraisals continue to perform better than the trusts targets though turnover has been significant with CCG’s offering our highly trained band 7 and 8a pharmacists working patterns that acute trusts cannot ever deliver. This point needs to be reflected in the overall discussions with NHSE and Commissioners to ensure trusts are not destabilised by the process of constant training and throughput of new staff.

Overall we have and continue to make progress towards Carters metrics. Our Senior Manager team in pharmacy and our GM Collaborative , supported by the relative Boards are committed to achieving the required changes before the deadlines.

  1. HPTP Plan Summary

Locally we will deliver the remaining elements of EP within 2017 and the bio-similar switch programme will deliver continued benefits throughout 2017. Local changes to pharmacy structures will improve effectiveness and delivery of Carter metrics from early 2017 onwards.

GM Level - Standardising Clinical Support and Corporate Functions- Transformation Theme 4

The Greater Manchester Hospital Pharmacy Transformation Collaborative (GMHPTC) has been established as part of health and social care devolution in Greater Manchester. GMHPTC is a distinct project within Transformation Theme 4- Standardising Clinical Support and Corporate Functions and is supported by the Acute Trust Provider Federation. GMHPTC reports to the GMHSC strategic partnership board and is challenged with delivering hospital pharmacy recommendations form the Carter report. The project will have access to transformation funding via the strategic partnership.

Collaborative membership, as detailed below, depicts a diverse and all-encompassing participation form healthcare providers across GM and beyond. This level of collaboration ensures unwarranted hospital pharmacy variation can be challenged across a complete GM healthcare footprint and permits hospital pharmacy efficiency and productivity to be scrutinised across the region as a whole.

GMHPTCmembership

5 Boroughs Partnership NHS FT / Bolton NHS FT / Central Manchester University Hospital NHS FT
East Cheshire NHS Trust / Greater Manchester West NHS FT / Manchester Mental Health and Social Care Trust
Pennine Acute
Hospital NHS Trust / Pennine Care NHS FT / Salford Royal NHS FT
Stockport NHS FT / Tameside and Glossop Integrated care NHS FT / The Christie NHS FT
University Hospital of South Manchester NHS FT / Wrightington, Wigan and Leigh NHS FT

Reviewing local and regional provision of infrastructure services is a focus for the GMHPTC and scoping many of the services detailed in the Carter report has already commenced.

Variable infrastructure services currently under GMHPTC review:

Supply Chain Management

McKesson, on a consultancy basis, are supporting GMHPTC Trusts in undertaking a comprehensive assessment of the pharmacy supply chain across the region. Data from the collaborative has been provided for review and analysis and detailed visits to Central Manchester NHS Foundation Trust and Stockport NHS Foundation Trust have been conducted. The final report, detailing a summary of McKesson’s findings, innovative practice and a series of options for the GMHPTC to consider will direct future supply chain work streams and will be available before the end of the calendar year.

Greater Manchester Patient Own Drug (POD) Campaign

The use of patients’ own drugs throughout hospital admission is a quality initiative that many Trusts have explored in the past. Launching a GMHPTC campaign across the region will revive historic programmes and will communicate, with consistency, how patients and Healthcare professions should manage patient own medication on admission into hospital. Administering PODs can lead to fewer missed doses and reduces patient confusion on discharge as familiarity with medication supports adherence. This campaign also aligns with the NHS financial agenda as medication will not have to be reissued from Hospital pharmacy stock. Reduced inpatient dispensing, supporting Lord Carter’s recommendations, will also create additional workforce capacity to invest in direct medicines optimisation activities.

Variable infrastructure services awaiting GMHPTC review (2017/18):

The following reviews have been prioritised by GMHPTC and scoping will commence in the coming months.

Aseptics strategy across GM- Initially a scoping exercise will review aseptic resource and capacity across the region. Once understood the collaborative aseptic strategy can be developed ensuring demand across GM, and potentially beyond, is achieved. Various delivery proposals will be considered as part of this review.

Outpatients and Homecare- review current service delivery models across GM identifying potential opportunities to enhance, transform and collaborate.

Education and training programme- ensure Trusts across GM are working to common clinical standards, reducing variation in service provision. Training for pharmacists and technicians will be standardised and utilising higher level apprenticeships will be explored. As a priority NMP training for pharmacists will be reviewed to increase the number of actively prescribing pharmacists across the region.

Medicines information- Understand local service provision and then, in conjunction with the on-going SPS review, explore delivery options across GM.

Research and Development- common Clinical Trial SOP’s need to be developed and adhered too. A collaborative approach to R&D service provision will be explored.

Risks and mitigations

GMHPTC risks

Capital risk- Insufficient capital to invest in hospital pharmacy transformation solutions has been identified as a risk by the collaborative as restricted funding would impact on identified service improvements. The creation of the Finance Executive Group (FEG), by the GMHSC board, helps to mitigate this risk as the FEG will identify and manage financial risks associated with the delivery of the GM Strategic Plan.

Workforce capacity- due to the abundance of initiatives currently taking place across GM (Manchester Single Hospital Service, creating hospital chains across the region, Carter/HoPMOp implementation) there is a risk that some organisations won't have the capacity to deliver additional transformational work while still meeting local operational demands. Consequently this would impact on agreed transformational deadlines and delay service enhancement.
Local risks for medicines management are detailed within the trusts risk register. The major risk to transformational change at local level will undoubtedly be maintenance of safe and effective staffing levels during such a period of flux.

  1. Issues and mitigations

Information Management and Technology- across GM we recognise IM&T is a critical dependency which underpins our capability to deliver many of our transformation plans. In response GMHPTC will initiate discussions with pharmacy IT providers, combining with GMHSC Transformation Programme theme 5- IM&T, to determine how limitations can be overcome.

Local Contracts- throughout the collaborative existing provider contracts will impact the delivery of infrastructure reviews and service redesign. Strategically this will be taken into consideration whilst project plans are being developed.
Local mitigations to safe staffing will be discussed within Workforce planning at local level initially but GM Level as transformational change accelerates.