Black Country and West Birmingham STP

1. Black Country and West Birmingham STP Integrated Pharmacy and Medicines Optimisation Regional Engagement Event

2. Welcome and Introductions • Please tweet! • #IPMO Housekeeping Wifi access Plan for the day

3. Plan for the day

4. Black Country & West Birmingham STP/Integrated Care System Update Dr Helen Hibbs MBE Senior Responsible Officer, Black Country and West Birmingham STP

5. Our vision

6. Leadership and governance Over the last three years, the STP has provided us with a framework to transform our local health and care system in the Black Country and West Birmingham. It has enabled us to act systematically and together - to agree and address common challenges in a way that we could not as individual organisations. • Senior Responsible Officer, Dr Helen Hibbs Independent Chair, Jonathan Fellows • Portfolio Director, Alastair McIntyre • STP Programme Management Office (PMO) Team • STP Clinical Leadership Group – monthly • Establishing clear, robust and manageable processes to provide clinical leadership and assurance across work programmes • STP Partnership Board - quarterly • Sets the vision, strategy and pace of STP development • Overseas the delivery of the Partnership • Ensures effective collaborative working • STP Health Partnership Board - monthly • Identifies and advances collaborative priorities across the health system • Overseas delivery of national NHS targets • Aligns integrated, place-based delivery in each locality

7. Future model for delivering integrated care Networks Services wrapped around and delivered by GP Primary Care Networks Our five places support the integration of health and care services focussed around the patient. This includes: acute, community mental health, local authority and voluntary sector services. Place • The STP Partnership sets the vision, strategy and pace of system wide development. It will oversea the delivery of the Partnership and ensures effective collaborative working. • This is supported by: • STP Health Partnership Board • Black Country Joint Commissioning Collaborative • STP Clinical Leadership Group System Region NHS England will continue to directly commission some services at a national and regional level, including most specialised services.

8. Our Integrated Care System (ICS) Roadmap Our ICS roadmap is structured around five key workstreams. The roadmap outlines the activities, milestones, delivery and resources to ensure we are on track to reach ICS status by 2021

9. Progress to date across the STP Joint plans for workforce development from HEE budget NEWSpecialist Community Perinatal Mental Health Service Launched NEWBlack Country Pathology Service Plans to develop a BCWB Academy

10. Black Country & West Birmingham Clinical Strategy Building on our strong place-based integration and financial performance, clinical leaders have developed an STP clinical strategy, which is clinically led. It will make a difference to local patients by: Reducing unwarranted variation and duplication across health and care services Helping to address the triple aim: improve people’s health, improve the quality of services and deliver financial stability. Ensuring the services we deliver are of the highest quality and sustainable. Ensuring clinical services are delivered with a workforce equipped to deliver.

11. Clinical priorities Our clinical leaders have identified 12 priority areas: Cancer Mental Health Learning Disability Services Maternity and Neonates Children and Young People Urgent and Emergency Care Cardiovascular Disease Pathology and Interventional Radiology Primary Care Musculoskeletal conditions Respiratory Disorders Frailty

12. Long Term Plan – Implementation Our local five year plan will be aligned with the following principles: Clinically-led Locally owned Realistic workforce planning Financially balanced Delivery of all commitments in the Long Term Plan and national access standards Phased based on local need Reducing local health inequalities and unwarranted variation Focussed on prevention Engaged with Local Authorities Driving innovation

13. Long Term Plan - Delivery Foundation plans for years one and two: Transforming out of hospital care and fully integrated community based care Reducing Pressure on emergency hospital services Giving People more control over their health and personalised care Digitally enabled primary and outpatient care Better care for major health conditions: improving cancer outcomes, Mental Health, shorter waits for planned care All areas to become ICS by 2021 Focus on population health management

14. Long Term Plan - Delivery Staged implementation years two and five: More NHS action on prevention Strong start in life for children and young people Learning disabilities and autism Better care for major health conditions CVD, Stroke, Diabetes, Respiratory Disease Research and development Genomics Volunteering

15. Local medicines optimisation priorities Transfer of care around medicines (TCAM) Medicine reconciliation and improving communication after discharge Medicine Safety Hospital admissions related to medicine Mental Health and Learning Disabilities Stopping over medicating people (STOMP) Workforce Pharmacy workforce review Polypharmacy (over prescribing) Medicine reviews to help patients on multi-medications

16. Pharmacy and Medicines Optimisation in a Collaborative System Richard Cattell, Deputy Chief Pharmaceutical Officer 24 July 2019 NHS England and NHS Improvement

17. The NHS Long Term Plan outlines the ambitions for the NHS and clinical pharmacy has never been more importantMedicines are at the heart of the key themes of cancer, cardiovascular disease, diabetes, respiratory medicine and stroke care WHO Medication Without Harm…..Rethinking Medicine……Me and My Medicines……Choosing Wisely….. Realistic Medicine…..Canadian Deprescribing Network…..English Deprescribing Network

18. NHS Long Term Plan sets the context and themes for us all for 2019-2029 The NHS Long Term Plan is about integrating services around the patient more effectively, and making inroads into the major ‘killer’ diseases and causes of ill health. Its three main ambitions: 1. Making sure everyone gets the best start in life 2. Delivering world class care for major health problems 3. Supporting people to age well Ambitions underpinned by action to overcome specific challenges: Personalised care, Prevention and health inequalities, Workforce, Data and digital technology, Delivering better value 18 l NHS England and NHS Improvement

19. NHS Long Term Plan direction of travel for pharmacy

20. The aim is integrated medicines optimisation led by clinical pharmacists Development of PCNs by July 2019 and ICSs by April 2021 • 2019/20: • AMR National Action Plan • GP contract Quality Improvement module on prescribing safety • National Patient Safety Strategy – Medicines Safety Programme • Public Health England Review into Dependence Forming Medicines • Integrated Urgent Care – roll out of NHS Community Pharmacist Consultation Service • Community Pharmacy Contractual Framework • 2020/21: • GP contract national service requirements including Structured Medications Review and Optimisation and Enhanced Health in Care Homes • National Overprescribing Review report Supported by Interim People Plan, published June 2019, and final plan due in Autumn 2019

21. Framework for system-wide pharmacy integration is via the PCN NHSE / NHSI DHSC • CPhO and Deputy CPhOs • Medicines and Pharmacy Policy Directors National HEE PHE Regional Medicines Optimisation Committees • Regional Chief Pharmacists Pharmacy Deans Regional Controlled Drug Accountable Officers Specialist Pharmacy Service • Clinical Directors of Pharmacy and Medicines Long Term Plan Implementation ICS • PCN Clinical Directors • PCN Clinical Pharmacy Team Local integrated Care • CCG Pharmacy Team • Specialist Pharmacy Team • Acute • Mental health • Patient • Urgent Care Pharmacy Team • Community Pharmacy Team 21 l NHS England and NHS Improvement

22. Vision for the integrated clinical pharmacy team • All pharmacists and pharmacy technicianssupporting patients are part of the multi-professional team in a PCN • Clinical pharmacists are a central part of the PCN team • Community pharmacy teams deliver consistent, high-quality minor illness care and support the public to live healthier lives • Community pharmacists have capacity to deliver more clinical care • Hospital and mental health pharmacists continue to be part of specialist teams and extend their practice into primary care, including providing consultant pharmacist support • CCG pharmacy teamsleading on population health • Consistent delivery of these goals will require clinical and professional leadership across the health and care system, by Regional Chief Pharmacists and proposed Clinical Directors of Pharmacy and Medicinesin each ICS 22 l NHS England and NHS Improvement

23. Workforce planning and development are priorities • Interim People Plan – The Vision for Pharmacy: • Ensure the initial education and training of pharmacists and pharmacy technicians creates the right workforce in the right place • Introduce new approaches to cross-sector pre-registration and postgraduate clinical training pathways • Deliver a cross-sector foundation programme for all newly-registered pharmacists • Intention to develop a professional framework for pharmacy technicians • Reform undergraduate and pre-registration training • Create routes to progress to higher levels of practice • Appointment of senior and experienced NHS pharmacists as clinical directors of pharmacy and medicines optimisation in each ICS • Enable ICSs to deliver the NHS Long Term Plan through national and local management of workforce demand and supply • Attract more, and a wider pool of, people to the pharmacy professions by improving the image and reputation of the pharmacy professions • Key IPP themes: • Making the NHS the best place to work • Improving the leadership culture • Tackling the nursing challenge • Delivering 21st century care • A system wide board will oversee the delivery of the NHS Long Term Plan pharmacy workforce plans, to enable a focus on the key activities, and ensure engagement with stakeholders

24. Advancing Pharmacy Education and Training Review report 1. NHS pharmacy workforce needs to continue to meet the highest professional standards, underpinned by a rigorous, more clinically-focused, career-long framework of training and education to benefit patients2. Recommendations based on an analysis of existing evidence and reflecting best practice across the career stages3. Timely in considering the supporting infrastructure to deliver the NHS Long Term Plan4. Transformational changes for foundation level pharmacists to equip with skills for the vision in the NHS Long Term Plan5. GPhC review of initial education and training shows need to ensure that newly registered pharmacists are ready for multidisciplinary teams and working flexibly in patient facing roles6. Opportunities to stretch to advanced and consultant practice7. Pharmacy technicians to embrace new training and roles too 24 l NHS England and NHS Improvement

25. Integrating Pharmacy and Medicines Optimisation into an ICS and PCNs Richard Seal, Regional Chief Pharmacist (Midlands and East) 24 July 2019 NHS England and NHS Improvement

26. RMOCs: • Important role as move towards system approach • Focus is on medicines optimisation programmes – best value biologics; polypharmacy; AMR; shared care • Variation between and within regions • Ensure alignment with APCs Working together to deliver medicines optimisation • Secondary care: • Electronic Prescribing and Medicines Administration rollout • Getting it Right First Time • Clinical research • Primary care: • Clinical pharmacists in PCNs • Structured medications review and optimisation • Enhanced health in care homes • New Medicines Service • Social prescribing 26 l NHS England and NHS Improvement

27. Role of the clinical pharmacy team in a PCN • Provide a focal point for collaborative working across the different pharmacy providers including hospital, mental health and community pharmacy • Teams will be supervised by a senior clinical pharmacist, to support professional and career development at a network level • Posts are clinical and person-facing • Will receive support and supervision to allow them to do the job safely and confidently Clinical pharmacists: • 18-month training programme to ensure competence and confidence to consult directly with patients, working in a multi-professional team • Supported to become independent prescribers • Undertaking structured medication reviews, improving medicine optimisation and safety, improving antimicrobial stewardship, supporting care homes, as well as running practice clinics • Advocates of medicines optimisation and safety and embed principles of shared decision-making 27 l NHS England and NHS Improvement

28. Network contract service requirements • Many will include direct involvement of clinical pharmacists • Collaboration with providers, including community services and community pharmacy, to deliver • Will include standard national processes, metrics and expected quantified benefits for patients • Designed with stakeholders, and part of the formal contract negotiations • Published 2020 as part of changes to Network DES Specification

29. Education and training for PCN clinical pharmacists • Clinical pharmacists employed through the network contract funding will either be already undertaking, need to enrol in or have qualified from an accredited training pathway • NHSE&I and HEE have arranged a new Primary Care Pharmacy Education Programme to allow all clinical pharmacists in PCNs to access and complete an accredited training pathway if required • All appointed undergo a robust learning needs assessment with their education supervisor to plan development   • While some will have done other qualifications, this content may not align fully with the outcomes required of a PCN pharmacist • No need to repeat education but NHSE/NHSI needs to be assured, e.g. a person may need to revisit learning (not repeat a qualification) and develop a plan and portfolio to build skills Primary Care Pharmacy Workforce Survey completed: To capture the national educational needs of the pharmacy workforce in primary care

30. Role of the clinical pharmacy team in a PCN: Community pharmacy • Community pharmacy will focus more on its clinical role managing the minor illness aspects of urgent care, and supporting patients to prevent ill health • It will need to have strong links with PCN clinical pharmacists • Working with GPs to deliver their obligations under the network contract DES: • There could be a delivery role in areas such as CVD early detection and prevention and awareness of cancer symptoms • Some community pharmacists could be recruited to work in PCN clinical pharmacist roles, for which they would do the additional 18-month training, and which would not involve dispensing • Community pharmacy providers could be providers of clinical pharmacists to PCNs • Key areas of focus: • Urgent care and minor illness • Prevention and public health • Supporting medicines optimisation and safety

31. NHS Community Pharmacist Consultation Service (CPCS) • NHS Long Term Plan signals rollout across England, subject to contract negotiations • Initial design work underway with NHS Digital to develop 111Online referral pathway to CPCS • CPCS national stakeholder group involves BMA and RCGP • National evaluation is ongoing Estimate up to 6% of all GP consultations (up to 20m appointments a year) could be safely transferred to a community pharmacist [GPFV] Fast and convenient access to clinical advice for patients with minor illnesses NHS111 referral to a community pharmacist: • 4 pilot sites – North East, East Midlands, London, Devon • Now rolling out to all community pharmacies from 1 October 2019 GP practice referral to a community pharmacist: • Pilot sites being developed through to March 2020 • First phase: 5 sites Summer 2019: Cheshire and Merseyside STP, Lancashire and South Cumbria ICS, North East and North Cumbria ICS, Greater Manchester ICS, Bristol, North Somerset and South Gloucestershire STP – 30 practices and 67 pharmacies • Second phase in Sept/Oct 2019 • Commission nationally from April 2020 if it demonstrates value for money 31 l NHS England and NHS Improvement

32. The development of the Integrating Pharmacy and Medicines Optimisation into an ICS programme ICSs set up to coordinate services, agree system-wide priorities, and plan collectively how to improve the health of the local population IPMO programme to develop the principles for integration for pharmacy and to test different models ICSs benefit from considering medicines optimisation and pharmacy activities as a cross-cutting theme, rather than as a standalone item or as ‘medicines management’ Needs strategic coordination in an ICS, encompassing local knowledge of the population, processes and relationships and, critically, a willingness to work beyond the natural walls of individual organisations Senior NHS pharmacists, from across NHS settings, to set the direction for the local system to ensure there is collaboration Their expertise vitally important in supporting ICS boards and programmes on the use of the pharmacy workforce and medicines optimisation 32 l NHS England and NHS Improvement

33. A project to establish an ICS Clinical Director of Pharmacy and Medicines who is accountable for, and the governance structure for decision-making about, NHS-funded pharmacy and medicines optimisation across an ICS and its PCNs IPMO Programme – outline Black Country STP (Midlands) Cumbria and North East STP (North East) Dorset ICS (South West) Hertfordshire & West Essex STP (Central & East) Lancashire & South Cumbria ICS (North West) South East London STP (London) Surrey Heartlands ICS (South East) Developing the potential to link PCNs and clinical, community and hospital pharmacy together across the NHS system through a clinical and professional leadership function Pilots developing plans for delivery of national priorities and contribution to ICS priorities and for a flexible clinical pharmacy workforce across a PCN 33 l NHS England and NHS Improvement

34. IPMO Programme – progress and next steps • NHS pharmacy system developments: • Regional chief pharmacists, RMOCs andpharmacy deans: Working with and supporting teams across England • ICS leadership: Seven Integrating Pharmacy and Medicines Optimisation into an ICS pilots completed; framework developed and next steps agreed for development of Clinical Director posts • Primary care networks: • 900+ pharmacists in Clinical Pharmacists in General Practice scheme offered transition to PCN workforce scheme • Up to 6 additional clinical pharmacists will be appointed in each PCN by 2024 • Some PCNs appointing pharmacists as clinical directors • IPMO next steps: • Framework due to be published in August 2019 • Including 7 case studies from the ICS pilots • Further develop governance framework for IPMO and evaluate • Pilot project to continue for two years and roll-out to other STP/ICSs • Regional chief pharmacists continue to lead 34 l NHS England and NHS Improvement

35. Engaging with PCNs Expectation that practices will work collaboratively with others, dependent on the needs of the local population Network Contract DESwill be amended from 2020/21 to include collaboration with non-GP providers as a requirement • Network Agreement outlines how practice(s) and other partners work together • PCN engagement with pharmacy likely to take place from July 2019 onwards • For community pharmacy – working through the LPC which would work with the LMC to facilitate community pharmacies to develop and negotiate a coherent offer • Chief pharmacists in providers and CCGs, should begin talking to CCG heads of primary care and PCN clinical directors to discuss how they can work with the PCN • Clinical pharmacists who are transitioned into PCNs and new PCN clinical pharmacists are encouraged to work with other pharmacists in general practice and community pharmacy teams

36. Engage with us Sign up for the quarterly Pharmacy and Medicines Bulletin: https://www.england.nhs.uk/email-bulletins/pharmacy-and-medicines/ Recording of ‘Working with Pharmacy’ webinar – request access to the site via england.PCN@nhs.net Upcoming pharmacy podcast at www.england.nhs.uk/pcn Primary care networks: A briefing for pharmacy teams: https://www.england.nhs.uk/wp-content/uploads/2019/06/pcn-briefing-for-pharmacy-teams.pdf Primary Care Pharmacy Education Pathway: https://www.cppe.ac.uk/career/pcpep/pcpep-training-pathway English Deprescribing Network: Raise awareness and skills around deprescribing among healthcare professionals and highlight the need for it to be part of appropriate patient care Increase the use of shared decision-making when agreeing treatment options with patients Contribute to the development of a national strategy to avoid harm caused by inappropriate polypharmacy www.sps.nhs.uk/networks/English-deprescribing-network/ @EDeprescribeN eden@deprescribingnetwork.com

37. Ruckie Kahlon Associate Director of Medicines Optimisation and Chief Pharmacist Dr Duncan Jenkins Specialist in Pharmaceutical Public Health IPMO in the Black Country and West Birmingham STP

38. IPMO in the Black Country and West Birmingham STP Our STP footprint and member organisations

39. Pharmacy Integration • The Integrated Pharmacy Medicines Optimisation pilot will produce the following outputs in 2019/20: • Describes how pharmacy interacts with each part of the system • A pharmacy and medicines leadership structure • A “plan on a page” for delivery of national priorities related to pharmacy and medicines optimisation • A “plan on a page” for developing a flexible clinical pharmacy workforce over the next two years • A stakeholder engagement plan.

40. IPMO in the Black Country and West Birmingham STP How it all began… Why the Black Country and West Birmingham STP Historical strong collaborative approach and shared vision Birth of Strategic Pharmacy Leadership Group Our model demonstrates system leadership that is collaborative and crosses boundaries

41. IPMO in the Black Country andWest Birmingham STP Identification of local work streams with short and longer-term goals Project prioritisation! Future-proofing post-IPMO pilot?

42. Clinical Strategy and STP Working Groups Pharmacy Leadership Group actively assessing opportunities to link into the clinical work-streams

43. Michelle Haddock and Satnaam Nandra IPMO Programme Co-managers The IPMO Programme Manager’s Perspective

44. Programme Manager Role • IPMO pilot site privilege! • Funded 0.8 WTE via Pharmacy Integration Fund until Feb 2020 • Joint-programme managers seconded; primary care and secondary care expertise • Maintained links with own Organisations strengthens role • Provide project leadership and expertise across all work streams • Collaborate across the STP footprint ensuring: • Consistency • Harmonised approach • Communication • Develop understanding of local requirements for integration sustainability • Fantastic challenge and opportunity to standardise medicines optimisation across the STP – scaling great practice to support patient care!

45. IPMO Immediate Priorities STOMP LD Pharmacy Workforce Medicines Safety TCAM Polypharmacy IPMO Programme Leads Opportunities Challenges IPMO Work Stream Leads Clinical Leadership Group Pharmacy Leadership Group STP Programme Leads Local Pharmaceutical Committees External Stakeholders Black Country STP Board

46. Dr Duncan Jenkins Specialist in Pharmaceutical Public Health Workstream Headlines Workforce

48. Hemant Patel Head of Medicines Optimisation Wolverhampton Clinical Commissioning Group Workstream Headlines Transfer of Care Around Medicines (TCAM)

49. Transfer of Care Around Medicines (TCAM)

50. Clair Huckerby Consultant Pharmacist Primary Care Dudley Clinical Commissioning Group Workstream Headlines Medicines Safety