Collaboration with Pharmacy at a National Level

1. Collaboration with Pharmacy at aNational Level Elizabeth Plant President,Pharmaceutical Society of NZ Inc

2. Collaboration with Pharmacy • Current Situation • Medicines New Zealand • National Strategic Alliances • National Pharmacist Services Framework • Funding Challenges

3. Pharmacy in New Zealand New Zealand Pharmacists under utilised Not integrated into General Practice Generally operate in isolation Funding is fee for service and not patient focused Current Funding model drives prescription volume incentives Legislation requires Pharmacists to dispense No sustainable alternative funding options currently in operation

4. Medicines New Zealand • Medicines Strategy for New Zealand launched in 2007 • Quality, safe and effective medicines • Access to medicines • Optimal use • Identified within the Actioning Medicines New Zealand 2010 Action Plan • “Support initiatives to realise the potential of the pharmacist workforce and address the barriers to the delivery of innovative pharmacy and pharmacist services, including those identified at the health sector workshop in August 2009”

5. Actioning Medicines Workshop 2009 • PSNZ facilitated the workshop on behalf of the Associate Minister Peter Dunne • Six work streams resulted as outputs of the workshop: 1. Define the medicine management continuum and which healthcare provider is involved at what level and for what type of patient group. This will include a review of the National Pharmacist Framework. 2. Carry out financial modelling on alternative funding formulae to identify sustainable alterative options. 3. Identify legislative barriers - what requires change? 4. Develop shared visions, build alliances and clinical networks across and within health professions. 5. Support and facilitate IT initiatives ensuring appropriate, compatible and interoperable. 6. Investigate and report on barriers to access.

6. National Collaboration PSNZ and RNZCGP Strategic Alliance signed in March 2010 Enable two professions to work more closely together for benefit of patient Focus on education CPD Quality Workforce development Meeting the needs across the patient continuum Political advocacy

7. National Collaboration cont’d Strategic Alliance with GPNZ May 2011 Aim - to improve primary health services by progressing models of integrated care Enable cohesive and joint advocacy Demonstrate unified leadership Facilitate strong relationships at national, regional and most importantly at local levels

8. Pharmacy Workforce Forum 2010 • Multidisciplinary Forum • Is Pharmacy Fit for Purpose for 2014 and Beyond? • Five work-streams resulted: • Development of career structure across all aspects of pharmacy • Define educational structure aligned to career paths • Professional capability campaign • Clearly defined model of care across patient groups with agreed collaboration between health providers • Addressing capacity

9. National Pharmacist Services Framework • All Pharmacist services referenced in the Framework • Existing Dispensing Service • Health Education (HE) • Medicines Clinical information Services (MCIS) • Medicines Use Review and Adherence Support (MUR) • Medicines Therapy Assessment (MTA) • Comprehensive Medicines Management (CMM) • Launched in 2007 by DHBNZ and promoted by PSNZ • Currently under review by PSNZ • New services to be developed and added

10. Community Pharmacy Anticoagulation Management (CPAMS) • Aim: to provide a safe, effective and cost effective care acceptable to patients and other health professionals • New model of care - Comprehensive Medication Management (CMM) • Integrated care - an opportunity to make it work • One point-of-care for the patient • Better use of clinically trained pharmacists

11. CPAMS Interim Results • Internationally robust and exceptional • At four months - 671 patients • TTR 77.6% (cp 45-55% av current model) • 85% compliance (99% if add in one to three days late) • Survey responses excellent with positive feedback (100% Pharmacist, 60% Patients and 40% Doctors replied)

12. Collaboration Opportunities • CPAMS has proved that Community Pharmacy can deliver on an integrated care model • Use it for: • Diabetes Management • Cholesterol Management • Mental Health Medication Management • Residential Care Patient Care Management

13. To quote Professor Des Gorman, Chair of Health Workforce NZ- • “A Profession should be operating at the top of it’s scope of practice not the bottom” • Dispensing is a technical function that technicians can and should be enabled to fulfil • Pharmacists are Medication Management experts - use them appropriately!

14. Funding Challenges • Must be patient not prescription centred • Patient groups need different funding approaches • Acute medications • Long term conditions • Special populations (rest homes, NGO mental health residents) will have special dispensing needs eg blister/robotic packs • Targeted populations (specific health initiatives - priority area for funder) • Minor ailments

15. Funding Challenges cont’d • Chronic Patients • At risk • Long term stable/self managing • Long term not stable/not fully self managing Funding options likely to be mix of capitation (long term conditions), specific population based – adjusted bulk funding (special populations), fee for service (acute meds) Patient enrolment for Pharmacist services must be debated

16. In Summary • Willingness for collaboration and integration • National alignment and alliances • Funding for Pharmacy services MUST change NOW • General Practice needs to engage and embrace Community Pharmacy at local level and integrate pharmacists into their primary care models