Managing the Performance of Homecare Medicines Services

1. Managing the Performance of Homecare Medicines Services Jane Kelly, Procurement Project Pharmacist Mick Butterfield, Specialist Technician: Homecare Medicines

2. PDIG Award • Project proposal • Survey other Trusts across the UK to find out how they performance manage their Homecare Contracts • On-line Survey • Distributed via primary and secondary care e-mail networks • Limitations • Distribution of survey • Secondary care bias

3. National Survey • 114 responses obtained • Differing geographic locations • Homecare Provider survey • 100,000 patients • Top 6 companies • 5 homecare companies responded

4. Survey Results - Background Sector Response(95 responses from hospital)

5. Survey Results - Background Is the Homecare route ever used in your organisation? (n = 95)

6. Survey Results -Background Approximate number of patients on Homecare medicines (n = 93)

7. Survey Results -Background Top 10 Homecare therapy areas (n = 78)

8. Survey Results - Background Homecare Providers (n = 71)

9. Why is performance management important? • Puts the patient at the centre of the homecare service • Aims to deliver safe and effective patient care • Ensures the same high quality standards at home as in hospital • Aims to engage the clinical multidisciplinary team, procurement, and homecare providers for the benefit of the patient • Aims to demonstrate value for money • Monitors compliance and contractual obligations • Helps inform at future homecare contract adjudications

10. Practical performance management • Contracting • Key performance indicators • Service Reviews • Patient Surveys

11. Contracting • Performance management starts with a well written tender document and service specification • A ‘specification checklist’ is one of the documents on the NHMC website • The specification must include clear information about how the homecare service is going to be performance managed and / or audited

12. Survey Results - Contracting Who arranges the contract for each therapy area? (n = 77)

13. Survey Results – Contracting Pharmacy procurement 66% Pharma. sponsored 32% Finance 11% Pharmacist 72% Clinician 68% Nurse 37% Supplies 13% Patient 10%

14. Practical performance management • Contracting • Key performance indicators • Service Reviews • Patient Surveys

15. Key Performance Indicators • Agreed KPI’s can be used to assess the quality of the service provision • Targets are set to maintain a high level of service to our patients • KPI results are reviewed regularly with the homecare provider and action taken to resolve any issues

16. Survey Results -KPIs Rank the following KPIs in terms of importance (62 / 32)

17. Incidents and Complaints Monitoring • Formal incident and complaints procedures • Sharing Trust policy with Homecare companies • Define contact pathways • Collaborative reporting / resolving issues

18. Practical performance management • Contracting • Key performance indicators • Service Reviews • Patient Surveys

19. Service Reviews • Who – involve the whole team • Frequency – quarterly, half yearly or yearly depending on contract • Agenda • Review actions from last meeting • Presentation of KPIs • Review incidents and complaints • Invoice/finance issues • Staff changes • Contractual changes

20. Survey Results – Performance management Do you performance manage your homecare contracts? (n = 69)

21. Survey Results – Service Reviews How often is performance reviewed? (n = 40)

22. Survey Results –Service Reviews Pharmacy procurement 66% Pharma sponsored 14% Finance 10% Pharmacist 72% Clinician 40% Nurse 44% Supplies 12% Patient 0%

23. Practical performance management • Contracting • Key performance indicators • Service Reviews • Patient Surveys

24. Patient Surveys • Just 17% have used patient questionnaires to review the performance of the homecare provider • Surveys are undertaken after a change of provider or every year • Patients are asked to rate the performance of their homecare service provider • Ensure results are fedback to clinical teams / homecare providers and patients

25. Patient consent to homecare • Current project at Leeds is to review how patients consent to homecare • Professional guidance is that healthcare professionals should obtain consent for everything involving the patient • How should consent be obtained and recorded?

26. Survey Results – Patient Consent Do patients have a choice? (n = 61)

27. Patient Consent Are patients asked for their consent to homecare? (n = 73) Don’t Know 43%

28. Survey Results – Patient consent Is the consent informed? (n = 71)

29. Survey Results - NHMC • 72% did not know NHMC existed • 15% had visited the website • 70% who visited the web site used the information they found there

30. Summary • Contracting – ensure clear service specification that includes performance management • Formal Review – pharmacy should co-ordinate formal reviews of service at regular intervals • Homecare incidents and complaints – ensure these are reported and learned from • Patient involvement – increase patient involvement • NHMC – raise profile in the NHS

31. Future / Next Steps • Visit other centres • Share best practise with NHMC