Chronic Medication Service

1. Chronic Medication Service

2. Objectives • To describe the background and policy context for the introduction of the Chronic Medication Service • To outline the general elements of the Chronic Medication Service • To look at each of the three stages of the Chronic Medication Service • To share the plans being considered for implementation of the service

3. Background & Policy

4. The patient journey • Prescribing • Prescribing error rate 7.5% • Dispensing • Dispensing error rate 3.3% of all items • Compliance / concordance • non-adherence 30-50% • hospital admission due to ADR 2.7% - 6.5%

5. Building on existing evidence • Repeat dispensing pilots • Paper based trials • Reduce wastage • Improve access • Pharmaceutical Care Model Schemes • Care of the elderly • Chronic disease areas • Medication review

6. General Description of the Chronic Medication Service

7. Purpose To ensure patients obtain optimal therapeutic benefit from their medicines and minimise any predictable undesirable effects. Description A system of personalised pharmaceutical care to patients with long term medical conditions. Chronic Medication Service (CMS)

8. Purpose • Move focus from dispensing to clinical practice and quality • Patient centred, medicines focused • Building on what people already do • Based on a systematic approach • Document practice • Improve continuity of care

9. GP System CP System Core Infrastructure CHI GP (1000) NSS PSD Patient Registration Service Information Services Division A ePharmacy Message Store Elec msgs via N3 network Payment process Pharmacy (1200) ePay rules engine A Forms sent to PSD Scanning and message processing

10. The Three Stages Of CMS

11. Overview Stage 1 Patient registration Community pharmacy Priority profiling Stage 2 Pharmaceutical Understanding care planning Reinforcement Problem solving Informed choice Stage 3 Therapeutic Serial prescribing & partnership dispensing Disease protocol Referral Feedback

12. Mapping out the processes Patient Registration Notification message Stage 1 Patient Registration Stage 3 Serial Prescription Care plan based on ‘risk’ Risk Assessment Stage 2 Identify Pharmaceutical Care Issues Monitor & Review Formulate Care Plan

13. Stage 1: Registration • Voluntary opt-in • Patients registers with pharmacy of their choice • Register with one pharmacy • Via the Patient Registration System (PRS) using CHI • Underpinned by explicit patient consent • Eligibility: • Patient must be registered with a Scottish GP practice • Patient must have a long term condition/s • Not resident in a Care Home • GP practice receives an electronic registration notification message

14. Stage 1: Priority Profiling • Completed within three months of registration • Based on • Medication profile • Questionnaire on medicines and consequences • Yes, No, Not Recorded & free text field • Patient profile • General health • Medical conditions • Allergies & sensitivities • Patient factors • Supported by a web based care planning tool • Assign an overall priority rating: • low, medium or high priority

15. Stage2: Pharmaceutical Care Planning • The patient and pharmacist • discuss and assess the patient’s condition/s, medicine/s and general health • identify any issues / problems • establish desired outcomes • agree any actions to address them • The pharmacist • documents the issues, desired outcomes and actions using the care plan system • Monitors, reviews and updates the care package • Supported by a web based care planning tool

16. Web-based care Planning Tool

17. Pharmacy Care Record • Web based • a secure system (holds patient data) • fully robust (data recovery, data replication to a backup site) • username and password protected • Hosts the pharmaceutical care plan • priority profiling • pharmaceutical care plan • Build in additional applications e.g. PHS?

18. PCR Search Screen

19. Search from: PCR Enter patient details Click search If ‘not found’ you can generate a PCR record by uploading data from your PMR PMR Link up from patient record on PMR Information uploaded from PMR: Patient demographics Name Address Postcode Date of birth CHI Gender Telephone number Dispensing history Finding a patient

20. PCR Medication Details

21. PCR Priority Profiling: Medication Profile Free text box for notes

22. PCR Priority Profiling: Patient Profile Record priority based on patient and medication profile: Low, medium, high

23. PCR Care Planning: Care Issue Summary

24. PCR Care Plan

25. Stage 3: Serial prescribing & dispensing • The patient’s GP • Eligibility based on age, medical and maternity exemptions • decides on their suitability for a 24 or 48 week serial prescription • selects dispensing intervals • The pharmacist • dispenses the prescription according to defined intervals • engages with the patient over the time period according to the disease specific protocols • Feedback • dispensing information with each dispensing episode • end of care treatment summary information • dispensing information and any specific relevant care information • can include a request for new serial prescription

26. Benefits • Improved clinical outcomes • Improved concordance • Reduced wastage • Easier patient journey • Promotion of self care • Better utilisation of the workforce • Encourage team working

27. Further information… Establishing effective therapeutic partnerships: The Ritchie Report http://www.scotland.gov.uk/Publications/2009/12/08131756/0 NES CMS Implementation Resource Pack: http://www.nes.scot.nhs.uk/pharmacy/newcontract/cms.asp

28. Implementation

29. CMS Dates • Commence roll out from 1 April 2010 (final date still to be agreed) • Operationalise working processes from April – September 2010 • CMS ‘live’ from September 2010

30. Operationalisation Phase • ‘Bedding in’ stage • Phased from April to September • CPs familiarise themselves with eCMS software • Registration • Care planning • Serial dispensing • Reporting • GPs familiarise themselves with eCMS software • Serial prescribing • Managing end-of-care treatment summaries

31. Current position • All GP and Pharmacy IT system suppliers on course for April delivery • NSS PSD system changes in place • Patient Registration Service (PRS) • ePay • ePharmacy infrastructure in place • ePharmacy Message Store (ePMS) • Pharmacy Care Record (PCR) • Early Adopter phase underway in NHS Fife

32. National Priorities for Next 2 Months • GP and Practice Manager NES Packs • PCR User Manual • PCR ‘test’ patients for training on PCR • PCR user name and password processes • Identifying a process to issue user names and passwords • Finalising and distributing CMS patient leaflet • CMS disease specific protocols

33. Supporting Implementation Locally • Local awareness sessions • Identifying community pharmacists who require PCR user names & passwords • Issuing user names & passwords • Agreeing local working processes • Endorsing NES sponsored GP & CP workshops (May & June 2010) • Supporting practitioners during the implementation phase

34. Milestones • Agree final service specification • During March 2010 • Finalise national implementation plan • During March 2010 • Agree CMS start date • During March 2010 • Delivering CMS! • From April 2010