New Contract Quality Criteria January Session

1. New Contract Quality Criteria January Session Fiona Lowe Chief Officer Coventry, Warwickshire, Herefordshire & Worcestershire LPCs This meeting has been supported by the following Companies: Christie. Napp Pharmaceuticals, GSK, Pfizer, Teva, Boehringer-Ingelheim and Chiesi through the purchase of the Exhibition stand space. These Companies have had no involvement with the Speaker selection or content of this meeting

2. Registration & Stands (09:00 – 09:30) Breakout Room – Basics & Gateway Practical Support 09:00 – 10:00

3. Introduction (09:30) Fiona Lowe

4. Welcome & introducing the team • Domestics • Fire Alarms • Toilets • Phones • Sponsors • Pre-work and Handouts • How the day will work • Main Room & Breakout Room Welcome & Introduction

5. 09:00 Registration, refreshments and view stands (Basics, Gateway and other QC practical support in breakout room until 10 am) 09:30 Introduction followed by Dementia Friends session with Hayley Berry 10:15 Patient Safety session with Surinderpal Virdee (refreshments available at 12:00) 12:15 Asthma – Clinical Effectiveness session with Fiona Lowe 12:45 Q&A 13:00 Lunch and stands (Christie’s session in breakout room 12:45-13:30) 13:30 Dementia Friends session if required (Basics, Gateway and other QC practical support sessions in breakout room) 14:00 Safeguarding Level 2 (CPPE) with Hayley Berry (refreshments available at 15:45) 16:00 Healthy Living Pharmacy Introduction with Fiona Lowe (Basics, Gateway and other QC practical support sessions in breakout room) 16:30 Wrap Up and any remaining Q&A (Basics, Gateway and other QC practical support sessions in breakout room) Agenda

6. Quality Payments in 17/18 • Total of 100 points • £64 per point • = £6,400 per contract • Could increase as additional allocation if less than 100% uptake • To a max of £128 per point Gateway • EPS is active and used • NHS Choices is up to date and maintained (7th Feb onwards) • Active NHS Mail address and active (apply during January for generic email) • Delivery of at least ONE specified Advanced service

7. LPC Communications

10. A Dementia Friend learns a little bit more about what it's like to live with dementia and then turns that understanding into action - anyone of any age can be a Dementia Friend. Dementia Friends (9:45) Hayley Berry https://www.dementiafriends.org.uk/

11. Patient Safety & CPPQ (10:15) Surinderpal Virdee MRPharmS MFRPSII

12. Objectives To meet the following criteria that fall within the Quality Payments Scheme • Community Pharmacy Patient Questionnaire (CPPQ) results • Patient Safety Report

13. Details CPPQ • Results of the CPPQ from the last 12 months is publicly available on the pharmacy’s NHS Choices website Patient Safety Report A written safety report at premises level available for inspection at review point covering:- • Analysis of incidents and incident patterns • Evidence of sharing learning locally and nationally • Action taken in response to National Patient Safety Alerts

14. Community Pharmacy Patient Questionnaire (CPPQ) REPORT

15. The CPPQ survey must be done annually • Each site has a minimum number of responses required based on their average monthly items Average monthly script volume (Items) Minimum number of returned surveys 0-2000 50 2001-4000 75 4001-6000 100 6001-8000 125 8001-upwards 150 • The questionnaire is available on the PSNC website and available in 3 formats (PDF, Word document and a Large print Word document)

16. The PSNC have also provided a worksheet tool to enable you to analyze the results • Section 1 - Data collation • Section 2 - Ranks each question • Section 3 - Action plan. This is the part that will need to be published on your NHS Choices profile (for each site) • The survey needs to be completed by End March • Need to get started as soon as possible, you do not want to be chasing surveys close to the completion date • Most actions will actually be very simple and only require simple changes

17. Some examples of questions and potential solutions include:- • Waiting area not of sufficient size and was left standing for prescription • Solution - Review seating arrangement and added 2 more chairs • Was not offered any lifestyle advice • Solution - Pharmacy leaflet now directs patients to pharmacist when seeking such advice • Not enough stock to fulfil my prescription • Solution - Now have in place recommended average stock levels on electronic stock file

18. Patient Safety Report

19. Before a patient safety report can be written, a number of other forms require completion. These forms will enable you to be more thorough in your analysis and review. However…..before we look at those forms….let’s understand some key reasons why patient safety is important:- • Firstly and most importantly, none of us want to harm a patient and therefore want to constantly improve our standards to avoid patient harm • GPhC Standards for registered premises: Principle 1 ‘The governance arrangements safeguard the health, safety and wellbeing of patients and the public’ In particular, it focuses on identifying and managing risk i.e. ‘what happened, why did it happen and what do we now need to do to make sure it doesn't happen again • Finally, the RPS released a new document in November 2016 titled ‘Professional Standards for the reporting, learning sharing, taking action and review of incidents’ (Please note: further details of the GPhC Principles and Standards can be found on the GPhC website)

21. Forms* that will help you complete a patient safety report include:- Near misslog Near Miss Error Improvement Tool (RPS) Community pharmacy medication safety incident (Pharmacy error) report form Controlled Drug incident report form * There may be other forms that also require completion. The above list is an example

22. Near miss log • Templates available e.g. RPS website • Log must be readily available to all staff • Need to have an open culture of reporting • Have a no blame culture • Before we look at a good example of a completed near miss log…I have some questions for you……….

24. Near miss log Improvement Tool • Templates available from RPS website • To be used when reviewing the near miss log • Tool allows you to work out your near miss error percentage (calculated using your total items dispensed) • Review lets you understand • What type of near misses occurred • Why did they happen • What needs to happen to minimise the risk of it happening again • Review the actions within an agreed timescale to ensure action has been met • Complete as a team…not the pharmacist stuck in an office!!! • Does not have to be a drawn out process. If done weekly/monthly should not take > 30 - 60 mins • The more reviews you do…the easier they become….and if the actions you put in place are correct, the error percentage will start to reduce

25. Before we carry on discussing the remaining forms………………. …..using your own near miss logs you have bought with you today……spend 10 minutes to start to complete the improvement tool (at this stage only need to compete boxes 1, 2 and 3) We will walk around and field any queries or questions

26. Community Pharmacy Medication Safety Incident report form • Templates available from various sites e.g. PSNC (or if you have company specific version…use them) • NPA’s Chief Pharmacist Leyla Hannbeck is acting as the Medication Safety Officer (MSO) for all independent pharmacies in England with fewer than 50 branches • All incidents should be reported to the NPA via their website (you do not have to be a member of the NPA to do this) • Completed forms can be printed off and kept in the pharmacy • When reporting using the NPA website, you will not need to also report to the National Reporting and Learning System (NRLS) as the NPA will do this for you (Please note: these incidents will be anonymised prior to sending) • Where you have a Superintendent Pharmacist, please ensure they are notified of the incident and that you follow the approved SOP process for incident management for your business

27. Community Pharmacy Medication Safety Incident report form Key points to note on the incident form • Date of incident - where possible include date of dispensing and date notified of incident • Time • Degree of harm - don’t forget to update if the patients condition worsens • Patient details - Try and capture as much information as possible. It will make contacting the patient much easier especially to help resolve any issues • Contributing factors - just be honest !!! • Planned actions to prevent reoccurrence - The most important box !!!! • Contacting the patient - where a representative wishes to be the point of contact….don’t forget that patient consent must be received before you can discuss with anybody else

28. Controlled Drug (CD) incident report form • All healthcare professionals have a statutory duty to report all complaints, concerns or untoward incidents involving controlled drugs to the Controlled Drug Accountable Officer (CDAO) • All CD incidents need to be reported to the CDAO using the secure email account provided • Upon discovering the incident, report as soon as possible and definitely by close of the play of the following day. At this stage you may only have partial information, however, further details can be submitted as they come to light • CD incident report should include: • Name, Role and Professional registration number (if applicable) • Date and location and telephone number where incident occurred • Drug name, form, strength and quantity • Details of actual incident, action taken, action planned and measures to prevent recurrence (information below taken from Arden and GEM CD bulletin Issue 1 Dec 2016) tails of any internal investigation and learnings identified

29. Controlled Drug (CD) incident report form Examples of what to report: to CDAO- • Stolen/missing/lost CD prescriptions • Fraud involving CD’s Supplying CD’s without a valid prescription • Incorrect item/quantity dispensed • Dispensing out of date CD items • Spillages and missing CD’s • Prescribing errors involving CD’s • Incorrect labelling of CD’s • Incidents involving CD instalment prescriptions (FP10MDA) • CD balance discrepancies • Issues with CD requisitions • Incidents involving CD deliveries • CD’s handed out to incorrect person

30. Patient Safety Alerts • NRLS (NRLS) leads and contributes to improved, safe patient care by informing, supporting and influencing the health sector • Types of alerts from the NRLS include:- • Rapid Response Reports • Patient Safety Alerts • Safer Practice Notices • Other places you can receive alerts from include:- • MHRA • GOV.UK • RPS (if registered with them, they can send you drug and device recalls, patient safety notices etc) • NHS England • Local teams

31. Patient Safety Alerts Things to think about:- • How do you get your alerts? • How do you know you are receiving all of them? • What do you do when you get the alerts? • What do you do with the alerts that are not applicable to you?

32. Case study The month has ended and you are required to complete a Patient Safety Report Using the information below….start to complete the report • Total items dispensed for the month 9,642 • Total number of near misses for the month 86 • Total incidents reported to NPA 2 • Incident 1 - Azithromycin dispensed instead of Azathioprine. No incorrect medication taken by patient. Contributing factor - messy shelves • Incident 2 - Patient given Insulin Humalog Mix 25 instead of Mix 50. Patient has used three doses and suffered mild side effects however patient is now OK. Contributing factors - disorganised fridge and dispenser who lacks knowledge of insulins • 1 CD discrepancy - 1 Concerta XL 18mg tablet missing. Reported to CDAO • Zero patient safety alerts received • 15 CPPQ responses • Zero pharmacy complaints

33. ANALYSIS Complete the next section after your team has discussed and identified the key contributing factors and root causes for each of the following

35. Refreshments (12 noon)

36. Asthma – Clinical Effectiveness (12:15) Fiona Lowe

37. Community pharmacy contractors passing the gateway criteria will receive a Quality Payment if they meet one or more of the Quality Payment criteria. One of these is: ‘On the day of the review, the pharmacy can show evidence of asthma patients, for whom more than 6 short acting bronchodilator inhalers were dispensed without any corticosteroid inhaler within a 6 month period, are referred to an appropriate health care professional for an asthma review.’ Two opportunities to collect 10 points (each worth £64) Asthma – clinical effectiveness quality payment

38. Requires pharmacists to refer asthma patients to an appropriate healthcare professional if they have been dispensed more than six short-acting bronchodilators without any corticosteroid inhaler within a six month period • Evidence required and if a minimum number of patients to be referred not yet clear • In the meantime, consider what changes may need to be made to, for example, standard operating procedures (SOPs), and Patient Medication Record (PMR) systems • Ensure pharmacy team can identify short-acting bronchodilator inhalers and corticosteroid inhalers Asthma review

39. Eligibility • They have been diagnosed with asthma • They have been prescribed an inhaler containing one of the following short-acting bronchodilators: • Short-acting beta-2 agonist • Ipratropium bromide • They have been prescribed more than six inhalers containing a short acting bronchodilator in the last six months • Inhaled corticosteroid therapy has not been prescribed during this six month period Asthma review

40. Meeting the criterion • Identify potential patients that meet this criterion • E.g. Checking patient medication record (PMR) to see if the patient is eligible when presenting with a prescription • Speak with the patient to understand their inhaler use • Medicines Use Review (MUR) or their inhaler technique check may be undertaken • If an issue is identified: • Refer patient to their GP using the pre-determined referral system • All referrals should be documented on the patients PMR • It may also be appropriate to use a data collection form as evidence for the criterion being met Asthma review

41. Further information on this Quality Payment criterion is available in PSNC Briefing 068/16: Quality Payments – referrals for asthma reviews (November 2016) Process A suggested process for pharmacy teams to follow to incorporate this Quality Payment criterion into their daily practice can be found below. Asthma referrals – Suggested process for referring patients for an asthma review (Word) Asthma referrals – Suggested process for referring patients for an asthma review (PDF) This process looks to identify patients who have been diagnosed with asthma and have been prescribed more than 6 short-acting bronchodilators in the last 6 months as these patients are likely to require their asthma to be assessed urgently. How to achieve the quality payment

42. Referral Process

43. Tools available on PharmOutcomes

46. MUR NMS Inhaler technique checks Differential diagnosis from COPD Clinical audit Evidence of supporting patients with LTC Link to other services Build relationships with GP Practice team Future sessions – NMS/ MUR support and inhaler technique training What added value is possible?

47. Q&A (12:45) (Christie’s in breakout room)

48. Lunch & stands (13:00) Christie Presentation in Breakout Room Or in Breakout Room – Basics & Gateway Practical Support 13:30 – 14:00 https://www.youtube.com/watch?v=FakBT7oYsKE

49. A Dementia Friend learns a little bit more about what it's like to live with dementia and then turns that understanding into action - anyone of any age can be a Dementia Friend. Dementia Friends (13:30) Hayley Berry Or in Breakout Room – Basics & Gateway Practical Support https://www.dementiafriends.org.uk/

50. Safeguarding (14:00) Hayley Berry