NTA

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Community prescribing London June 2006
Dr Emily Finch, Clinical Team Leader
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Findings - Overall Score
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Community Prescribing
4
Community Prescribing - commissioning
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C1 Commissioning

• Community prescribing services are commissioned
  in line with models of care and clinical
  guidelines
• Self assessment of service level agreement
• Specified template of best practice (10 spot
  check)
• Core items are
• Definition of service
• Aims and objectives
• Eligibility criteria
• Description of service
• Priority groups
• Exclusions and contraindication
• Description of services
• Policies and protocols
• Level 2 3 basic core items, Level 3 all items

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Community Prescribing - access
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C2 Access

• Service users have prompt, equitable and flexible
  access to community prescribing services
• How long do people have to wait to access
  community prescribing?
• Can people who use services access primary care
  treatment? gt30 of GPs in some sort of shared
  care
• Flexible opening hours (aggregated to DAT level)
• Findings from user satisfaction which are
  relevant
• - longer waits associated with less
  satisfaction
• Research evidence does not show a clear
  association with outcome

8
Community Prescribing assessment and care
planning
9
C3 Assessment and care planning

• Personalised care plan that incorporates
  comprehensive assessment
• Are the tools comprehensive?
• Is there a comprehensive risk assessment
• Relates to triage, comprehensive assessment care
  plans and risk assessment tools submitted by
  agencies
• Scored on a proforma
• Done for prescribing services in the DAT only
• User satisfaction findings
• - 59.4 had a care plan
• - Review in last 3 months are more satisfied
• - No care plan are least satisfied

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For exampleRisk assessment scoring template
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Community Prescribing prescribing practice
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C4 Prescribing Practice

• Prescribing practice is in line with Models of
  care and the Clinical Guidelines
• Is the agency's prescribing policy in line with
  MOC and CG?
• Experience of service users
• Title of completed audits by SM service or trust
  in last 18 months
• Looking for outliers and inflexible policies
• User satisfaction
• 50.4 receiving 57.5mg
• 35.3 gt60mg
• Prescribing audit
• Mean dose nationally 56.7mg methadone
• 8.9mg buprenorphine
• NICE technology appraisals (methadone and
  buprenorphine for maintenance and naltrexone for
  relapse prevention) and guidance awaited on
  detoxification and psychological interventions
• Clinical guidelines revision in progress
• Role of low doses uncertain

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Prescribing audit

• What is the mean daily dose for methadone?
• Range of doses prescribed
• Range of supervised consumption for Methadone
  undertaken within the first 12 weeks
• Range of supervised consumption for Methadone
  undertaken after the first 12 weeks
• Range of methadone treatment options (i.e.
  tablets/ oral methadone/ mixture) offered
• Range of buprenorphine doses prescribed
• Range of supervised consumption for Buprenorphine
  undertaken within the first 12 weeks
• Range of supervised consumption for Buprenorphine
  undertaken after the first 12 weeks

14
For examplePrescribing audit scoring

• If 60 or more of doses fell within 1-30mg and
  31-60mg or alternatively 60 fell within 91-120mg
  and 121 this raised concerns about the range of
  prescribing offered and therefore scored a one,
  anything else scores a two.

15
Community Prescribing controlled drugs
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C5 Controlled drugs

• Community prescribing services have procedures in
  place to ensure controlled drugs are administered
  in accordance with best practice
• Following procedures in place
• adverse incidents procedure
• prescribing policy
• prescribing review procedure
• complaints procedure/ practice protocols
• meetings with pharmacists to discuss issues (e.g.
  adverse incidents)
• risk assessment protocols (e.g. in the case of
  overdose)
• formal dose titration process for methadone
• formal dose titration process for buprenorphine
• How many untoward incident reports have been
  completed in last 12 months?
• Against national benchmark
• Do staff feel able to report such incidents?
• Staff feedback in NHS staff survey

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C5 Controlled drugs issues?

• User satisfaction
• 73.4 supervised methadone 5-7 days per week
• 65.6 supervised buprenorphine 5-7 days per week
• Not associated with satisfaction
• Use of NHS staff survey
• Pharmacy guidance clarifies some issues

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Community Prescribing staff competencies
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C6 Staff competencies

• Community prescribing services are delivered by
  competent practitioners who are appropriately
  trained and supervised
• Covers range of staff
• Focus on vacancies and temporary staff as
  reported by services
• Use of NHS staff survey
• User survey
• Keyworkers most likely to treat them with respect
• Pharmacy staff and other users least likely

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Staff competencies - questions

• Is the service delivered by experienced and
  trained staff?
• What is the prescribing service(s) rate of
  vacancies by staff group?
• What is the prescribing service(s) rate of
  temporary staff by staff group?
• Do you have a case load management system (case
  load weighting system)?
• What is the level of staff satisfaction with
  their job and the organisation?
• Do staff report adequate support, training,
  supervision and appraisal mechanisms?
• What is the experience of service users being
  respected by staff?

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Conclusions

• Each criteria is supported by indicators of good
  practice only
• Overall picture more important than individual
  areas
• Acknowledge areas of uncertainty
• Encourage services and partnerships to continue
  to examine their practice
• Encourage services to learn from and repeat audits