PhwSI timeline

1
PhwSI timeline

• September 06
• National PhwSI framework launched
• April 07
• New DH publications on commissioning and
  accreditation of practitioners with special
  interests (GPs, Pharmacists, Dentists)
• July December 07
• Refresh of specialty-specific frameworks, led by
  RCGP
• PCC implementation support
• template portfolio
• October 07 events for early adopters
• From late 2007
• Individual pharmacists begin to develop towards
  accreditation as PhwSIs?

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PhwSI press reactions..
3
Who could provide care closer to home?
4
PwSI Principles

• Revised GPwSI and PhwSI definition
• First and foremost a generalist
• Must be able to act without direct supervision
• The level of skill or competence will always
  exceed the core competencies of the individuals
  normal professional role
• A qualification alone will never demonstrate
  suitability for the role
• Accredited PwSIs deliver clinical services
  directly to patients and it is the personal
  interaction and clinical relationship between a
  PwSI and a patient, which makes accreditation
  necessary

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PhwSIs what are they? The definition is now
shared with GPwSIs
A Pharmacist (or a GP) with a Special Interest
supplements their core generalist role by
delivering an additional high quality service to
meet the needs of patients. Working principally
in the community, they deliver a clinical service
beyond the scope of their core professional role
or may undertake advanced interventions not
normally undertaken by their peers. They will
have demonstrated appropriate skills and
competencies to deliver those services without
direct supervision.
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• The key to PhwSIs is that these roles are driven
  by the need to redesign services in order to
  improve access to care for patients, and to
  improve the service they receive.
• It is not a requirement for a PhwSI to be
  qualified as a prescriber, but in practice this
  may enhance the scope of the role.
• They will normally practise across a locality,
  PCT or within a clinical network.
• As part of a local accreditation process, PhwSIs
  will be expected to demonstrate competencies in
  line with the generic competency framework

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The vision underpinning new publications on PwSI
commissioning and accreditation

• What does good clinical governance look like for
  PwSI services?
• Minimum necessary bureaucracy
• Not duplicating other regulatory processes
• Clear responsibilities for
• PwSI
• Commissioners
• Providers
• Accreditation bodies

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Implementing care closer to home convenient
quality care for patients

• A new series of updated and linked resources
  published in April 07
• Part 1 an introduction to shifting services into
  the community
• Part 2 a step by step guide on the issues for
  consideration when redesigning patient
  pathways using PwSIs
• Part 3 a nationally recognised accreditation
  process for GPs and Pharmacists with
  special interests
• And links to updated guidelines for clinical
  specialities, with competencies
• All available at www.pcc.nhs.uk

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PCT Directions
PCTs shall have regard to the provisions set out
in Part 3 when commissioning, assessing or
accrediting a GP/PhwSI service
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Implementation timescales

• All existing GPwSIs be re-accredited by March
  2009
• All new GPwSIs and PhwSIs be accredited in
  accordance with these guidelines.
• If the GPwSI or PhwSIs work is discontinued, or
  if for any other reason after the commencement of
  the service the individual is unable to use their
  enhanced skills for a period longer than twelve
  months, they should be re-accredited before they
  work again as a GPwSI or PhwSI.

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What will the accreditation process involve?
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The Accreditors

• Subset of PCT and include, as a minimum
• Senior commissioner
• Senior professional rep (LMC, PEC, LPC, Lead
  Pharmacist, GP from RCGP)
• Lay person
• Senior clinician
• Supported by generic PhwSI competency framework
  and updated specialty-specific guidance, where it
  exists
• May work across a number of PCTs
  eg through Deanery model

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Local (PCT held) list

• All accredited GPwSIs and PhwSIs
• Length/dates of accreditation
• Specialty
• Available for public inspection

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What will PhwSI accreditation involve?

• Preparation of a portfolio of evidence which
  is likely to include
• Formal learning (eg University based specialist
  course)
• Applicants experience to date in the specialist
  area
• Learning through supervised practice (eg within
  the specialised service)
• Evidence of competence in core role
• A range of other relevant evidence

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PhwSIs - what do they offer for patients?

• More convenient and locally based care
• A wider choice of NHS services
• Pharmacy-based clinical care that is integrated
  with other NHS clinicians
• Services that can be carefully tailored to local
  needs
• Confidence that the NHS service offered is of at
  least the same standard as when received from a
  hospital or GP

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PhwSI whats the attraction for pharmacists?

• Formal recognition of advanced clinical practice
  beyond the core pharmacy role
• An opportunity to be commissioned to provide some
  of NHS specialist services that will increasingly
  be moved into primary care
• Playing a key part within a local clinical
  network
• Greater security in the longer term if SLAs
  specify PhwSI then this is the standard that
  other providers must meet

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PhwSIs what about funding?

• There is no nationally agreed fee or remuneration
  rate for services using PhwSIs this will be
  locally negotiated
• Possible new funding streams could be linked to
  redesign of care pathways, to move care into
  community settings
• Some opportunities to present robust business
  cases
• Long term conditions
• Areas of need where here may be less interest
  from GPs eg sexual health, substance misuse
• To fill local gaps in primary care provision

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Specialty-specific frameworks in development may
include (tbc)

• GPwSIs
• Child protection
• Child and adolescent mental health
• Endoscopy (and similar procedures)
• ENT
• PhwSIs
• Dermatology
• Anticoagulation

• GPwSIs and PhwSIs
• Diabetes
• Substance misuse
• Sexual Health
• Care of older people
• Mental health
• Cardiology/CHD
• Musculoskeletal services
• Pain management
• Palliative care
• Respiratory medicine
• Learning disability
• Epilepsy
• Social exclusion

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• NHS Primary Care Contracting support for PwSI
  implementation during 2007
• Updated specialty-specific frameworks
• Events to support early adopters and networking
• Development of support tools eg template
  portfolio
• Identify and share examples of best practice
  through www.pcc.nhs.uk

Daily Mail 4.9.06
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Where can you find more information?

• A wide range of practical resources to support
  PhwSI implementation is available at
• www.pcc.nhs.uk/119.php
• These resources include
• The PhwSI competency framework
• A practical tool to to help practitioners explore
  the potential that this model may offer for them
• Links to other relevant resources such as updated
  specialty guidance
• Later in 2007, a template PhwSI portfolio
• The CPPE website signposts information on
  specialist courses which may be relevant for
  PhwSIs

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Some key questions for discussion today

• Where can PhwSIs really add value to NHS care?
• Could PhwSIs develop within clinical networks
  across primary and secondary care, eg sexual
  health, CHD?
• Defining core roles vs more advanced roles
• Do we envisage services where all must be PhwSIs,
  or where a few PhwSIs provide more complex care
  and also support colleagues in core roles
• Where and when will PCTs establish accreditation
  processes in line with new requirements?
• Getting the balance right a robust process but
  avoiding bureaucracy or overkill