Implementing Pharmacists with Special Interests

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Implementing Pharmacists with Special Interests

• beth.taylor_at_southwarkpct.nhs.uk
• August 2007

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Why develop practitioners with special interests
(PwSIs)?

• DH policy direction (CPLNHS and Our Health, Our
  Care, Our Say) and proper commissioning
• Improving access
• Improving quality
• Addressing health inequalities
• Provider development
• Supporting innovation
• Managing risk and protecting patients

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Who could provide care closer to home?
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PwSI background 2002-6

• DH worked with RCGP and developed broad strategic
  advice for PCTs and GPs, and also a series of
  detailed clinical guidelines for individual
  specialites
• NatPaCT published practical advice
• PCTs now report over 1750 GPwSIs
• Frameworks developed 2003-6 for nurses, AHPs,
  Pharmacists and Community Dentists

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However

• Concerns over quality some developed in
  isolation without appropriate training, CPD and
  governance arrangements especially from
  secondary care
• AOD found
• 64 not within national guidelines
• 45 not been through any accreditation process
• 14 no experience of working in secondary care
• 75 did not attend clinical governance meetings
• So .. new workstream to review PwSI accreditation

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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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Vision

• 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
• Adhere to set of competencies

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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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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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PhwSI press reactions..
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Pharmacists with Special Interests (PhwSIs) who
are they?

• We cant use the PhwSI term until some have been
  formally accredited
• BUT
• These are some examples of practitioners already
  working in similar models

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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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What does the national PhwSI framework include?

• A definition and principles for PhwSI
• Guidance on how NHS services involving PhwSIs can
  be commissioned (assessing the need, planning,
  commissioning, accreditation, contracting,
  practical issues)
• Guidance for practitioners who wish to consider
  this model
• Established and emerging service models similar
  to PhwSI
• A competency framework for PhwSIs

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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 - whats in it for commissioners?

• Supports the DH policy of shifting care closer to
  home
• Helps meet targets such as max 18 week waits and
  48 hour GP access
• Allows best use of available skills for
  instance where GP recruitment is a challenge
• Secures quality if service may only be provided
  through PhwSI
• This model can be used to meet very specific
  local requirements
• Multi-professional teams can be based in primary
  care to support people with long term conditions
  

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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 about funding?

• There is no nationally agreed fee or remuneration
  rate for services using PhwSIs this will be
  locally negotiated
• Possible new funding streams will 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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A competency framework for PhwSIs

• To clarify the generic competencies which will
  need to be demonstrated within local approval
  processes
• To support practitioners seeking accreditation
• To encourage robust and consistent implementation
  of the national framework
• To be used alongside relevant specialist
  competency frameworks, where these exist

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The range of competency clusters
The framework was adapted with permission from
the 2005 framework produced by the Competency
Development and Evaluation Group (CoDEG)
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Specialty-specific frameworks in development may
include

• 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

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

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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
  book now at www.pcc.nhs.uk
• Oct 2nd Leeds
• Oct 11th London
• 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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Whats the next step?

• Detailed consideration of both the national
  framework and the accreditation requirements
• How could you propose to use this model to meet
  local clinical priorities, especially services
  that are being redesigned?
• Would all pharmacists delivering this new service
  need to be accredited at PhwSI level
• Could a few PhwSIs lead and support a larger
  number of pharmacists to deliver a new service
  (eg substance misuse)
• Get with local commissioners on board you cant
  progress this without their support
• Dont underestimate the support that individuals
  will need to go forward for local PhwSI
  accreditation

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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