www.england.nhs.uk

GM Pharmacy Transformation Event

Building the Greater Manchester pharmacy service for tomorrow – today!

Monday 2nd November 2015

www.england.nhs.uk

Welcome and Housekeeping

Kate KinseyHead of Primary Care OperationsNHS England

www.england.nhs.uk

AgendaTime Item Speaker

19:00-19:05 Welcome and Housekeeping Kate KinseyHead of Primary Care OperationsNHS England

19:05-19:15 Setting the scene Jane BrownChair Local Pharmacy Network

19:15-19:35 Devolution Manchester Rob BellinghamDirector of CommissioningNHS England

19:35- 19:50 Pharmacy Transformation Amy LepiorzSenior Primary Care ManagerNHS England

19:50-19:55 Break-out session introduction Kate Kinsey

19:55-20:05 Break

20:05-20:50 Break-out session All

20:50-21:00 Summary and next steps

www.england.nhs.uk

• Fire alarms- no alarm planned• Phones- please turn onto silent/vibrate• Toilets – located through the double doors

Housekeeping

www.england.nhs.uk

• To inform patients, commissioners, providers and the third sector about the role that pharmacy plays in the delivery of NHS care and how this could be strengthened in the future.

• To inform pharmacy about the plans for changes in NHS care delivery under Greater Manchester Devolution.

• To raise awareness of the Pharmacy Local Professional Network’s two year transformational plan.

Objectives for the session

www.england.nhs.uk

Setting the scene

Jane BrownChairLocal Pharmacy Network

www.england.nhs.uk

• Use of a medicine is the most common intervention in the NHS

• Many patients don’t take their medicines as prescribed

• Medication errors / incidents / ADRs• NHS spend on medicines second only to staffing

costs• Pressure on NHS services• More people visit pharmacies than any other health

care setting

National context

www.england.nhs.uk

• Keeping people well• Smoking, alcohol, weight management

• Managing acute illness / long-term conditions• Minor ailments / common conditions• Support to optimise medicines (NMS / MUR)• Supporting people post-discharge

• Pharmacist prescribing

Where does pharmacy fit?

www.england.nhs.uk

• Provide clinical services• Medicines optimisation• Safe• Evidence based

• Excellent consultation skills• Best use of skill mix• Support patients on their whole care pathway

How can we achieve this?

www.england.nhs.uk

• Develop intra-professional relationships – between hospital and community pharmacists

• Develop inter-professional relationships – between pharmacists and doctors

• Raise the profile of pharmacy and the range of NHS funded services within our population

• Reduce variations in care

What do we need to do?

www.england.nhs.uk

• Pharmacy has a huge role in keeping people well• Medicines use is enormous• Many people don’t get the best outcomes from their

medicines• Pharmacy can change this

Key points

Pharmacy Event – 2nd November 2015

Rob Bellingham – Director of Commissioning (GM)

13GVA – Gross Value AddedLEP – Local Enterprise Partnership

Greater Manchester: a snapshot picture

• Greater Manchester Devolution Agreement settled with Government in November 2014, building on GM Strategy development.

• Powers over areas such as transport, planning and housing – and a new elected mayor.

• Ambition for £22 billion handed to GM.

• MoU Health and Social Care devolution signed February 2015: NHS England plus the 10 GM councils; 12 Clinical Commissioning Groups; supported by the 15 NHS and Foundation Trusts

• MoU covers acute care, primary care, community services, mental health services, social care and public health.

• To take control of estimated budget of £6 billion each year from April 2016.

• Commitment in July 2015 budget to align the Spending Review process for health and social care to our Strategic Sustainability Plan

The background to GM Devolution

• Health in Greater Manchester will remain within the NHS, continue to uphold standards in national guidance and statutory duties outlined in the NHS Constitution and Mandate

• Districts will continue to have oversight and responsibility for delivery of social care and public health services

• Decisions will continue to be made at the most appropriate level to the benefit of people in GM – sometimes locally and sometimes at a GM level

• Organisations will work together to take decisions based on the needs of the population not institutions

• From 1 April 2015 ‘all decisions about GM nationally are taken with GM’

What will – and won’t - this mean for the NHS and social care

• Devolving powers to GM will enable us to have a bigger impact, more quickly, on the health, wealth and wellbeing of GM people

• It will allow us to respond to the needs of local people by using their experience to help change the way we spend the money

• It will allow us to better co-ordinate services to tackle some of the major challenges supporting physical, mental and social wellbeing

How will we do this?

• By integrating our governance arrangements; ensuring that GM can take decisions as one.

• By integrating planning; working across CCGs, local authorities and trusts in our 10 areas to create aligned local plans feeding one GM strategic plan

• By integrating delivery; mobilising best practice at pace and at scale

Why do devolution?

• Improve the health and wellbeing of all Greater Manchester people – of all ages

• Close the health inequalities gap faster within GM, and between GM and the rest of the UK

• Integrate physical health, mental health and social care services across GM

• Build on the Healthier Together programme

• Continue to shift the focus of care closer to homes and communities where possible

• Strengthen the focus on wellbeing, including a greater focus on prevention and public health

• Contribute to growth and connect people to growth, eg helping people get in to and stay in work

• Forge a partnership between the NHS, social care, universities and science and knowledge industries for the benefit of the population

• Make significant progress on closing the financial gap

What have we said we’ll do in the MoU?

To ensure the greatest and fastest possible improvement to the health and wellbeing of the 2.8 million citizens of Greater Manchester

The vision for GM Devolution

19

DMT contact: Katy Calvin-Thomas

Strategic Plan (Clinical & Financial

Sustainability)

Health & Social Care Devolution Programme

DMT contact: Liz Treacy

Establishing Leadership,

Governance & Accountability

DMT contact: Sarah Senior

Devolving Responsibilities and

Resources

DMT contact: Warren Heppolette

Partnerships, Engagement and Communications

DMT contact: Leila Williams

Early Implementation Priorities

7 Day Access to Primary Care 7 Day Access to Primary Care

Public Health place-based agreement major programmes and

early intervention priorities

Public Health place-based agreement major programmes and

early intervention priorities

Academic Health Science System Academic Health Science System

Healthier Together Decision Healthier Together Decision

Dementia PilotDementia Pilot

Mental Health and Work Mental Health and Work

GovernanceGovernance

Legislative and Accountability Framework

Legislative and Accountability Framework

Workforce Policy Alignment Workforce Policy Alignment

The GM plan contains the following chapters:• Strategic Plan• Locality and Sector Plans• GM Transformation Proposals

and • Financial Plan and Enablers

It is recognised that a large proportion of the other programme areas will feed in to the Strategic Plan at the appropriate point, highlighted to the right.

The GM plan contains the following chapters:• Strategic Plan• Locality and Sector Plans• GM Transformation Proposals

and • Financial Plan and Enablers

It is recognised that a large proportion of the other programme areas will feed in to the Strategic Plan at the appropriate point, highlighted to the right.

Resources and FinanceResources and Finance

Primary Care TransferPrimary Care Transfer

Specialised Services TransferSpecialised Services Transfer

Prevention, Self Care and Public Health (Single Unified Public

Health System)

Prevention, Self Care and Public Health (Single Unified Public

Health System)

Enablers:• Workforce Training,

Development and transformation

• Capital and Estates• IM&T• Contracting and procurement

Enablers:• Workforce Training,

Development and transformation

• Capital and Estates• IM&T• Contracting and procurement

CAMHSCAMHS

Programme approachW

ork

stre

ams

Wor

k st

ream

sW

ork

pack

ages

Wor

k pa

ckag

es

Patient, Carer & Public Engagement

Patient, Carer & Public Engagement

Change MovementChange Movement

OD and Leadership DevelopmentOD and Leadership Development

Support Services StrategySupport Services Strategy

Decision Making MechanismsDecision Making Mechanisms Communications and Stakeholder Engagement

Communications and Stakeholder Engagement

PartnershipsPartnerships

2015 07 17

Learning DisabilitiesLearning Disabilities

Journey so far

MOUEarly

Implementation Priorities

Governance Developments CSR

Clinical and Financial

Sustainability (Strategic Plan)

Aligning the elements of the Strategic Plan

Overarching planIntegrated document

including detailed financials

Locality plans (10)Set out local ‘place view’ and key focus

on integrated care approach; Consistent format and structure that can

be aggregated

Provider Collaboration PlansSet provider intentions and opportunities

of how will deliver better care and productivity, combined with estates

requirements

GM Workstreams Set out plans for GM-wide initiatives

including provider reform/configuration and key enablers

Resulting Components of the GM Model1. A Social Movement for Change 2. Evidence Based Care across all Settings3. Locality Based ICO/ACO operating a common prospectus4. New Hospital Models5. Health In novation Manchester6. Single Estates Function7. Single Workforce Transformation Plan8. Single Information Governance and Data Sharing

Agreement

Transformation Initiatives

22

The Strategic Plan review cycle23

rd O

ctob

er 2

015

Aligned goals & visionBackground & rationale narrativeStatus of current initiativesProvider intentions definedDraft GM transformation prospectus & strategiesAny gaps and areas of further alignment identified

23rd

Nov

embe

r 201

5Refined metrics & mechanism to measure successInterim data modelAligned locality & GM narrativeRefined transformation prospectusFinal inconsistencies and opportunities identified and addressedReadiness for final approval as per the agreed process

4th D

ecem

ber 2

015

Reconciled set of plans, including:Aligned 5-year ambition2-year view of change proposals and aligned operational plansFinal metrics & mechanisms to measure successInitiatives / proposals already deliveredGovernance arrangementsFinal financial plan & data model

Janu

ary

– M

arch

201

6

Align & Revise Plan based on:CSR announcementLocal Government SettlementCCG Planning GuidanceCCG Planning Round

Internal review / first pass First draft Final version

Reviewed by: DMT 30/10

Update to: SPB 30.10, Programme Board 12.11

Reviewed by: DMT 24/11, SPB 27/11,

Update to: SPB Exec 13/11

Reviewed and signed off by: SPB Exec 07/12, DMT 08/12, AGG 15/12, Programme Board 16/12, SPB 18/12, Provider Forum 18/12

Reviewed and signed off by: DMT, AGG, WLT, Provider Forum SPB Exec, Programme Board, SPB, organisational governance , OSCs

Final draft

Note: dates still being finalised and subject to change

Rapid & Continuing Progress

24

• Launch of the commitment that all 2.8 million people across GM will have access to primary care services seven days a week from the end of the year

• The final decision, following a three year process, about which hospitals will work together as single services following the Healthier Together consultation

• Launch of a new model of public health leadership in GM, putting public health at the heart of wider economic and skills potential of area by helping people into work, encouraging independence and reducing demand on the NHS.

• Launch of Health Innovation Manchester bringing together world class experts in health, academia and industry to enable GM to compete on a global level through aligning Manchester Academic Health Science Centre (MAHSC), Greater Manchester Academic Health Science Network (GMAHSN) and Local Clinical Research Network (LCRN)

• Alignment of our submission to the Spending Review process for health and social care to our Strategic Sustainability Plan

• We have made enormous progress on our intentions to establish integrated commissioning well beyond the framework of the Better Care Fund with pooling ambitions now exceeding £2.7bn.

| 25

So what do we think could be achieved?

Strategic Plan – our vision – by December

By April 2016 we will take care of our own £6bn funding, and with this money we will make a number of significant investments so that by 2020 we will have…

• 64,000 less people with chronic conditions• 10% less visits to urgent care• 6,000 less people being diagnosed with

cancer• 25,000 people with severe mental illnesses

will benefit from better community-based care, reducing need for urgent services by 30%

• 18,000 children better supported by local services

• 700,000 people with chronic conditions, better able to manage their own health

26

Worklessness & Low Skills Children & Young People Crime & Offending Health & Social Care Long-term JSA claimants ESA claimants (WRAG) ‘Low pay no pay’ cycles

Working Tax Credit claimants Low skill levels (vocational or

academic) Insecure employment

NEET (Young People) Compounding factors:

Lone parents with children 0-4 Poor literacy and numeracy Poor social skills Low aspirations Living alone

Child in Need Status (CIN) / known to Children’s Social Care Child not school ready Low school attendance & exclusions Young parents Missing from home Compounding factors:

Repeat involvement with social care

LAC with risk of offending Poor parenting skills SEN Frequent school moves Single parents

Repeat offenders Family member in prison Anti-social behaviour Youth Offending Domestic Abuse Organised Crime Compounding factors:

Lost accommodation Dependent on service Vulnerability to sexual

exploitation Missing from home Violent crime

Mental Health (including mild to moderate) Alcohol Misuse Drug Misuse Chronic Ill-health (including long-term illness / disability) Compounding factors:

Unhealthy lifestyle Social isolation Relationship breakdown / loss

or bereavement Obesity Repeat self-harm Living alone Adult learning difficulties

The roots of poor health are found across society and the public service – we need to do more than just respond at the point of crisis. This requires integration of not just health and care, but contributing wider public services focussing on health, wealth and wellbeing

Devolution isn’t just about health & social care

We are integrating at all levels across all public services…

With individuals, their families and their communities - All parts of the public service, civic society and business committed to improving the health of the population as part of a New Deal

Local integrated care “Health Benefit Trusts” looking after the day to day care and support of a defined population. Incentivised & accountable for keeping people well.

Activated Person

Community & Family

School & workplace

Integrated Care Organisation

• Centres of Excellence

• Hospital Groups/ service chains

• Specialist Treatment

Binding Provider governance that will deliver accelerated improvements in patient outcomes and productivity.

• Outcomes Framework• Technology enabled,

proactive care co-ordination

• Capitated Budget & bundled payments

1

2

3

Highlights & opportunities

28

• A genuinely galvanising effect – whole system enthusiastic participation. Everyone wants to help. This is true at both the local and national levels, as well across the statutory and voluntary/third sector.

• A collaborative breakthrough – system governance across all partners underpinned by clear joint decision making capability. This includes the unique elements of a GM Joint Commissioning Board and an NHS Providers Federation Board and explicitly priortises public benefit about organisational self interest.

• A lifting of the ambition – now planning to bring together £2.7bn of commissioning resource. Also looking at more radical change through the Transformation Initiatives.

• Devolving power/evolving citizenship – generating enthusiasm for a different relationship between the public and their public services, responding to social action, tapping into the strengths and assets of our communities.

• The Economics of Prevention – the key opportunity for us to understand the associations between key preventive interventions (early years investment, employment support, lifestyle adjustment, community development etc) and impact on the characteristics of current demand.

Challenges

29

• Subsidiarity and operation at the right spatial level– getting the balance right between what we do 10 or more times to hold relevance at the ‘place’ level and what we do once at the GM level to secure the benefits of transformation at scale.

• The financial case for prevention & early intervention – we are challenging ourselves to make the most powerful case yet for the ‘economics of prevention’ demonstrating the link between public health, employment and early intervention outcomes and setting this out in a joint submission to the Spending Review.

• Exciting the public about devolution – we have some way to go to opening out the discussion and engagement to the public at large at a level where we could genuinely drive a significant shift in social action and citizenship.

www.england.nhs.uk

Pharmacy Transformation

Amy LepiorzSenior Primary Care ManagerNHS England

www.england.nhs.uk

Pharmacies in Greater Manchester

75

72

42

72

139

59

67

51

64

60

www.england.nhs.uk

• 16 million patients per year visit a GM pharmacy• c.230,000 MURs and 45,000 NMS consultations

undertaken in 2014/15• £800 million spent on medicines per year• Approx. 100 patients daily are accessing the GM

minor ailments scheme• 30% improvement in patient’s inhaler technique after

accessing the GM scheme• Circa - 120 Healthy Living Pharmacies

Facts and figures

www.england.nhs.uk

‘‘To build the Greater Manchester pharmacy service for tomorrow- today!’’

Vision

www.england.nhs.uk

Transformation Plan

www.england.nhs.uk

‘‘Transactional reform [has the ability] to trump transformational change.’’

Mark Britnall,

Global Chairman for Health, KPMG

Doing things better

www.england.nhs.uk

PaulAnne

Patient Journey

www.england.nhs.uk

• 59 years old• Retired- former business manager• Recently diagnosed as hypertensive• Manchester United fan

Paul

www.england.nhs.uk

Medicines Use Review

Targeted lifestyle interventions

New Medicines Service

Opportunistic healthy lifestyle advice

Paul’s devo pharmacy experience

www.england.nhs.uk

• 57 years old• Recently retired school teacher• Hypertensive with family history of CVD• Enjoys spending her children’s inheritance on

holidays-(lots of holidays!)

Anne

www.england.nhs.uk

Practice pharmacist management

Repeat dispensing

Electronic Prescription Service

MUR and lifestyle advice

Anne’s devo pharmacy experience

www.england.nhs.uk

• For our patients?• To ensure a happy healthy population?• To be the best we can?• Because we can!• But also………

So why is it important that we make these changes?

www.england.nhs.uk

Mum and Dad

..because Anne and Paul are also known as…

www.england.nhs.uk

Kate Kinsey

Head of Primary Care Operations

NHS England

Break-out Session Introduction

www.england.nhs.uk

• Facilitator/scribe on each table;

• Questions posed have been developed by the working groups;

• Responses will be used to influence the working groups goals and objectives;

• Please choose a table you have an interest in; if full go to your 2nd/3rd choice;

Break-out session

www.england.nhs.uk

• Medicines Optimisation x 2• Health and Wellbeing x 2• Patient Safety • Engagement and Communication • Workforce x 2• Seamless Care x 2 • Service Development x 2

Break-out session tables

www.england.nhs.uk

Break

Please return to your chosen table in 10 minutes

www.england.nhs.uk

Break-out Session

www.england.nhs.uk

Summary and next steps

Jane Brown

Chair

Local Pharmacy Network

www.england.nhs.uk

Thank you for attending

Safe journey home!