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Nov 19, 2014 - Samira Ben Omar, Assistant Director, Patient ... management – community pharmacy case study .... inform
PATIENT SELFMANAGEMENT 19 November 2014 St Paul‟s Centre

Hammersmith

Order of events 09.30

Arrival and registration

10.00

House Keeping

Christopher Gamblin, Independent Facilitator

10.05

Opening welcome and vision for the day

Dr Tony Willis, Hammersmith and Fulham Clinical Commissioning Group

10.10

The evidence and context for Self Management including what is happening locally.

Samira Ben Omar, Assistant Director, Patient Experience and Equalities CWHHE CCGs (Central London, West London, Hammersmith & Fulham, Hounslow, Ealing)

10.20

Working in partnership with local people to promote self management – community pharmacy case study

Ash Khan, Senior Pharmacist

10.30 10.40

A patient‟s perspective Facilitator briefing and process

Liz Sanchez Christopher Gamblin

10.45

Session 1 – “What ideas and examples of good practice would you like to share?”

Table discussions

“What would be your top three priorities?” 11.30

Break to collect refreshments and drinks

11.50

Session 2 – “What might some of the barriers be and what would need to change to overcome them?”

Table discussions

12.30

Review

Christopher Gamblin/ Dr Tony Willis

12.45

Close

Dr Tony Willis

2

Welcome

Dr Tony Willis

GP Member, Hammersmith and Fulham

Clinical Commissioning Group Collaborative Clinical Lead for Diabetes,

Central London, West London, Hammersmith and Fulham, Hounslow and Ealing CCGs

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Dr Tony Willis

My roles: •

Diabetes strategy and transformation in the 5 CCGs



IT strategy and systems design within North West London

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Dr Tony Willis

New contract with Primary Care in CWHHE: •

Significant investment as CCGs



Up-skilling of primary care



Improving quality and outcomes



Self-management including collaborative goal setting and care planning at its very core



Due to launch Feb-March next year

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Dr Tony Willis

NW London Care Information Exchange • Significant local investment from CCGs and providers

• Link health records locally • Allow users and carers ability to interact with records

• Support self-management • Allow 2-way communication • Interact with medical devices, apps, etc

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Dr Tony Willis

Vision for today’s event Your views on what best practice self-management programmes should be like • Key issues • Actions • Opportunities to bring you together to design a model to deliver self-management

You are: • • • •

Service users Carers Community and voluntary workers Health and social care professionals 7

The evidence and context for self-management

Samira Ben Omar Assistant Director,

Patient Experience and Equalities, CWHHE CCGs (Central London, West London, Hammersmith & Fulham, Hounslow, Ealing)

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Samira Ben Omar

What are long term conditions?

Why self-management?

How you can help?

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Samira Ben Omar

What are long term conditions? Medical conditions that cannot be cured but can be managed through medication and/or therapy: e.g. diabetes, dementia, chronic heart disease (CHD),chronic obstructive pulmonary disease (COPD), arthritis and hypertension. Why self-management? To work in partnership with people with long term conditions so that they can effectively manage their health on a day-to-day basis. How you can help? Work with us today to help identify and identify the best approaches for people in our community. 10

Current self-management and self-care locally Self-management support type

Example

Active, evidence-based, peer-led programmes for generic selfmanagement

Expert Patient Programme (EPP)

Active, evidence-based, peer and clinician-led programmes for condition-specific self-management

MyAction for COPD

Condition or skill-specific workshops and seminars

Recovery College at NWL

Technology-assisted self-monitoring

DaFne or DeSmond for Diabetes

Interactive web-based self-management programmes

Online EPP

Self-care support type

Example

Condition-specific support groups

Local Breath-easy Groups by British Lung Foundation

Befriending services

Local Mind UK Befriending

Health mentors, navigators and community champions

Westway Health Champions, Turning Point Health Mentors

Social support groups and networks

Knit and Natter Earls Court Wellness Centre

Generic self-management and self-care information

**

Condition-specific self-management and self-care information

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**

Self-management services and change needs What are we doing?

How could we improve?

CCGs commission self-management courses, provided in community settings

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Sign-post to services Adapt programmes to match population need Commission condition-specific programmes Make the care-plan and care-planning process the central connection between services

Health mentors, health trainers, community champions available to help people develop care-plans and to signpost to services

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Develop trainer, navigator and champion capacity Improve understanding, links and relationships between HCPs and various support services Improve systems to support more integrated and seamless referral pathways and increase local awareness of services Make the care-plan an active tool used to connect services

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Self-care and self-management programmes delivered by community and voluntary organisations

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Self-care and self-management information available online and in multiple formats

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-

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Build capacity of third-sector to be able to deliver these services to target populations Improve local knowledge of services to enable greater access Improve access to information by connecting information with other services and make it „subscribable‟ depending on need Tailor information to reach hard-to-reach groups 12

Evidence review - why transform selfmanagement? 1 The people who use the services say that they are not good enough… “I want to be involved in decisions about my care – I want to be listened to” “I want access to information to help me make decisions”

Therefore: Care and support need to change to meet the needs of those with long-term conditions

“I want support to understand my condition and confidence to manage – support to self care” “I want to be treated as a whole person and for the NHS to act as one team” “I want joined up, seamless services”

“I want proactive care “

“I do not want to be in hospital unless it is absolutely necessary and then only as part of a planned approach” Based on extensive consultation with people with long-term conditions from: Our health, our care, our say: a new 13from people with long term conditions direction for community services - consultation responses

Evidence review - why transform selfmanagement? 2

We have an ageing population who will increasingly live with one or more long-term conditions Long-term conditions adversely effect a person’s health, wellbeing and happiness The current support offered by the NHS is costly and not fit for purpose The Health and Social Care Act – “health and social care providers, where appropriate to provide opportunities for self-management” 14

The co-creating health model What works for self-management

The Health Foundation‘s House of Care model suggests that changes to self-management support services need to happen in parallel…

The person

Commissioning Evidence-Based SelfManagement - Giving people with long term conditions the skills, confidence and support to self-manage.

The professional

Clinician Training - Helping clinicians to develop the skills, knowledge and attitude to support and motivate people with long term conditions.

The organisation

Changing health systems - So that they encourage and facilitate self-management

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Working in partnership

Ash Khan, Senior Pharmacist Community pharmacy’s role in Health and Well-being Healthy Living Pharmacies

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Community Pharmacy • Over 11,000 community pharmacies in England • 99% of population can get to pharmacy within 20 minutes by car; 96% by walking or using public transport • Estimated 1.8 million visits a day • Average 14 visits per year

• 84% of adults visit a pharmacy at least once a year, 78% for health-related reasons • Most frequent users are females; 89% at least once a year • Those with LTCs or disabilities or living in rural areas are more likely to visit the same pharmacy • Majority (>75%) use same pharmacy all the time

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Pharmacies in CWHHE

Westminster

93

Kensington & Chelsea

42

Hammersmith & Fulham

40

Hounslow

54

Ealing

72

CWHHE Total

301 18

Pharmacy‟s strengths

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Making Every Contact Count

Common Ailments

Ongoing adherence support

Medicines Optimisation

Promotion Prevention Protection

Self care & Healthy lifestyle interventions

PATIENT and PUBLIC Initial supply and support

Early detection

Diagnosis & Treatment

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COMMUNITY PHARMACY’S ROLE IN HEALTH & WELL BEING

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What is a “Healthy Living Pharmacy”

A nationally recognised concept enabling pharmacies to help reduce health inequalities within the local community, by delivering high quality health and well-being services, promoting health and providing proactive health advice.

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What distinguishes a Healthy Living Pharmacy?

 Consistently delivers broad range of high quality commissioned services

 Quality, innovation and productivity  Proactive team ethos  Has a least one Health Champion  Identifiable by the public  Achievement of Quality Criteria  A quality mark

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Portsmouth HLPs

Portsmouth PCT in partnership with Hampshire & Isle of Wight Local Pharmaceutical Committee first developed the Health Living Pharmacy Concept in 2009

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Portsmouth HLP

The foundation criteria for the award of Level 1 HLP status in Portsmouth were:

• Developing the workforce, including having a healthy living champion (formerly health trainer champion) and developing leadership and change management skills • Premises having a suitable environment, consultation room and IT capability • Multidisciplinary engagement working with GPs, PCT and other provider services.

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Headline findings from Portsmouth • 140% increase in smoking quits from pharmacies compared with the previous year • Over 3500 individuals received brief advice on safe alcohol consumption; 36% were at increasing risk and 10% at high risk from current levels of use • Over 1100 patients with a respiratory condition have been supported i n the effective use of their medicines • 70% of patients with a respiratory condition showed an improvement in the anagement of their condition as a result of the pharmacist ervention. • 126 clients successfully lost weight with more than half achieving a otal weight loss of greater than 5% •.

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m int t

Services that could be commissioned and delivered by HLPs include:

• Stop smoking • Weight management • Management of Long Term Conditions (asthma, diabetes, COPD) • Physical activity • Men‟s health • Minor ailments

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Key question

Can the results seen in Portsmouth be replicated elsewhere with different demography and geography?

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Pathfinder Programme 2011

Dept of Health set up Pathfinder Programme to replicate Portsmouth HLP model • To evaluate the benefits of the HLP model • 163 pharmacies across 15 Primary Care Trusts

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PUBLIC REPORTED EXPERIENCES

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Public engagement (n = 1034)

Were you comfortable to receive this service in the pharmacy?

99.9%

Were you happy with how you were treated by the pharmacy staff?

99.7%

Do you feel you were provided with enough information by the…

99.6%

Would you recommend this service to others?

98.3%

Before coming in today, had you heard of healthy living pharmacies?

27.0% 0%

20%

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40%

60%

80%

100%

How would you rate the service provided? (n = 1034)

Excellent

80.6%

Good

17.4%

Ok

1.5%

Poor

0.0% 0%

20%

40%

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60%

80%

100%

Location where service users would have sought help/advice had this service not been available in the pharmacy, shown as a percentage (n = 1034)

Doctor

60.2%

A&E

1.6%

Walk-in Centre

5.4%

Internet

3.7%

I wouldn't have done anything

21.2%

Other (please state)

1.3% 0%

20% 34

40%

60%

80%

Pathfinder Project Report (April 2013)

“Successful implementation of the HLP concept required considerable commitment over many months, multidisciplinary working, some financial investment and a skilled workforce to proactively deliver health promoting messages and public health services. HLPs have, over time, developed new ways of working, maximising the skill mix within the pharmacy to deliver services to meet local needs. Geography, deprivation, location of pharmacy or type of pharmacy does not seem to affect successful implementation.”

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The Inhaler Technique Improvement Project (South of England)



Medicines Use Reviews with people on asthma and COPD medication



Pharmacists tested how well people were managing their asthma and COPD



Specialist asthma inhaler advice



Use of training devices to aid correct technique



206 pharmacies



5000 reviews



Over 800 follow-up reviews monitoring progress

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The Inhaler Technique Improvement Project (South of England – Aug 2012)



40% of asthmatics showed better asthma control



55% COPD patients showed symptom improvement



emergency admissions data suggests a positive association between the introduction of the project and changes in hospital emergency admissions



patients increased their knowledge of respiratory conditions and how to control them better



patients developed greater confidence in controlling these conditions and were able to use “simple tools” to aid management of conditions

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The Chief Medical Officer said …

“HLPs work!” “They improve choice and we must ensure they are embedded in the new NHS” “Inspirational concept!”

Dame Sally Davies 38

A patient‟s perspective

Liz Sanchez

39

Today‟s process

Christopher Gamblin

40

Group session 1

“What ideas and examples of good practice would you like to share?” “What would be your top three priorities?”

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Group session 2

“What might some of the barriers be and what would need to change to overcome them?”

42

Review and next steps

Christopher Gamblin Dr Tony Willis

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