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Healthy Living Pharmacy
Maintaining and building on QPS
The Government and PSNC have agreed an interim arrangement to extend the current funding arrangements, including the Quality Scheme, until October 2018. The scheme, which began in April 2017, is but the start of a process which aims to drive improved quality and value into the current contractual framework for the NHS and the public. It comes with a £37.5 million budget for the 6-month period and a June 29 review point with a claim period from June 11 – July 13.
The direction of travel indicated by the NHS Five Year Forward View, government policy and increasing consumer expectations is clear; its based on high quality, efficient and effective clinical health and wellbeing services. This is not just about pharmacy, but all providers of health and care to bridge the current gaps in quality, health inequalities and finances.
Initial information indicates that 11,410 pharmacies in England submitted a QPS claim to the NHS Business Services Authority for the April and November review dates. There was broad engagement across the Quality Criteria with 9,474 pharmacies declaring Healthy Living Pharmacy (HLP) Level 1 status. A great commitment and achievement by all and clearly demonstrates a desire to meet the quality criteria and a need to receive the payment in what are very challenging times. These are strong and important messages to send to the NHS, the Department of Health and Social Care and Ministers.
This excellent engagement with the Quality Payment Scheme needs to be maintained for the next review date on June 29 when all criteria must still be fully compliant in order to make the claim.
QPS Criteria
As before there are four Gateway Criteria (Advanced Services, NHS Choices, EPS and NHSmail) all of which must be met, and eight Quality Criteria. There are some minor amendments to the Gateway criteria for using NHSmail from a premises shared account and listing Bank Holiday opening times on NHS Choices; these are covered in the Pharmacy Complete QPS Quick guide with key requirements and solutions. More information is available on the PSNC website
Healthy Living Pharmacy
There are about 2000 pharmacies yet to declare HLP status and for some that may require more forward planning, work and evidence to achieve or maintain the criteria. For those who have yet to start or complete their HLP journey, we have developed our HLP Countdown initiative supported by a 6-week pathway and a series of short online videos.
We should recognise that becoming an HLP is not a tick-box exercise, it is the beginning of a new culture and business model based on quality people, premises, services and consumer experience which could and should form the foundation of a healthier future for pharmacies.
HLP is built on the basic business principles of organisational development and change management. The enablers are workforce development, engagement with the community and creating a health-promoting environment. These have never been more important.
What to do now?
You will need to regularly ensure you are meeting all the HLP quality criteria and have the evidence to show that. Please don’t wait until to last minute for the QPS claim or if there is a Quality Payment Scheme request or Assurance visit; HLP provides many benefits in addition to the payment. Once you are confident, start to build on the criteria utilising an empowered and engaged team:
1. Understand your market – Start with your local Joint Strategic Needs Assessment (JSNA) and Pharmaceutical Needs Assessment (PNA), both will be on your local authority website. Please note that many areas have recently updated both so download a summary and pop in your HLP portfolio folder. Your local Health Profile also provides a snapshot of needs and priorities. Work as a team to identify what you believe are the biggest health issues, based on what you see day-to-day.
2. Engage with others – be proactive by contacting local GP practices and other providers, NHS and public health commissioners. Use open discovery questions and active listening to understand their challenges and see what your pharmacy could offer to help with their issues. Speak to your LPC to understand what they are doing and how they can support you.
3. Develop the team – have a team meeting and ask them to write down their strengths and the areas they would like to develop. Some pharmacies have invested in the Health Champion qualification for all their team who have patient contact, including their pharmacists and home delivery colleagues. Many are now looking to develop knowledge and skills further, e.g. Flu Champions and Mental Health Champions.
Summary
This remains a very challenging time for pharmacy contractors, particularly with negative cash flow and rising costs of running a business. However, the landscape in which community pharmacy is operating will continue to change so the sector and the professions must adapt to these evolving needs to remain relevant and compelling to commissioners and consumers of our services. Achieving the quality scheme payment is but the start of that process; continual improvement and investment in quality will remain a critical success factor for a sustainable and healthier sector.
Hidden value
I was in Practice on Saturday – working for an independent community pharmacy owned by the adjacent GP practice. As frequently happens, we received a call from a young woman (late 20′s) who wanted to speak to the pharmacist.
This case highlights just how much value pharmacists add to the health system but goes completely unnoticed by those who hold the purse-strings.
She explained she had Lupus and had been late requesting a flu vaccination. She was visiting her mother from the North West and with the increased press noise about flu she was keen to have a number of queries answered before having the vaccination. Was the flu jab appropriate for her and if so, what could she expect? Would she be able to have it as she had recently been prescribed a course of steroids by her consultant and she had heard that she should not have ‘live’ vaccinations? She then went on to add that she thought the Prednisilone tablets were causing her bad stomach symptoms as she believed herself to be lactose intolerant and she had read that the tablets contained lactose – could this be the tablets and if so, what alternatives could she have?
One thing at a time – I explained that she should have the flu vaccination, it was inactivated so fine with her Prednisilone although she might expect a flare up of her Lupus symptoms as a side effect. I also explained the availability of the vaccination (we don’t provide it at the pharmacy I work in as adjacent to the GP practice and this is a decision they have made) and that she was eligible on the NHS – meeting our Healthy Living Pharmacy (HLP) requirement of signposting someone to the flu vaccination service. I encouraged her to find a pharmacy that provided the vaccine and gave her some local examples.
I then asked a few questions about her symptoms and whether she was on any other tablets – she was. Sertraline (confirmed by access to the SCR following her explicit permission) could cause an increased risk of bleeds/stomach problems combined with the steroids. She had previously been prescribed Omeprazole (but not taking) and so I explained that whilst it could be lactose intolerance (difficult to determine) but (perhaps more likely) could be the combination of both medicines causing her tummy to be upset. I advised she reinstate her Omeprazole (explaining that this may initially upset her tummy) and encouraged her to speak to her consultant/GP when back in the North West, monitoring her symptoms to see whether the PPI helped. I reiterated my recommendation to have her flu vaccination as soon as practical.
We finished the call with her very satisfied with the level of service she had received and with me having a glow of professional fulfilment. I had made a difference. From a system perspective, the contribution undoubtedly added value – here’s a patient who could have ignored the recommendation for a flu vaccination, fearful of having it and potentially had problems with her stomach and a bleed. Instead she felt empowered, informed and motivated to put in place what she needed to continue her treatment.
So, what’s the issue? This call took around 20 minutes of my time, some research and a call-back. From a sustainability perspective none of this was remunerated; this call actually cost the pharmacy money. With the focus on funding supply, our current reality is that the time spent on supporting and caring for patients is becoming increasingly difficult to justify. There was no ‘footfall’ within the pharmacy which would result in a sale, we did not benefit from a Rx nor an additional service or vaccination. None of this directly impacts my role or my desire to help, however phone calls for professional advice are an increasing trend in our pharmacy and I worry that we cannot continue offering ‘free’, easily accessible advice as a sector. I can only think this trend is going to increase further as patients want to speak to a healthcare professional but cannot get a GP appointment. This is fabulous for the profession but for it to be sustainable, the NHS must wake up to the hidden value that pharmacy offers.
What’s the answer? More of us MUST highlight stories such as these and help our local MPs, Commissioners and our negotiating body to understand what we really do. We need more evidence and research to persuade those who define policy and payment. We require a new contract which reflects the care package we provide in our communities and perhaps a Quality Payment which recognises interventions made.
One thing is for sure, with pharmacies closing and finding it increasingly difficult to operate, we need to have our professional contributions properly recognised. I don’t know anyone who would turn a patient away and not help so please, NHS, properly recognise the difference we make and fully integrate us into the system.
Brilliant progress with HLP accreditation
In Public Health England’s winter HLP newsletter they announced that over 8300 pharmacies have progressed to the profession-led self-assessment process and registered as a Healthy Living Pharmacy (HLP) with the Royal Society for Public Health. These 8300, together with those pharmacies who had previously been locally accredited and therefore qualified for their Quality Payment with NHS England, means that 9390, the vast majority of pharmacies in England, will now have this important quality mark. This is an outstanding achievement and is cause for celebration amongst the sector! Everyone involved should be rightly proud.
Being recognised as an HLP shows local commissioners, other providers of health and, perhaps most importantly, the public, that the pharmacy has the willingness and capability to engage proactively with the local community on health and wellbeing. It is critical that the achievement of the quality mark is not seen as the end of an exercise to achieve the quality payment but the platform on which to build to further demonstrate the difference pharmacy makes. Simply displaying the HLP logo will not be enough; embracing the culture and living the HLP ethos will result in increased effectiveness in service delivery, improvements in team productivity and customer experience and loyalty. All critical at this difficult time of funding cuts, uncertainty and greater demand on health services.
Community pharmacy has over 1.6 million opportunities a day to make every contact count on important public health issues such as smoking, healthy diet and weight, physical activity and safe alcohol consumption. We are also excited about the opportunity pharmacy has to engage with the most vulnerable within our communities and support people with their mental wellbeing, building on the excellent start shown with the team becoming Dementia Friends.
All HLPs must display their logo and maintain their status as a condition of registration so please do get in touch if you want more information on how to achieve this. We have some great resources to support HLPs to be the best they can be and have some exciting product launches for 2018. Register here to be kept up to date with further information.
Next steps for HLP?
From a concept in the 2008 Pharmacy White Paper, Healthy Living Pharmacy (HLP) was first developed in Portsmouth, then supported and nurtured through a pathfinder programme, an NHS reorganisation and two changes in Government. It is testament to community pharmacy and the gritty determination of a few that it has become the national quality mark it is today.
From the start it was clear that the sector must adapt to the ever-changing landscape in which it operates. Commissioners were and still are looking to pharmacy for more consistent delivery of high quality services as a solution to some of its worsening health inequality challenges and evidence that they provide good value for money.
Aside from the focus on improving the public’s health through proactive health promotion and engagement in the local community, HLP is built on principles of organisational development and change management. The core enablers of HLP are developing the workforce, the pharmacy environment and engagement with other providers, commissioners and the community – these are the fundamental elements of any good business development strategy. The outcome is having the right people with the right skills doing the right things to create excellence in customer experience, meeting a market need from premises that are fit for purpose and promoting what we do.
Becoming an HLP is just the beginning and if pharmacies stop at the point of self-declaration then nothing will change and the many benefits of HLP will not be achieved. What we do next to build further on these foundations will enable a healthier future for community pharmacy and the communities we serve.
What can you do now that you have achieved HLP accreditation?
- Understand your market opportunities – One of the HLP criteria is to understand local health needs and having done so, focusing on the priorities where pharmacy can have the greatest impact. This is your market research and should be constantly developed through broader engagement with your local community, commissioners and other providers of health and wellbeing services. The starting point is your local Joint Strategic Needs Assessment (JSNA) and Pharmaceutical Needs Assessment (PNA), both will be on your local authority website. Your local Health Profile also provides a snapshot of needs and priorities.
- Engage with others – Do not wait for someone else to do this, be proactive by opening and continuing a dialogue with local GP practices and other providers, CCGs and public health commissioners. Use open questions and active listening to understand their challenges to see where community pharmacy could offer an effective and cost-effective solution. As a minimum this builds relationships, facilitates understanding and 2-way referral that could lead to commissioned services and increased footfall. You should also speak to your LPC to understand what they are doing and how they can support you.
- Effective campaign planning – Use local relationships and connections to put together your health promotion campaign programme both in the pharmacy and out in the community; this makes a real difference and is both fun and effective in promoting the pharmacy and what it does. These activities can be linked into national campaigns such as those from Public Health England and the calendar of national campaigns hosted by NHS Employers. We are developing a Health Promotion Zone starter pack and a suite of campaign packs for 2018.
- Develop capability – A developed, engaged and motivated workforce is more productive and this has been frequently demonstrated in HLPs where teams deliver more. Having one full-time equivalent Health Champion is the minimum requirement for HLP, but many pharmacies have invested in this qualification for all their team who have patient contact, including their pharmacists and home delivery person, to grow their knowledge, skills and confidence. This will also improve customer experience, loyalty, footfall and job satisfaction resulting in increased productivity and retention. It is important that Health Champions and colleagues are empowered to undertake their role and this is where the ability to delegate appropriately and effectively is a critical leadership skill. Check out the training section of our website.
What next for HLP?
Whether HLP will remain in the Quality Scheme for 2018/19 has yet to be confirmed, but a healthier future is partly down to the sector itself and its ability to demonstrate what it can achieve and shape its own future in the ever-changing landscape. One of the reasons HLP has come this far, is the evidence that has been collected; we must continue to capture and demonstrate the difference we make.
If we explore the current NHS, public health and consumer priorities some future options could include:
- Consumer experience – the public’s expectations of the quality of their experience and accessibility to services continue to rise. People no longer buy product, they buy an experience which is the outcome of an interaction between an organisation and a customer over the duration of their relationship. The days of relying on quick turnaround of FP10s as a measure of customer service has moved on. A great HLP feels different, there is a buzz and a positivity about the experience which results from the ethos that the whole team live and breathe. Everything about the pharmacy including your premises, website, promotional materials and social media must reflect this ethos.
- Health interventions – Making every contact count (MECC) is an approach to behaviour change that utilises the millions of day-to-day interactions that organisations and people have with other people to encourage changes in behaviour that have a positive effect on the health and wellbeing of individuals, communities and populations. With an estimated 1.8 million contacts per day, pharmacy is well placed to implement this approach and make a difference in supporting people to stop smoking, improve their diet, increase physical activity, lose weight and reduce alcohol consumption.
- Risk assessment and management – the early identification of people at risk of hypertension, atrial fibrillation, diabetes, cancer and a range of other critical health risks based on your local health profile is an opportunity. This could be locally commissioned, but could also be a privately offered service covering health awareness, detection, prevention interventions and support and referral as appropriate. We would like to see a Quality Scheme criteria which pulls together the strength of the pharmacy workforce to make a tangible difference in outcome in one or more of these priority areas.
- Digital – community pharmacy must embrace technological advancement through integration, information and communication. Further embedding the use of smart recording of interventions and referrals or signposting in routine practice would be a great place to start. Some HLPs are using information screens in the pharmacy to promote healthy living messages, campaigns and services; tablet devices to engage and illustrate key health issues within proactive conversations then capture those interventions; and using their website and social media to promote what the local population and businesses can access from their pharmacy.
Whilst this a very challenging time for pharmacy contractors, the landscape in which community pharmacy is operating will continue to change. The sector and the profession must constantly adapt to these evolving needs to remain relevant and compelling to commissioners and consumers of our services. Becoming a Healthy Living Pharmacy is the beginning; it is not a bolt-on, it should be business-as-usual. Continual improvement and investment in quality and experience will remain a critical success factor for a healthier future for community pharmacy and our communities.