Pharmacy Complete

QPS

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Quality Payment Scheme 2018/19

The criteria for the second half of the 2018/19 Quality Payment Scheme have been announced with some changes to both the Gateway and the Quality criteria. The review point for this period will be February 15, 2019.

We are pleased to see that Healthy Living Pharmacy has been retained with an additional public health capability requirement for the pharmacy team to have completed child oral health training in advance of a planned health campaign on this important topic in 2019.

In addition there is a greater focus on patient safety with three criteria covering incident reporting, risk management and an NSAID and gastro-protection audit. There is also an additional element in the clinical effectiveness criteria linked to the provision of a spacer device for all children aged 5-15 years prescribed an inhaled corticosteroid.

You can find a summary of the new scheme requirements in our updated Quality Payments Quick Guide.

Pharmacy Complete have a complete package of support to become and maintain the HLP quality mark. We can also help you build on this foundation through additional team development, leadership and business development programmes.

If we can help you, please connect with us.

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Healthy Living Pharmacy and the NHS Ten Year Plan

It is excellent news that we now have 9436 (88%) pharmacies in England declared as Healthy Living Pharmacies, this represents an additional 5% on the November 2017 declaration. For these pharmacies the key will be ensuring that all the HLP criteria continue to be met in order to maintain the status and thus be able to promote the quality mark.

Becoming an accredited HLP is just the beginning, its what HLPs then do differently, bigger and better that will define and differentiate them. This will then help them realise the benefits of the improved ethos, engagement, capability and activity that comes with doing the right things with the right people.

The next step is building on that capability and activity for a healthier future for their community and their pharmacy. Pharmacy Complete have a range of resources and courses to support this. Developing and demonstrating this capability and commitment should have its own benefits through increased productivity and delivery of both private and commissioned health promotion, prevention and protection services.

What we need to see now is the NHS and Public Health, at both national and local level, recognising the HLP asset to deliver against the Staying Healthy and other objectives within the recent NHS Plan consultation to reduce health inequalities and improve the health of the population. Good to see some early signs of engagement from PSNC and RPS with this consultation which requires new thinking focussed on NHS and public health needs both now and in the future.

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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.

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Beyond QPS?

The direction of travel indicated by the NHS Five Year Forward View, government policies and consumer expectations is clear – it’s based on high quality, efficient and effective clinical care in health and wellbeing.

As part of the imposed community pharmacy funding arrangements the government included a Quality Payments Scheme consisting of 4 Gateway Criteria and 8 Quality Criteria. The scheme, which aims to drive up consistency of quality and value of pharmacy services comes with a £75million budget taken out of current funding so would be a further loss to contractors beyond the existing cuts if not achieved.

Initial information indicates that the majority of contractors in England claimed at least some of the quality criteria thus presuming that the Gateway Criteria were also met. As yet, no detail is available on who and which criteria were claimed for.

What to do now?

Having worked hard to achieve some or all of the criteria, it is now about leveraging that and understanding local needs and priorities is a great place to start. The Joint Strategic Needs Assessment (JSNA) and Pharmaceutical Needs Assessment (PNA) highlight these for you and will be hosted on most CCG and Local Authority websites. Another place to look is the Health Profiles website, these provide a snapshot of local needs and hence opportunities for pharmacy campaigns, interventions and services.

Opening dialogue with local CCGs and Local Authority Public Health commissioners is also important, particularly for LPCs who have a key role in driving new services for their contractors.

All of the Quality Criteria are important but perhaps some more than others on which to build a healthier future for your pharmacy and your community. Achieving Healthy Living Pharmacy (HLP) status is but the beginning and should be the platform for the development of a future professional business model based on an effective workforce, community engagement and a professional pharmacy environment. The Dementia Friend criterion also adds to team skills.

Patient Safety is also a critical element of the criteria with safeguarding, clinical effectiveness (asthma management) and effective use of the Summary Care Record.

Ensure that your local population, other health and wellbeing providers and local commissioners understand what you do by keeping NHS Choices and NHS111directory of services up-to-date.

What next?

Most people believe that the QPS is here to stay but, given the drivers in the landscape, there is a natural evolutionary pathway. Once some of the criteria are bedded down one could imagine them transferring into the Essential Services specifications and being replaced with others. Workforce capabilities may include making every contact count, behavioural change or mental wellbeing; clinical effectiveness may focus on T2 diabetes, hypertension or high-risks medicines; prevention criteria maybe introduce on lifestyle-related health risks such as smoking, healthy diet and healthy weight, alcohol, physical activity or hypertension and AF-related stroke risks.

Conclusions

Whilst this is a very challenging time for community pharmacy, particularly in England, the landscape will continue to change and the pace will only accelerate so the sooner we embrace it and adapt to it the more likely we are to achieve a healthier future.