Medicines Optimisation and Improving Inhaler Technique through Community

Medicines Optimisation and Improving Inhaler Technique through Community Pharmacy Dipesh Raghwani and Peter Marks

What the session will cover: Welcome and Introductions Presentation 1: Medicines optimisation in COPD/ Asthma • Opportunities for Community Pharmacy • Service outline and service specification • Roles and responsibilities • Pharm. Outcomes • Resources Workshop exercise: • In-Check and Inhaler devices – Demonstration – table top exercise Presentation 2: How to make the most of the service - delivery support • Relationship to the quality payments • Top tips for delivery – Make this a successful service • Utilisation of the wider pharmacy team

Introductions • • • Background Role at GMLPC Housekeeping Mobile Phones Feedback

Principles of Medicines Optimisation

Opportunities in CP • • NMS MUR (t. MUR, d. MUR) Inhaler Technique Flu vaccination (including carers) Smoking Cessation Public Health Interventions Do. C Services Building Loyalty

Opportunities with COPD

Opportunities with Asthma

Improving Inhaler Technique through Community Pharmacy Service

Service Description • Pharmacist review with patient only • The pharmacist will assess disease control, inhaler technique and provide health promotion information • Eligible patients follow up review 6 -8 weeks later. • Face to face service in the pharmacy • Recording on Pharm. Outcomes

Service Outline

Service Outline

Service Outline Payment • A payment of £ 10 will be made on completion of the initial assessment and a further payment of £ 7 on completion of the follow-up. A minimum of 5 consultations must be completed before the first payment is made. • A £ 10. 00 payment will be made on completion of the initial assessment and a further £ 7. 00 payment will be made on completion of the follow up, if clinically necessary. However payment will only be made once the pharmacy has completed an initial 5 consultations in full. No payment will be made if the required information has not been recorded on Pharm. Outcomes. • Pharmoutcomes will generate the invoices for payment. • Payment shall be made by BCAS.

Roles and responsibilities Training requirements: All pharmacists providing the service are to self-declare their competence using the ‘Declaration of Competence for Improving Inhaler Technique through Community Pharmacy’ available at www. cppe. ac. uk. Pharmacist should ensure they re-accredit in line with the requirements of the ‘Declaration of Competence’. This is usually every three years.

Resources and podcasts Visit our website! • The GMLPC website holds a list of resources you can utilise to deliver this service effectively. We have included this information in your training pack. You can look us up on: Greater Manchester LPC: http: //psnc. org. uk/greater-manchester-lpc/service-information/improving-inhalertechnique-through-pharmacy-service-resources/ Podcasts • In addition there are podcasts available and these can be found here: www. greatermanchesterinhalertechnique (it is the 1 st hit)

Resources and podcasts A number of podcasts are available – The links are available on our LPC website MDI, Autohaler, Accuhaler, Easibreathe, https: //www. asthma. org. uk/advice/inhaler s-medicines-treatments/using. Easyhaler, Turbohaler, Small & Large inhalers/#Videos volume spacers Respimat https: //vimeo. com/193359965 Breezhaler https: //vimeo. com/215977594 Ellipta https: //vimeo. com/192943114 Novolizer https: //vimeo. com/179442809 Handihaler https: //vimeo. com/178617777

Resources and podcasts You will also find additional information and resource on the LPC websites from the following: • • Nice Guidance BTS Guidance GMMMG Charities including: Please check their websites • • • Websites: • • British Lung Foundation Asthma UK Smoke free Cancer Research UK Be Clear on Cancer Patient. co. uk – Asthma Patient. co. uk – COPD

Workshop Exercise

Workshop Exercise • Demonstration of basic types of inhalers • Time for you to get involved with handson practice! • DON’T BE SHY

Recap You should be aware how to use: • In-Check Dial • Inhaler devices • Various available resources

How to make the most out of the service

How to make the most out of the service • Involve the whole pharmacy team in identifying patients • Make sure that you have all your resources ready

Relationship to Quality Payments The Greater Manchester Inhaler service links well to the Quality Payment around Asthma referral. What’s required The Quality Payments guidance states: “On the day of the review, the pharmacy can show evidence of asthma patients, for whom more than 6 short acting bronchodilator inhalers were dispensed without any corticosteroid inhaler within a 6 month period, are referred to an appropriate health care professional for an asthma review. ” You can claim 10 points at both review dates but if you didn’t claim 10 points at 28 th April 2017, you will miss out on them; you cannot claim 20 points at 24 th November instead. Income available 2 x 10 = 20 Quality Payments points i. e. £ 1, 280.

Top tips for successful service delivery • • • Whole team involvement Prepared paperwork Have a good system for follow-up Identify your challenges and be prepared to address them All apply even if you do not deliver the service directly

Top tips for successful service delivery Challenge 1: My patients say they don’t want these services Patients may be reluctant to receive services for a variety of reasons, including lack of time or feeling that they don’t need help beyond that given by their GP. Try some of the following: a) Don’t force it b) Go beyond the GP - explain how services support GPs’ work c) Think about your terminology: many patients will be receptive to the offer of "a chat about medicines" but may be put off by words like "service" and "review". d) Use prompts: consider using patient queries or even planned GP reviews as triggers to offer services, e) e) Sell the benefits: emphasise the potential benefits of services

Top tips for successful service delivery Challenge 2: I’m too busy to stand at the counter looking for patients! • Utilise your whole team! • Make the most of your PMR system: many PMR systems can flag patients who are likely to be eligible for the service • Organise training: Ensure your staff are fully briefed

Top tips for successful service delivery Challenge 3: How can I reach patients who don’t collect their own medicines? • Take-home materials: Have materials ready for patients to take home • Be flexible: Ensure you are open to communicate in various ways – Text, email, phone etc

Top tips for successful service delivery Challenge 4: How can I balance unpredictable workloads with consultations? • Plan your days: booking calls and appointments for times when the pharmacy tends to be less busy and use your wider team • Work in time slots: if you are agreeing to call a patient, ask for convenient time slots (e. g. 5 -7 pm) rather than a specific time • Be flexible: Ensure there is always someone able to provide the service

Top tips for successful service delivery Challenge 5: My patients forget appointments and don’t answer the phone! • Remind them: giving patients an appointment card or other written reminder of their planned consultation can be helpful • Embrace technology: if patients have requested a call at a certain time or booked a follow up appointment, you could remind them about this beforehand with an email or even a text message. • The right number: Ensure you have the right contact details and more than one way of getting in touch

Top tips for successful service delivery Challenge 6: My local GPs just aren’t interested in these services GPs are often difficult to win over when it comes to pharmacy services, sometimes because they’re under too much pressure to be interested, and sometimes because they don’t see the value. Keep these facts in mind in any dealings with them and try the following. • • • Think about the team: Engage the whole GP team Work together: Work with pharmacies that are engaging with the same GP. Value their time: Try and find a way that works for them. Don’t undersell yourself: Take the time to inform them of the benefits and successes of the service Be concise: appropriate feedback and referral back to GPs Keep up the momentum: if referrals from a practice are low, or start to dwindle, speak to them again

EOI forms • EOI Process • Potential for review of participating pharmacies in the New Year • Can demonstrate delivery without being part of the service

How can I make this work for my pharmacy?

Contact us: Our website holds FAQs about the service and additional resources. We are also at the end of an email or phone, so please do not hesitate to contact us with any queries you may have on the details below: Greater Manchester LPC – Support Team Enquiries@gmlpc. org. uk 0161 228 6163 Dipesh Raghwani – Clinical Lead Dipesh. raghwani@gmlpc. org. uk 0161 228 6163/ 07592691205

Any questions?

Thanks for Listening Best of Luck