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Improving the Delivery of Community Pharmacy Services

PharmOutcomes: Supporting Seamless Transfer of Care and Local Service Management Community Pharmacy: Time to Take Note of Your High Street Healthcare Professionals Cuts and the Growing Role of Community Pharmacies Harnessing the Potential of the Paperless NHS Making Technology Work Technology Can Power the Community Pharmacy of the Future

Published by Global Business Media



Improving the Delivery of Community Pharmacy Services

Contents Foreword


Tom Cropper, Editor

PharmOutcomes: Supporting Seamless Transfer of Care and Local Service Management Community Pharmacy: Time to Take Note of Your High Street Healthcare Professionals

PharmOutcomes: Supporting Seamless 3 Transfer of Care and Local Service Management Pinnacle Health Partnership LLP

Cuts and the Growing Role of Community Pharmacies Harnessing the Potential of the Paperless NHS Making Technology Work Technology Can Power the Community Pharmacy of the Future

Published by Global Business Media

Published by Global Business Media Global Business Media Limited 62 The Street Ashtead Surrey KT21 1AT United Kingdom Switchboard: +44 (0)1737 850 939 Fax: +44 (0)1737 851 952 Email: info@globalbusinessmedia.org Website: www.globalbusinessmedia.org

Fully Integrated Solutions to Manage Transfer of Care Local Service Management A Completely Paperless Service Management Solution

Community Pharmacy: Time to Take Note of 7 Your High Street Healthcare Professionals Cuts and the Growing Role of Community Pharmacies 10 Tom Cropper, Editor

Publisher Kevin Bell

Funding Crisis Proving Value An Expanding Role

Business Development Director Marie-Anne Brooks

Harnessing the Potential of the Paperless NHS

Editor Tom Cropper Senior Project Manager Steve Banks Advertising Executives Michael McCarthy Abigail Coombes Production Manager Paul Davies For further information visit: www.globalbusinessmedia.org

The opinions and views expressed in the editorial content in this publication are those of the authors alone and do not necessarily represent the views of any organisation with which they may be associated. Material in advertisements and promotional features may be considered to represent the views of the advertisers and promoters. The views and opinions expressed in this publication do not necessarily express the views of the Publishers or the Editor. While every care has been taken in the preparation of this publication, neither the Publishers nor the Editor are responsible for such opinions and views or for any inaccuracies in the articles.


Jo Roth, Staff Writer

A Paperless Future The Role of Pharmacies High Tech Services Positives and Negatives

Making Technology Work


James Butler, Staff Writer

Security Issues Implementing the Technology

Technology Can Power the 16 Community Pharmacy of the Future Tom Cropper, Editor

A More Demanding World Linking Services Technology Holds the Key

References 18

Š 2017. The entire contents of this publication are protected by copyright. Full details are available from the Publishers. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical photocopying, recording or otherwise, without the prior permission of the copyright owner.



Foreword P

HARMACISTS FACE some tough challenges. On the one hand, they are expected to take a more prominent role in healthcare delivery, but on the other they are facing budget cuts. How do they cope in such an environment? They turn to technology. Digital technology is transforming the NHS and other sectors. The government remains committed to its goal of becoming entirely paperless, and new systems allow for faster administration and greater connections between departments. Our opening article comes from a company which is providing one of those systems. Pinnacle Health Partnership is a social enterprise started by pharmacists delivering a cutting edge digital pharmacy platform which can reduce administration, increase services and make it easier for commissioners to see the impact of various initiatives. Elsewhere in this Report, we’ll also take a closer look at this system and others provided by a new generation of entrepreneurs who are convinced IT can help the NHS address many of its most pressing problems.

We will also look at how government cuts are impacting pharmacy providers. Plans for cuts will put pressure on services at a time when they need to take a more active role in healthcare delivery. Demographics are changing and so too are patient expectations. By delivering services in the community at a more convenient time, pharmacies can make life easier for its patients as well as relieve the pressure on secondary care services. Jo Roth will then look at the drive towards a paperless NHS and how this is influencing the development of community pharmacies. James Butler will then examine some of the key issues pharmacists should be considering when implementing new systems – particularly the question of data security. The role and nature of community pharmacists is changing rapidly – spurred in part by a more demanding breed of patients and economic realities. Next generation technology can play a key role in helping them rise to the occasion.

Tom Cropper Editor

Tom Cropper has produced articles and reports on various aspects of global business over the past 15 years. He has also worked as a copywriter for some of the largest corporations in the world, including ING, KPMG and the Zurich.



PharmOutcomes: Supporting Seamless Transfer of Care and Local Service Management Pinnacle Health Partnership LLP


HARMOUTCOMES IS now so much more than a paperless service management solution. The great functionality that has always been there still exists but the team at Pinnacle Health LLP, a not for profit social enterprise based on the Isle of Wight, are now able to offer fully integrated solutions to support Transfer of Care Initiatives and are able to provide the same integration with NHS 111 systems allowing direct referrals to community pharmacies for any appropriate disposition. All of this means fewer presentations at stretched out of hour’s services and fewer people returning to hospitals for medicinesrelated issues. Even better news is that, because Pinnacle Health LLP works in close partnership with the “Pharmaceutical Services Negotiating Committee (PSNC)”, the implementation of PharmOutcomes across any commissioning footprint is easy and straightforward as every pharmacy in England already has access! So, what can this intelligent web-based system offer to commissioners?

Fully Integrated Solutions to Manage Transfer of Care 1. Hospital referrals to community pharmacies on patient discharge The recent NHS ITK accreditation of PharmOutcomes now allows seamless transfer of care solutions to be put in place. This fully

integrated solution allows a direct link between PharmOutcomes and hospital clinical systems to support the transfer of discharge information from secondary to primary care pharmacy. This, in turn, allows follow up support and care to be delivered at community pharmacies. As information can be drawn directly from the hospital patient administration system and/or the electronic dispensing system with the content of agreed fields being directed seamlessly to a nominated community pharmacy as a data packet, there is no need for hospital teams to log into a web application at all once set up.1 A variety of support options exist dependent upon IT infrastructure at the hospital site. As is usual with any PharmOutcomes service templates, each site can set its own service structure to reflect what is required (service requirements for one hospital may not reflect another) through the adoption of the system’s unique edit functionality that allows local service template design. Recent evidence published in BMJ online has demonstrated considerable efficiency savings for the NHS through the adoption of such support services where PharmOutcomes has provided the service solution. Just 10 referrals per day on 5 days a week can save the local health economy £1.4million split between CCG and Hospital Trust as a result of reduced readmission rates. 2. NHS 111 integration Using the same functionality, PharmOutcomes can integrate directly with NHS 111 systems.



Use of the system provides an efficient means of sending referrals that negates the need to use nhs.net to send a separate message

Already live in several areas of the country, this allows onward referrals directly from NHS 111 systems to community pharmacies for any disposition. Current work streams include the adoption of PharmOutcomes to provide an integrated solution for the management of the new National Urgent Medicines Supply Service (NUMSAS). Use of the system provides an efficient means of sending referrals that negates the need to use nhs.net to send a separate message. Referral information is sent securely across the N3 network directly into PharmOutcomes with pharmacies alerted of the referral via email. Pharmacy teams then record a follow up that is in line with the national data capture requirements. Commissioners again benefit from a variety of real time reports showing activity at both NHS 111 sites and outcomes from the pharmacy follow-up.

Local Service Management Each year commissioners across the country will look at the outcomes from services they have commissioned locally to decide how cost effective those services have been, how they have improved patient care and if the services will continue for the next financial year. This process involves careful evaluation of service outputs to consider set Key Performance Indicators (KPIs) and if these have been achieved. The manual collation of outputs, both activity and service costs, along with the assessment of benefits versus cost is time consuming and laborious. PharmOutcomes is a secure web-based service management solution that has been implemented in a large number of commissioning organisations across England including NHS, Local Authority and Private Companies. The system offers service commissioners and providers a whole suite of functionality to help deliver, manage and evaluate services efficiently and effectively. Current functionality offers a whole range of service support options from the fully


integrated solution supporting Transfer of Care to the day to day management of all locally commissioned services. Having a system that is easy to use is key to the successful delivery and management of services. Feedback to date indicates a highly positive reaction to the introduction of PharmOutcomes from both commissioners and providers. PharmOutcomes offers the commissioner a secure means of communicating with service providers and the ability to create and edit data capture sets locally, meaning each individual commissioning area can create a service template that matches their needs exactly. Service templates when completed are accredited to qualified provider sites. The system is designed to be used by providers whilst patient facing to maximise benefits. Service templates can be edited locally by commissioners to ensure all relevant data is captured. The service templates available in the system library follow a logical approach to service delivery and also offer the ability for hyperlinks to be introduced that allow access to more information either directing the provider to reference documents or useful information resources. This means services are delivered more effectively as they are informed through direct links to local resources and template design makes it impossible to record provisions to patients outside an inclusion group.

A Completely Paperless Service Management Solution The act of saving data at the point of service provision: 1. Populates a real-time audit report that is freely available to the commissioner. 2. Populates a service claim for the provider that is “queued� for auto extraction and invoice creation at a point set by the service funding model that is in turn set by the commissioner. PharmOutcomes also manages service notifications when necessary with in-built nhs.net


capability being used to securely direct onward deprived areas. As the process is fully automated communication/notification when required. the need to carry out complex manual postcode Service audit functionality allows the mapping is removed and the time saving commissioner to carry out extended patient benefits are huge. profiling via system links to external public Additionally, the system offers a variety of health databases. These links allow information specialist reports supporting many services on public health measures such as Index of as standard, one example being the NHS Multiple Deprivation (IMD), ward information Digital quarterly stop smoking return that uses and other indices of deprivation to be added data recorded to automatically populate the to standard service reports. Access to this type return in the form required. Substance misuse of information can be extremely useful when commissioners benefit from a “supervised reviewing services in areas looking to prioritise consumption tracker report” that can provide an  Logged in as: 687761: Pinnacle Support from Pinnacle Health LLP (IOW Service Commissioner): 89361   keyExittarget groups of patients living in more overview of client medication pick-up profiles. Originally SysAdmin­Logged in as: 8: Gary Warner from Pinnacle Health Partnership LLP: 157








Spend Analysis by Service Invoice sent to: Pinnacle Health Partnership LLP, 1st Floor Weatherwise Building, Well Road, East Cowes PO32 6SP Spend for Service: BBV Testing ­ Stage 2 ­ Positive results reporting 


 Logged in as: 687761: Pinnacle Support from Pinnacle Health LLP (IOW Service Commissioner): 89361  

Originally SysAdmin­Logged in as: 8: Gary Warner from Pinnacle Health Partnership LLP: 157





Spend for Service: BBV Testing ­ Stage 3 ­ Client Results Delivery 

Service Design




BBV Testing (IDAS) ­ Stage 1 ­ Registration and test (Preview)

• Browse Service Library • View service accreditations • Edit Service Design • Preview Claim for this service

Provision Reports Preview

Date of Test 13­Apr­2017

Contact information Please collect either phone or email

Name Accessible Info Need?

Date of Birth

contact information to be used by

Yes    No Have you identified any needs of the individual to ensure information provided is accessible?

the clinical team in the event of a positive screen.

Enter as dd­mmm­yyyy (eg 23­Feb­1989)

Gender Male    Female    Trans EULA License Agreement • Cookie Policy • Contact Us • GlobalSign 0hKlAe/ • 20 in 0.025secs using 2MB  Select an option... Ethnicity © Copyright 2007­17 Pinnacle Health Partnership LLP ­ Supporting Community Pharmacy and Partners  Patient Consent Form (Sample) Postcode

Service Support


Address Contact Details Fraser Competency Status

This service can be offered on a

Not applicable (16 or over)

free of charge basis to any

Assessed client understanding




 Logged in as: 687761: Pinnacle Support from Pinnacle Health LLP (IOW Service Commissioner): 89361  

Originally SysAdmin­Logged in as: 8: Gary Warner from Pinnacle Health Partnership LLP: 157

Current functionality offers a whole range of service support options from the fully integrated solution supporting Transfer of Care to the day to day management of all locally commissioned services








Referral information Analysis of Referred by Awareness


Walk in client ­ not referred

135 (64.3%)

IRIS client

14 (6.7%)

Awareness from voucher

7 (3.3%)


GP referral

2 (1%)


28 (13.3%)

IDAS client

24 (11.4%)

 Logged in as: 687761: Pinnacle Support from Pinnacle Health LLP (IOW Service Commissioner): 89361  

Originally SysAdmin­Logged in as: 8: Gary Warner from Pinnacle Health Partnership LLP: 157



Analysis of Last test Last test Claims Within 3 months






Previous Claims

7 (3.4%)

3 months to 1 year 48 (23.1%) Claims are run automatically on the 3 years 21 (10.1%) day of the month specified by your

commissioners. More than 3 years


30 (14.4%)

Never been tested 102 (49%) With the exception of national

Advanced Services, there is no need for providers to claim ­ the system will automatically produce claims on the day specified by the service commissioner.

2016/17 Financial Year

Charged to Pinnacle Health Partnership LLP Pinnacle Health Partnership LLP

Claim Date 2016‑04‑30 

Sent: 2016‑05‑07



• View Claim • View Claim breakdown • Download PDF  • Add Claim adjustments


• View Claim • View Claim breakdown • Download PDF  • Add Claim adjustments


2016­06­07 13:32:53 ­ User Pinnacle Support (pinnacle.support@pinnacleIOW) Updated Invoice Pinnacle Health Partnership LLP (2016­05­31) as Published   Sent: 2016‑06‑08

The national Advanced Services 2016‑06‑30  should be claimed for as detailed in 2016­07­07 09:01:53 ­ User Pinnacle Support EULA License Agreement • Cookie Policy • Contact Us • GlobalSign 0hKlAe/ • 20 in 0.694secs using 6MB  Pinnacle the service specification. (pinnacle.support@pinnacleIOW) Updated Invoice Health © Copyright 2007­17 Pinnacle Health Partnership LLP ­ Supporting Community Pharmacy and Partners £120.00   Pinnacle Health Partnership LLP (2016­06­30) as Partnership LLP Published  

Claim Preview To preview your next claim amounts, click here... 

• View Claim • View Claim breakdown • Download PDF  • Add Claim adjustments

Sent: 2016‑07‑07

Pinnacle Health Partnership LLP


2016­08­08 08:37:59 ­ User ChrisWells (chriswells) Updated Invoice Pinnacle Health Partnership LLP (2016­ 07­31) as Published   Sent: 2016‑08‑08


• View Claim • View Claim breakdown • Download PDF  • Add Claim adjustments

This, in turn, enables effective client review by to inform timely decisions about effectiveness Pinnacle • View Claim Preview Claims 2016‑08‑31  Health costly • View Claim breakdown prescribing teams and can keep supervised and can accurately inform  future commissioning £113.98 Sent: 2016‑09‑07 Partnership • Download PDF  You have no stored or outstanding LLP • Add Claim adjustments regimes limited in line with NICE guidelines. All decisions. All of this means more efficient claim previews Pinnacle • View Claim 2016‑09‑30  • View Claim breakdown data is available in real timeHealth meaningSent: 2016‑10‑07 no waiting, service delivery, efficient service £30.00 more   Partnership • Download PDF  Claim Amounts no collation of paper returnsLLPand no need to work management, better uptake• Add Claim adjustments of services and Pinnacle • View Claim 2016‑10‑31  Health • View Claim breakdown out payments for service delivery. improved patient£223.98 outcomes. Click here to:   Sent: 2016‑11‑07 Partnership • Download PDF  LLP View a description of the • Add Claim adjustments Claims are automatically extracted by the Recent development has seen Pinnacle Health amounts claimable for service Pinnacle • View Claim 2016‑11‑30  Health • View Claim breakdown provisionseither monthly, quarterly £393.39 system or annually in line LLP attain NHS ITK accreditation. This has created   Sent: 2016‑12‑07 Partnership • Download PDF  Preview claim amounts for LLP • Add Claim adjustments with a funding definition setPinnacle by the commissioner. many new opportunities for system integration specific services • View Claim 2016‑12‑31  £165.00 The View Funding definitions in funding engine in Health PharmOutcomes that can allow the transfer  of • View Claim breakdown clinical data from Sent: 2017‑01‑07 is Partnership • Download PDF  Invoice Grouping mode (faster, but LLP • Add Claim adjustments extremely sophisticated and the claim itself can an external system into PharmOutcomes. Major no error checking) Pinnacle • View Claim 2017‑01‑31  Health • View Claim breakdown £135.00 be provided for the commissioner a variety of projects at present include  the• Download PDF  support of many Partnership inSent: 2017‑02‑07 Adjustments LLP • Add Claim adjustments formats including a file thatPinnacle allows direct upload Hospital transfer of care services and NHS 111 • View Claim 2017‑02‑28  Health • View Claim breakdown £130.00 to community   Claim adjustments will appear in into any finance system.Partnership As data Sent: 2017‑03‑07 is real time direct referral services pharmacies. • Download PDF  LLP • Add Claim adjustments the next claim preview, and can be reflecting records entered,Pinnacle the current month’s Pinnacle Health LLP, who • View Claim are responsible added to previous claims when you 2017‑03‑31  Health • View Claim breakdown £135.00 use "View claim" above. Partnership • Download PDF  cost of service can be shown at theSent: 2017‑04‑07 touch of a for PharmOutcomes, are  a social enterprise LLP • Add Claim adjustments To view outstanding claims button. This allows extremely2015/16 Financial Year efficient budgeting structured as not for profit. The licence pricing adjustments, click here with the ability to display cost of service to date structure is extremely competitive and cost analysis 2014/15 Financial Year To view all claims adjustments, along with a projection of year end costs, all of this across a typical commissioning organisation click here Export selected claims in the format: Core Information (Most recent) (CSV) Download Export along with a comparison against cost of delivery has seen administration costs slashed by 60% To add a new claims adjustment, click here Default Output in the previous financial year. following the implementation of PharmOutcomes. Similar functionality exists for service providers As licence prices have been held unchanged   showing data relevant to their own activity since 2012 this represents outstanding value Commissioner only versus aggregated activity by provider for for money. service commissioners. Access to real time service outputs for activity For more information on any of the above and service costs provide an evidence base contact info@phpartnership.com



Community Pharmacy: Time to Take Note of Your High Street Healthcare Professionals The Pharmaceutical Services Negotiating Committee (PSNC) represents high street community pharmacies across England. Working closely with PharmOutcomes, a secure web based service management solution, an evidence base demonstrating the value of community pharmacy interventions has emerged which shows added value for patients through improved service access and outcomes, coupled with added value for commissioning organisations that benefit from efficiency savings.


IMAGINE THE convenience of a trained healthcare professional who is open for long hours, located on a street near your home, available for regular catch ups on your health and wellbeing, could advise you on a range of conditions including minor ones or long term health problems and then give you the medicines you need or direct you to further care and support, and all without needing to book or wait for an appointment. Although many of your patients may not think about it, this is exactly what community pharmacy can be. Not only can community pharmacy teams reach those who need them most, but recent


research has shown that their services deliver substantially more in benefits than they receive in compensation, providing excellent value. A report by PricewaterhouseCoopers LLP (PwC) found that community pharmacies contributed a net value of £3 billion to the NHS, public sector, patients and wider society in England in 2015 through just 12 services, with an additional £1.9 billion expected to accrue over the next 20 years. Locally commissioned pharmacy services can provide significant benefits to their communities. For example, there are 129 supervised administration services, 119 needle and syringe programmes, 92 emergency contraception services and 82 minor ailments schemes currently in place around the country. Those areas using PharmOutcomes benefit from the system’s ability to link with other sectors sending automated, secure notifications and referrals as service data is saved. This functionality has seen needle exchange users referred to treatment services for support and introduced closer links with secondary care support services such as sexual health and hepatology. All of these services are already supporting patients to get the help they need quickly and easily, as well as reducing pressure on the wider NHS by saving on the costs of GP appointments or visits to urgent care providers that would be needed otherwise. Further examples of local services are shown in the boxes on the following page. Every pharmacist taking part in one of these local services has undergone training specific to that service, as well as the standard continuing WWW.PRIMARYCAREREPORTS.CO.UK | 7


Not only can community pharmacy teams reach those who need them most, but recent research has shown that their services deliver substantially more in benefits than they receive in compensation, providing excellent value



professional development required for all healthcare professionals. Some pharmacists have also taken advantage of changes in the law that allow them to prescribe certain medicines. This has helped pharmacists to provide more appropriate care for their patients, working alongside GPs and other health professionals. Again, the use of PharmOutcomes has facilitated the further integration of community pharmacists to multidisciplinary teams supported by system functionality that supports secure referrals between sites allowing a service to commence at site A, possibly a hospital that passes information securely to site B, a community pharmacy, for continuation of care. The community pharmacy representative bodies PSNC and Pharmacy Voice have said in their Community Pharmacy Forward View document that they want to develop pharmacy’s future: 1. A  s the facilitator of personalised care for people with long-term conditions 2. A  s the trusted, convenient first port of call for episodic healthcare advice and treatment 3. A  s the neighbourhood health and wellbeing hub For commissioners and local authorities looking to improve the health and wellbeing of the communities they serve, this should all be welcome news. The NHS and social care services are under immense pressure both to meet rising demands and to cope financially. But here we have a network of healthcare professionals who can help you to help the patients and communities that you need to look after, in a highly accessible and cost effective way, taking pressure of other local health services and budgets in the process.

The NHS and social care services are under immense pressure both to meet rising demands and to cope financially. But here we have a network of healthcare professionals who can help you to help the patients and communities that you need to look after, in a highly accessible and cost effective way



Cuts and the Growing Role of Community Pharmacies Tom Cropper, Editor A funding crisis in the NHS places community pharmacies to the fore. However, they need to demonstrate their value.

Against a backdrop of austerity, community pharmacies become an increasingly important way to manage costs and control admissions


N THIS day and age, it is difficult to go too far before you read another piece about the crisis in the NHS. Funding is short, waiting times high and quality in decline. To cope with these restrictions new models of health care delivery are coming to the fore. They are more flexible and community-based and can do a great deal to alleviate strain on more essential services.

Funding Crisis That strain can be considerable. More than two million people go to A&E with trivial problems, according to a report from the College of Emergency Data2. Despite attempts to offer a non-emergency alternative to 999, people are still misusing the service. Take the example of a woman who dialled 999 over a severe case of trapped wind – as reported in the Independent3. The cumulative impact of such wasted calls can be considerable, especially at a time when the NHS is desperately in need of funds. Figures released by NHS England point to a real-time funding cut of 0.6% per patient in 2018-194. The British Red Cross has termed the situation a ‘humanitarian crisis’5 and the Labour party has accused the government of ‘systematically underfunding’ the health service. Shadow Chancellor, John MacDonald, issued a call for the Office of Budget Responsibility to provide scrutiny of the figures6. Against a backdrop of austerity, community pharmacies become an increasingly important way to manage costs and control admissions. As the Local Government Association stated in its response to the Government’s consultation of community pharmacies: they have a “key role to play in the transformation of the healthcare delivery model by identifying health problems, managing existing conditions, and promoting healthy lifestyles, all at the heart of the community7.”


Even so, they are included in the government’s austerity plans. In 2016, it announced cuts to community pharmacies; funds would be slashed by 4% per year amounting to £2.7bn in the year 2016/17. There is also to be a further reduction of 3.4% in 2017/18, although they promise this will be re-invested back into the NHS8. Opponents claim the cuts will be counterproductive. In its response, the LGA said. “As health services are increasingly being delivered away from traditional health settings, such as GP surgeries and hospitals and aligned more closely with where people work, travel, shop and engage in recreational activities, the proposals outlined in the consultation could lead to unforeseen and unintended consequences that impact elsewhere in the local community.”

Proving Value It’s never been more important, therefore, to demonstrate value. A report from PricewaterhouseCoopers found that community pharmacies deliver a net value to the NHS of £3bn9. They deliver, said the report, more value than they take out. The study was commissioned by the Pharmaceutical Services Negotiating Committee following the government’s proposals to reduce funding. The report breaks down those £3bn in benefits in the following way: • A net value of £1,352 million, including cash savings, as a result of cost efficiencies, and avoided NHS treatment costs. • Other public sector bodies (e.g. local authorities) and wider society together received over £1 billion through increased output, avoided deaths and reduced pressure on other services such as social care and justice. • Patients received around £600 million, mainly in the form of reduced travel time to alternative NHS settings.


The report also stated that the expected level of public spending saved because of the 12 services analysed would be enough alone to offset the entire amount of public funding provided to community pharmacies in 2015.

An Expanding Role The value grows even more as the role of the community pharmacy expands. It is moving from a place where patients can quickly receive their prescriptions to a way to get quick and convenient medical advice from a trained professional. Speaking to the Royal Pharmaceutical Society Conference in 2015, the Chief Pharmaceutical Officer for England and Wales, Dr Keith Ridge, hailed the growing influence of clinical pharmacies: “People being admitted to hospital because of avoidable medicines issues simply cannot go on. Nor can the level of wastage of medicines use. Nor can over use of medicines, and medicines use has to get much safer. Add poor adherence and it’s nothing short of a scandal,” he said. “So a dead cert is expansion of clinical pharmacy in all settings to deliver the patient benefits, and system efficiencies, of using medicines optimally.” The local pharmacy has already delivered immense value to the NHS, but it can do much more. Equally, each community pharmacy outlet

will need to do more to generate a solid evidence base of the value they are adding. To do this, pharmacies are turning to webbased portals. These are increasingly affordable and accessible and offer a way to deliver more services, more effectively to the community. The tools facilitate management and administration of such services and also harvest a huge amount of data about how they are being used and the value they are driving. Data can be collated on the value of any new services or initiatives, and help to optimise the delivery of medications. By understanding how to analyse and present data, these online portals can deliver a multipronged series of benefits. They can optimise medicine delivery, reduce wastage, streamline administration, cut down on costs and free up staff for more productive duties. They can help assess and evaluate initiatives and create a strong, undeniable body of evidence about the value they create. Technology is making itself felt in many different areas of healthcare. In an environment where its use has sometimes been limited, it’s delivering transformative change. More importantly, though, against a background of austerity, where the Government’s first instinct is to cut funds, it provides an important way to increase and demonstrate the immense value local pharmacies bring to their patients and their communities.



The goal is to work towards an integrated healthcare service which is based around the needs of patients and gives them much greater

Harnessing the Potential of the Paperless NHS Jo Roth, Staff Writer The NHS is banking on digital technology to help create a more flexible and connected system.

flexibility over their care


T WAS an announcement many had expected. The NHS was on track to miss its own ambitious target of going paperless by 2018. While it may be a setback, digitisation is coming and it looks set to transform every aspect of the health service – including the way it interacts with community pharmacies. As with any transformative change it will bring plenty of opportunities as well as its fair share of challenges.

A Paperless Future The paperless NHS has been a fundamental part of government policy ever since the days of the Coalition. This latest news may mean it’s behind schedule but it’s still making progress. Most Trusts have plans in place to make the transition, and most medical professionals appear keen to make the leap. The benefits are relatively clear. Transferring to digital systems saves money, cuts administration, improves efficiency and reduces errors. Against that, there are questions of reliability, security and implementation all of which each practice will need to take into account. Support for the project is still strong. At the beginning of 2017 Jeremy Hunt announced a fresh injection of £4bn to help realise the dream of a paperless NHS. This will include £1.8bn to remove outdated technology such as fax machines; £400 million for a new website; £750 million to transform out of hospital care, medicines and to digitise social and emergency cases – plus £1bn on cyber security and data consent10. The NHS continues to make digitisation and integration a key part of its forward strategy and is rolling out a number of services and solutions for both patients and clinicians. These include the ability to book an appointment online with the GP of your choice; free WiFi available in health centres; online prescriptions, text message reminders about appointment 12 | WWW.PRIMARYCAREREPORTS.CO.UK

and online clinics providing instant access to a healthcare professional. Healthcare professionals are increasingly making use of digital services such as online training, computer based administration and integrated, cloud-based administration systems. The goal is to work towards an integrated healthcare service which is based around the needs of patients and gives them much greater flexibility over their care. It will provide access to medical support and expertise 24/7 including the ability to communicate with a healthcare professional. As things stand, performance remains patchy and sporadic. Adoption of technology and quality of care varies significantly from region to region. A more hi-tech and integrated healthcare service has the potential to improve services for patients, increase efficiency for healthcare professionals and reduce costs.

The Role of Pharmacies Community pharmacies have an important role to play here. They are changing, adding more advanced services and being increasingly connected to the rest of the care structure. They are opening longer, and aiming to take on much of the work which would have been done by primary care. Technology is crucial. More sophisticated cloudbased administration systems expedite basic duties, free up time and provide a much clearer and instant access to real-time information. Although many pharmacies already make use of IT administration, they are often only using a portion of the functionality. As digital technology evolves it is putting much more power at the hands of managers. Reports which might have previously taken days to compile can now appear in minutes. Data is accurate to the moment allowing managers to make much more informed decisions. Sophisticated modules can monitor patients’


use of medications and help in reviews and interventions. Access to patients’ medical records can make it easier to provide ongoing healthcare and support.

High Tech Services Services such as electronic prescriptions enable GP surgeries to send prescriptions directly to a pharmacy. The surgery benefits by spending less time dealing with queries and improving their prescription efficiencies. The pharmacy, meanwhile, can improve stock control, spend less time sorting, reduce paper usage and process their prescriptions more efficiently. The system is being progressively rolled out across the country, but in time it could replace paper prescriptions entirely. Robotics dispensing could also make a significant difference. A report entitled a Spoonful of Sugar in 200111 advocated automation to transform pharmacy. Since then it have been used in a number of UK hospitals with some success. St Thomas’ Hospital in London has a robotic dispensing device delivering medication directly to where pharmacy staff are working. It allows them to optimise storage procedures, reduces error count and saves space. The system is made up of two identical automated machines. Each has two sides of floor-toceiling wall space. Medications can be packed more densely because there is no need to leave space for human hands. It also reduces the amount of time skilled staff need to spend on packing and storage. Automation also comes to the fore in the use of apps and online services. Apps can offer

medication advice, information, support and drug identification. It’s a quick way for both pharmacists and patients to access information about the medication they can use. Thick and heavy drug information books can be replaced with mobile phones. No longer do professionals have to spend time wading through books looking for the right information – they can dial it up with a few clicks.

Positives and Negatives There is a natural concern about possible negative impacts of this technology. How can the profession be sure the information on an app is reliable? Will patients turn away from pharmacists if they can get the information quickly online? Automation will bring changes, and it may take work away from human staff. Will this lead to redundancies? Possibly – but it can also create jobs and improve productivity. A trained pharmacist must still be on hand to monitor technology and answer more complicated questions. Indeed, rather than being replaced by technology, pharmacists can be freed up to deliver more comprehensive patient care. Community pharmacies are changing rapidly – and much of that change is being spurred by technology. It acts both as a facilitator and prompt. The wider use of technology such as the arrival of the paperless NHS creates an initial impetus for change, but it’s the enhanced functionality that technology can bring which will enable community pharmacies to assume an increasingly prominent role in the delivery of health and social care.



The more health providers make use of technology the more vulnerable they are to data loss, and cyber

Making Technology Work James Butler, Staff Writer New technology has the potential to transform the way the NHS works. However, it won’t help if it’s not used in the right way.

criminals see health providers as ripe targets


ECHNOLOGY IS transforming the way we live and work – and community pharmacies are no different. It is reducing administrative burden, improving performance and expanding the reach of what a pharmacy can do. However, although the gains can be transformative, there can be problems. It’s one thing implementing new systems but if you don’t use their full capacity, they cannot deliver the performance you hope for.

Security Issues Security is one of the most pressing concerns for the NHS. There is a determined drive to make data more mobile and accessible. Patients will be able to view their records online, different practices will be able to share records, as will local pharmacies. It gives people more control over their healthcare, and helps professionals deliver a better and more personal service. Such flexibility and mobility, however, comes at a cost. The more health providers make use of technology the more vulnerable they are to data loss, and cyber criminals see health providers as ripe targets. Not only do they possess huge amounts of sensitive data, but their security systems are more vulnerable than larger corporations. The NHS has seen a rapid rise in various forms of data attacks. In January, an email sent to staff warned of a rise in spear phishing attacks. Criminals will masquerade as colleagues, sending emails to elicit cash12. Approximately one in three NHS Trusts have been affected by ransomware. Imperial College London suffered 19 attacks in just 12 months. Approximately 87% of attackers gained entry through an NHS networked device, with 80% using a phishing email13. Ransomware encrypts information on personal devices denying access to the data until a ransom has been paid. It’s fast simple and effective. The Hollywood Presbyterian Medical Centre in Los Angeles, for example, paid £12,000 to cyber criminals after being infected. Kansas Heart Hospital paid hackers $17,000 to unlock 14 | WWW.PRIMARYCAREREPORTS.CO.UK

data, after they had originally demanded more than $3million14. However, it didn’t stop there. The hackers unlocked some of the data and demanded a second ransom before they would unlock the rest. Unsurprisingly the hospital decided against it. NHS Trusts in the UK have also paid ransoms. The results can be pretty serious. When the North Lincolnshire and Goole Trust15 was hacked, the virus crippled three major British hospitals, leading to hundreds of routine operations being cancelled. While the attack was in progress, medical staff were forced to wind back the years and work with simple pen and paper. Meanwhile, patients were politely asked to put off going to A&E if they could possible help it. Cyber security should be at the forefront of planning for any IT system. It starts with processes and staff. While cyber criminals represent a real and growing threat, the biggest danger comes from staff error. Disclosures from Health Service Trusts show its own staff are the biggest cause of data loss16. It’s a statistic which holds true for all organisations. A survey from Experian found that 66% of respondents felt their own employees were the biggest threat to data security17. Comprehensive training in the type of threat faced, together with robust procedures to secure data, can do a great deal to reduce embarrassing and damaging instances of data loss. However, when it comes to using a web-based portal – as many organisations are now doing – IT security is much harder to control. A pharmacy which uses a web-based portal is relying on that provider to have the latest security protocols in place. In a sense, handing over to a specialist online portal should enhance security. They should possess the technical expertise and awareness to minimise any threat to data security. However, that’s not necessarily the case and no system will be 100% secure. Attacks are constantly evolving and so too must defences. Buyers will need to know what security protocols are in place and what contingency measures exist if things go wrong. The temptation will be to simply


hand over control to a specialist team of experts, but quality and reliability vary substantially.

Implementing the Technology The arrival of new technology will inevitably entail a degree of procedural and cultural upheaval. New systems will change the way a pharmacy works, which will require an adjustment from members of staff. Younger pharmacists, and those entering the profession, can be trained from the very start to work with technology, but older members of staff might be resistant to change. Equally, patient-facing technologies may offer a great deal, but not everyone will be comfortable with new systems. While transitioning to the new, pharmacies will still have to make provisions for those who are more comfortable

with the old. That means offering training to existing staff, and ensuring patients can still interact with a pharmacy in the ways they are used to. There is no doubt that the next generation of pharmacy software can do a great deal to improve life for patients and staff. There is always a risk, though, of treating technology as a goal in itself. Community pharmacies must ensure that new systems enhance and build upon their existing value. That means setting goals – establishing from the earliest stage what they want the technology to achieve and ensuring any new system contributes towards those goals. In an environment of low funding – in which every initiative must prove its worth – the margin for error is small.



Technology Can Power the Community Pharmacy of the Future Tom Cropper, Editor How new web-based technologies can help to improve patient experience.

Pharmacists are well placed to offer this kind of care, and they are already enhancing their role in areas such as sexual health, smoking, care for older people and drugs and alcohol services



EALTHCARE FACES some uncertain and challenging times. As it evolves to cope with patient demand and new technology, community pharmacies may take on an increasingly important role in healthcare delivery. To fulfil this role, they will have to change and embrace the potential of new technologies.

A More Demanding World Healthcare in the UK must adapt to numerous pressures. The population is aging, which will lead to a rise in the number of people living with complex and ongoing medical conditions. Patient expectations are rising. We have become accustomed to choice, flexibility and quality in all walks of life. It’s an anywhere, anytime service environment tailored to our specific requirements. Money is tight. As the NHS’ Five year Forward View18 acknowledges, the health service must work hard to close an unprecedented funding gap. To achieve this. the emphasis shifts towards preventative and community-based care, which is where pharmacies will be vital. For example, in 2016, Health and Community Care Minister, David Mowat, announced the launch of a pharmacy urgent care programme19. Patients who contact 111 for urgent repeat medications will now be sent straight to their local pharmacy instead of an out- of-hours GP service. Callers to 111 with minor emergency ailments such as earache, sore throats and bites can also be sent straight to pharmacies. Commenting on the proposals, the Royal Pharmaceutical Society 20 welcomed the overall intention, but said the existing locally commissioned NHS emergency medicines supply service is already tried and tested. Rather than spend time piloting a new program, it could simply implement the NHS Emergency Supply Service across the UK.

New initiatives such as these prove the need for pharmacies and other areas of the health service to be more integrated and communicate more freely. For that they will need a new technological infrastructure and its coming from a generation of tech entrepreneurs who combine medical knowledge and technical expertise to produce a host of new solutions for community pharmacies. One of the most influential is PharmOutcomes – a digital community pharmacy portal which aims to help pharmacies process services more effectively, and make it easier for commissioners to audit the performance of certain projects. It was developed by Gary Warner who, himself, is a pharmacist. It is a social enterprise, so any profits are put back into the business, which has allowed the company to deliver their service at a more affordable price-point.

Linking Services PharmOutcomes serves as a link between community pharmacies and other parts of the NHS. For example, the recent NHS ITK accreditation allows the swift transfer of discharge information, which enables community pharmacies to deliver follow-up support where needed. It also allows the referral of 111 calls to community pharmacies and can link with commissioners’ accounting systems. It provides commissioners with a real-time report about all the work which is being carried out. It gives them a comprehensive view of what is happening and the value that is being created by the pharmacy. It also allows them to approve payments without the need to raise an invoice, saving time and money for the pharmacy. The system increases significantly the amount of information commissioners can collect about the local services they commission. Every year, commissioners will assess the performance of


those services which have been commissioned. PharmOutcomes collects a wider range of data allowing for the provision of comprehensive real-time metrics. Pharmacies can detail every aspect of their impact, presenting a much more convincing evidence base to commissioners. The service is helping NHS Trust to set up new services such as the Swindon and Wiltshire LPC’s New Medicine Service. The hospital was concerned that many patients were being prescribed anticoagulants in the hospital but were not receiving NMS because they were not being referred by the hospital to the service. PharmOutcomes was set up to make referrals to the patient’s community pharmacy and for the pharmacy to show the actions taken to follow up on the referral21.

Technology Holds the Key Technology will be crucial in helping community pharmacies to take on a broader role in healthcare. The Royal Pharmaceutical Society’s Report ‘Now or Never, Shaping Pharmacy for the Future’22 argues that pharmacies should shift their focus from simply a supply function to one which offers an increasing range of advanced services. With technology, such as automated dispensing, and online administrations such as PharmOutcomes doing much to streamline processes, pharmacists are freed up to take a much more active role in the delivery of care.

Scotland’s ‘Prescription for Excellence’23, for example, sets out a vision of independent prescribing. Pharmacists will have initial responsibility for the choice of medication and continual monitoring while doctors will bear final responsibility for diagnosis. There will be a greater need to monitor patient outcomes and inform people about their choices of medication. Pharmacists are well placed to offer this kind of care, and they are already enhancing their role in areas such as sexual health, smoking, care for older people and drugs and alcohol services. By doing so, they can deliver on the Government’s key goals of alleviating the strain on secondary care providers while enhancing the quality of service, improving patient choice and, at the same time, saving money. That last quality could prove to be the most important. At a time when pharmacies face calls to expand, they also face a future of austerity. The Government has proposed stringent funding cuts over the next few years. As this Report has already shown, experts have been quick to criticise such cuts and emphasise the real value pharmacies will bring. Nevertheless, community pharmacies are likely to be asked to do more with less and provide more evidence about outcomes. The challenges are sizable and to meet them they will need to update processes and expand infrastructure. Next generation technologies such as digital portals will be crucial in helping them to do just that.



References: Nazar, H., Brice, S., Akhter, N., Kasim, A., Gunning, A., Slight, S. and Watson, N. (2016). New transfer of care initiative of electronic referral from hospital to community pharmacy in England: a formative service evaluation. BMJ Open, 6(10), p.e012532.


2 Two Million Non-Emergency Patients Rush to A&E http://www.express.co.uk/life-style/health/476612/Two-million-non-emergency-patients-overstretched-NHS-hospital-A-Es-last-year-study-shows 3

People are Still Calling 999: http://www.independent.co.uk/life-style/health-and-families/features/trapped-wind-when-not-to-call-999-9858617.html

NHS Funding Cuts: http://www.independent.co.uk/news/uk/politics/nhs-cuts-spending-policies-theresa-may-jeremy-hunt-tories-labour-lib-dems-a7549686.html



NHS Faces Humanitarian Crisis: https://www.theguardian.com/society/2017/jan/06/nhs-faces-humanitarian-crisis-rising-demand-british-red-cross

6 John MacDonald Calls for NHS Funding Review: https://www.theguardian.com/society/2017/jan/10/john-mcdonnell-calls-for-nhs-funding-audit-as-winter-crisis-deepens 7

LGA Response: http://bit.ly/2mWMsbP

Government Announces Cuts to Community Pharmacy Budget: http://www.pharmatimes.com/news/govt_announces_cuts_to_community_pharmacy_budget_1173167



PwC Report Quantifies Value of Community Pharmacy: https://psnc.org.uk/our-news/pwc-report-quantifies-value-of-community-pharmacy/


NHS to Get ÂŁ4bn: http://www.bbc.co.uk/news/health-35514382


Spoonful of Sugar: http://www.eprescribingtoolkit.com/wp-content/uploads/2013/11/nrspoonfulsugar1.pdf


NHS Spearphishing: https://www.digitalhealth.net/2017/02/spear-phishing-attack-targets-nhs/


Ransomware Brutes Smacked One in Three NHS Trusts: https://www.theregister.co.uk/2017/01/17/nhs_ransomware/

Ransomware Attackers Collect Ransom from Kansas Hospital: http://www.healthcareitnews.com/news/kansas-hospital-hit-ransomware-pays-then-attackers-demand-second-ransom



Appointments on Hold as Virus Wreaks Havoc: https://www.theregister.co.uk/2016/10/31/virus_shuts_down_nhs_trust/

The Biggest Security Threat to the NHS – Its Staff: https://www.theguardian.com/healthcare-network/2011/may/04/biggest-threat-nhs-data-security-staff


Employee Negligence the Cause of Many Data Breaches: http://www.darkreading.com/vulnerabilities---threats/employee-negligence-the-cause-of-many-data-breaches-/d/d-id/1325656



Five Year Forward View: https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf

Pharmacists to Supply Emergency Medication: http://www.thepharmacist.co.uk/news/latest-news/pharmacists-become-first-stop-urgent-prescription-medication/



Community Pharmacy Reforms: http://www.rpharms.com/landing-pages/community-pharmacy-reforms.asp


Service Case Study: https://psnc.org.uk/our-news/lpc-case-study-positive-results-in-first-six-months-for-anticoagulant-hospital-referral-service/


Now or Never: http://www.rpharms.com/models-of-care/report.asp


Prescription for Excellence: http://www.gov.scot/Topics/Health/Policy/Prescription-for-Excellence





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Primary Care Reports – Improving the Delivery of Community Pharmacy Services – Pinnacle Health Partnership

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