Led by Alliance Boots Day Two, Pop-up University 2, 10.00

1. Member of Walgreens Boots Alliance
How Community Pharmacy can
support the STP and Vanguard
programs
Garwyn Morris Shirley Walker
Senior Manager External Partnerships Healthcare Partnerships Manager
NHS South NHS London

2. NHS Five Year Forward View…
….concluded that to sustain a
comprehensive, high-quality NHS,
action is needed on three fronts:
1. Demand
2. Efficiency
3. Funding
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3. Current Situation
• NHS remains financially stretched
• Capacity in primary care
• A&E waiting times, especially winter
pressures
• Evidence that 20% of population spend
80% of the total heath budget*
• STPs at initial stages and Vanguards are
looking for solutions for new models of
care.
*Yeovil District Hospital –Leading the change 2014
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4. How can Community Pharmacy help?
• Some basic numbers
– 11674 community pharmacies in England*
– Over 1.6m people visit a community pharmacy every day*
– 96% of the population can reach a pharmacy within 20 minutes
by walking or using public transport*
• Services you can now see in a pharmacy:
- 595,467 patients got an NHS flu vaccination from
community pharmacy in England last year*
– Anti-coagulation services
– Travel vaccinations
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*Pharmacy Voice,
**Community Pharmacy Forward View,
***Pharmacy Voice,
****PSNC

5. Where can Community Pharmacy help primary
and secondary care?
1. Minor Ailments
2. Emergency Supply of Medicines
service
3. Discharge services and Admissions
avoidance
4. Anticoagulation
5. Impact on Long Term conditions
and many more……
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6. 1. Minor Ailments
• 8% of consultations undertaken in an A&E
department could be handled by a community
pharmacist*
• Common ailments cost the NHS an extra £1.1 billion
a year when patients are treated at A&E/GP
surgeries rather than at Community Pharmacies*
• The NHS Five Year Forward View highlights the
need to make far greater use of pharmacists
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*Pharmacy Research UK, 2015

7. A Tale of 2 Counties’ Minor Ailments service
Somerset*
61 pharmacies
commissioned out of 106
pharmacies
10 conditions
1169 patients over a 9
month period.
– 81% said would have
gone to GP
– 10% OOH/emergency
service
– 5% said A&E
Devon*
2235 patients over 15 months
Only 5 conditions
278 GP hours saved
19% said would have used
OOH or A&E – 72 OOH & 12
A&E hours saved
Winter ailments service 3300
patients, 45% would have
used OOH or GP
* An evaluation of the Somerset community pharmacy ailments service Jan 2016,
** Devon Pharmacy first evaluation 2015
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8. Impact of Inconsistency
• Different PGDs
• Different range of conditions
• One has OTC product, one does not.
• One has Winter Ailments, one does not
• One limited to some pharmacies, one open to all
What message does the Patient receive from this?
What impact could be achieved with consistent
Commissioning?
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9. Sore Throat and Treat service
• Launched Oct 2014
• Service supports Diagnosis of infection and
provides treatment options
• The service demonstrated two thirds of patients who
would have seen the GP did not need to be seen*
• Also added benefit of reduce antibiotic use
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*Boots UK and Professor APR Wilson, Dept of Microbiology and Biology UCE – August 2016

10. 2. Emergency Supply of Medicines service
• Emergency supply rules have been in place for many
years, but at a cost to the patient.
• Many medicines cost a lot more than the prescription
fees, especially insulin and many of the inhalers
• Patients opt for OOH GP or A&E to get their “free”
prescription
• A commissioned service ensures Community
Pharmacy can supply the patients, whatever their
economic situation, without driving increased NHS
capacity/cost burden.
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11. 3. Admissions avoidance
• 5-8% of hospital re-admissions are due to medicine related
issues
• 30-50% of patients do not take their meds as intended
• 30-70% of patients have an error or unintentional change in
their medicines when their care is transferred
• DMR service in Wales – report published March 2014
– reviewed 14,600 patient interventions, the total number of
discrepancies recorded was 19,878
– 52% of discrepancies related to re-starting or discontinued
meds following discharge.
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*PJ Oct 2014,
**www.rpharms.com/getting-the-medicines-right/keeping-patients-safe-report .
***NICE guidelines,
****EVALUATION OF THE DISCHARGE MEDICINES REVIEW SERVICE March 2014

12. 3. Admissions avoidance
C&D 16/8/16……
NHS trust uses community pharmacists to cut
discharge delays
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Alistair Grey, lead pharmacist at East
Lancashire Hospitals NHS Trust, told
C+D that a scheme to share electronic
patient discharge letters with local
community pharmacists has improved the
safety and speed of patients
leaving hospital…….We are starting to
see a reduction in readmissions

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14. • Community pharmacy has the
capability to care for clinically
stable anticoagulation patients
• Up to 70% of warfarin
patients could be clinically
stable enough to be
managed outside of
hospital*
• Boots manages 6,000 patients
across all of our
anticoagulation services
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4. Anticoagulation
** Percentages derived from the current Boots services run in Brighton, Croydon and Bromley

15. Community pharmacy can monitor INRs and manage
dose adjustments of warfarin in addition to;
• Manage over-anticoagulated patients by use of vitamin
K rather than refer them to A&E
• Collaborative working with secondary care for the
peri-operative management of low risk patients
• Initiate patients according to NICE guidelines on either
warfarin or NOACs by use of non-medical prescribers
• Support Patients who self-test
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4. Anticoagulation

16. Benefits to the NHS
– Better value for money
– Achieving clinical
outcomes and KPI’s
– Reducing inequalities by
covering a geographical
and socio-demographical
areas, caring for both
ambulatory and
domiciliary patients
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4. Anticoagulation
Benefits to the patient
– Improved waiting times and
10 minute tests
– Better accessibility to clinics
closer to home
– Point of care testing which
is potentially less painful
– Improved patient
satisfaction and patient
feedback

17. “Excellent – resulting in my eye test being
carried out at Boots Bromley. Look
forward to further services being
established”
"Promptness, clarity of purpose,
pleasant manner, positive clear
advice."
“Perfect in every sense”
" Instead of waking up at 6am to get to
PRUH for 7am, I can now make an
appointment and get there at leisure within
10 minutes.”
“Excellent! Seen immediately and
counselled with perfect clarity”
“Very satisfied, I prefer this to
the hospital – brilliant so far!”
“Really enjoy coming to Boots”
“No improvements required – a
brilliant service!”
“Very helpful to have home
visits and good clear advice
from a very friendly person”
What are the Boots Anticoagulation Services
Patients saying?
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18. 5. Impact on Long Term conditions
Community Pharmacy Future COPD project
• Support people with COPD making them better able to manage their
condition, and improve their quality of life
• Help people with COPD reduce risk factors associated with the
worsening of their condition by promoting and providing services where
appropriate
• 306 patients enrolled by 34 pharmacies across Wirral in three months,
across all socio-demographic areas
• Patients were already diagnosed with COPD
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19. 5. Impact on Long Term conditions
Community Pharmacy Future COPD project
Key results after six months;
– A significant increase in medicines adherence
– Reductions in overall NHS resource use by patients
– A significant increase in patients’ quality of life
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20. How can these services make a difference?
It’s not just about commissioning…………
– Consistency is key
– Patient message/engagement
– Internal NHS engagement
– NHS 111
– Move away from Pilotitis!

21. How will your STP/vanguard
use community pharmacy to
help shape the future?
Any Questions?
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