This webinar gives an example of how the role Pharmacy services are improving patient care and flow across seven days a week. Richard Cattell from NHS Improvement gave a national overview and weekend benchmarking information and Steve Brown, the regional lead from NHS Improvement & England gave some background information on the Carter Report. Iain Davidson from Royal Cornwall NHS Trust and David Heller from Surrey and Sussex Healthcare NHS Trust describe the development of their respective weekend Pharmacy services and how this has improved patient care and flow

1. www.england.nhs.uk
Seven Day Hospital
Services Webinar
July 2018
Transforming clinical
pharmacy into a seven day
service
Hosted by:
Sustainable Improvement
NHS England South

2. www.england.nhs.uk
Establishing a Virtual Community for All to
Connect, Share and Learn
• Series of regional webinars
• Share practical examples – discuss barriers and
generate improvement solutions
• NHS E Specialist Support Team - Sustainable
Improvement
• Work in collaboration with NHS Improvement and the
UEC Programme Board for South East and South West
Region
7 Day Hospitals – Virtual Community
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Objectives
This webinar will provide you with:
• A national and regional update
• Challenges and opportunities for service development
• An opportunity to raise queries and share learning
7 Day Hospitals – Objectives
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4. www.england.nhs.uk
Our Guest Speakers today are:
National Update
Richard Cattell, Deputy Chief Pharmaceutical Officer,
NHS Improvement rcattell@nhs.net
Regional update
Steve Brown, Regional Pharmacist,
NHS England/ NHS Improvement, SE & SW stephen.brown17@nhs.net
Two practical examples of how clinical pharmacy has been transformed into
seven day services
Iain Davidson, Chief Pharmacist, Royal Cornwall Hospitals NHS Trust
Iain.davidson7@nhs.net
David Heller, Chief Pharmacist, Surrey and Sussex Healthcare NHS Trust
David.heller@nhs.uk
7 Day Hospitals – Guest Speakers
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5. Pharmacy and 7DS
Richard Cattell
Deputy Chief Pharmaceutical Officer
NHS Improvement

6. 6 |6 |
• Local, regional and national interest in the contribution of pharmacy to
the 7DS and patient flow agendas
• From COOs to SoS
• Supply of urgently required in patient medicines - 24/7 emergency
access
• Delays in receiving (time critical) medicines
• Support for newly admitted acutely ill patients – front door services
• Support for patients – back door and discharge support
• Delays in receiving medicines required for discharge
• Cited as one of a number of route causes for patient flow difficulties
Seven Day Services – national context

7. 7 |7 |
National benchmarking information
Hours of
service
provision
2017
(range)
2014
Saturday Supply 7.3
(3-24)
6.4 All trusts provide Saturday supply
services
6 large acutes provide 24/7 services
Clinical 4.3
(0-12)
3.3
Sunday Supply 6.5
(0-24)
5.5 11 Trusts provide no Sunday supply
services
Clinical 3.8
(0-12)
2.9

8. 8 |8 |
• Provide Supporting information
• ECIP guidance on Pharmacy Contribution to Patient Flow *
• RPSGB Seven Day Services in Hospital Pharmacy*
• National plan
• Delivering the recommendations of the NHSE report and the pharmacy
elements of 7DS
• Establish a Clinical Pharmacy Reference Group through AECP
• Work with the regional NHSI/E 7DS delivery teams
• Develop 2018 NHS Benchmarking return
• Support benchmarking to enable investment or illustrate improvement
• Greater detail
• Matching service provision with demand
• Identifying the impact of service provision
• Board assurance model 2019
Next steps
https://improvement.nhs.uk/documents/627/optimising-medicines-discharge-to-
improve-patient-flow-RIG_holhrdD.pdf
https://www.rpharms.com/resources/reports/seven-day-services-in-hospital-
pharmacy

9. Pharmacy 7 day services
Steve Brown
NHSE / NHSI Regional Pharmacist, South of England

10. www.england.nhs.uk
Carter Report
10
Each trust board should nominate a director to be
responsible for developing the local HPTP plans,
and work with the trust chief pharmacist to
implement the changes identified in their plan, in
collaboration with professional colleagues locally,
regionally and nationally to deliver more efficient
services. NHS Improvement should sign-off,
coordinate and monitor plans at regional and
national levels in conjunction the Chief
Pharmaceutical Officer for England.
The plans should ensure more clinical pharmacy
staff are deployed on optimal use of medicines
and delivering 7 day health and care services.
Plans should also include the adoption of digital
information systems such electronic prescribing
and medicines administration systems (EPMA),
where they haven’t yet done so, and the
improvement of high cost drugs coding within
trusts’ NHS reference cost returns.

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7 day services
Back door and
inpatient
supply:
Operating
hours for
medicines
supply
24/7
emergency
access
Front door:
Clinical focus
Including
Medicines
Reconciliation
7 day services

12. www.england.nhs.uk
Model Hospital

13. www.england.nhs.uk
Model Hospital

14. www.england.nhs.uk
• From a regional
perspective I
observe significant
variation; is that
warranted?
• Have we made any
real progress since
the Carter Report
in February 2016?
• How can we
enable services to
meet national
recommendations
and standards?
14
Next Steps

15. Discussionooon
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question or comment-
or write it in the chat box to ‘all
participants’.
When speaking please let everyone know your
name, and your organisation
7 Day Hospitals – Discussion7 Day Hospitals – Discussion

16. Introduction of 7 Day Pharmacy Services at RCHT
Iain Davidson
Chief Pharmacist
Royal Cornwall Hospital

17. Session Objectives
• The 7 day context.
• Our evolution of 7 day services.
• Team, tasks and workload.
• Key enablers
• Our gaps

18. Background
Standard 3:
All emergency inpatients must be assessed for complex or on-going
needs within 14 hours by a multi-professional team, overseen by a
competent decision-maker, unless deemed unnecessary by the
responsible consultant. An integrated management plan with
estimated discharge date and physiological and functional criteria for
discharge must be in place along with completed medicines
reconciliation within 24 hours. The MDT will vary by specialty but as
a minimum will include Nursing, Medicine, Pharmacy, Physiotherapy
and for medical patients, Occupational Therapy.

19. Our TimeLine
Pre-2010
Overtime Saturday
service.
Closed Sunday
2011
Consultation 1
Morning weekend
working within contract
hours.
Supply Only
2014
Consultation 2
Full day weekend
working
Part-time workers
changes
Ward Service
2018
Consultation 3
Day-off in lieu for
weekend working
Weekday 7am to
7pm

20. Consultation 1- Dec 2011
• In response to lack of volunteers and increasing demand.
• Clear demand from clinicians.
• No extra funding.
• Split the department into 5 teams.
• The ‘10 minute nibble’.
• Hours 8.30am to 1pm
• Bank holiday- the whole team comes in.

21. Consultation 2- April 2014
• Service creep working passed 1pm.
• Winter pressures overtime to extend to full-day- then
funded as permanent investment.
• National 7 day standards published in Dec13.
• 10 minute nibble stayed in place. Afternoon as TOIL.
• Part-time were pro-rata- working 1 in 10- changed to 1 in 5
to increase clinical capacity.

22. Workforce Implications & Work-Life Balance
Acute Trust CCG/Mental Health/ GP Practice
On-call
Late duty
Weekend working
Inflexible working hours
Few working from home opportunities
More clinical opportunities outside of
hospital with:
• No on-call
• No late duty
• No weekend working
• Good opportunities for flexible and
home working

23. Consultation 3- Dec 2017
• Remove the 10-minute nibble.
• Full scheduled day off the following week.
• 7am to 7pm on weekdays to :
• Support compressed hours
• Address compensatory rest for the on-call
• Improve recruitment and retention
• Reduce missed doses of critical medicines
• Improve discharge turnaround time
• Supply focussed initially
• Implemented 1st April 2018- so far so good!

24. Weekend Teams
Role Task Role Task
Saturday Team Sunday Team
Pharm 1 Dispensary Pharm 5 Dispensary
Pharm 2 Dispensary/clinical Pharm 6 Dispensary/clinical
Pharm 3 Clinical Pharm 7 Clinical
Pharm 4 Clinical Tech 3 Dispense/ final check
Tech 1 Dispense/final check Tech 4 Dispense/clinical
Tech 2 Dispense/clinical Assistant 5 Dispense
Assistant 1 Dispense Assistant 6 Dispense
Assistant 2 Dispense
Assistant 3 Dispense/ top-up
Procurement
(am only)
Order receipt and
procurement

25. Workload
Daily Average Weekday Saturday Sunday
TTAs 120 45 35
Items
dispensed
2,054 675 480
Meds rec 110 20 13
Clinical hours ?100++ 7 4.5

26. Key Enablers

27. Access to Primary Care Record

28. EPMA

29. Pharmacy Ordering Portal

30. Prioritisation Tools

31. Porters

32. Where our gaps are….
• Clinical presence
• Level of timely meds rec & review
• Specialist Areas e.g. ITU transfer
• Outside hospitals and courier arrangements

33. Its not just about the weekend….
0.00%
0.10%
0.20%
0.30%
0.40%
0.50%
0.60%
0.70%
0.80%
Apr-15
May-15
Jun-15
Jul-15
Aug-15
Sep-15
Oct-15
Nov-15
Dec-15
Jan-16
Feb-16
Mar-16
Apr-16
May-16
Jun-16
Jul-16
Aug-16
Sep-16
Oct-16
Nov-16
Dec-16
Jan-17
Feb-17
Mar-17
Apr-17
May-17
Jun-17
Jul-17
Aug-17
Sep-17
Oct-17
Nov-17
Dec-17
Jan-18
Feb-18
Mar-18
Apr-18
May-18
Missed Dose Rate of Critical Medicines Due to
Unavailability Critical Medicine-missed doses due to
Unavailability
Average
7 day
weekend
portering
7am-7pm
weekday
opening
May 18- 0.39% = 208 doses.
That’s a % of the 50k critical medicines doses administered rather than a percentage of all medicines, 215K doses. Would be
0.01% of all doses missed due to medication unavailability.

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Discussion
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question or comment-
or write it in the chat box to ‘all
participants’.
When speaking please let everyone know
your name, and your organisation
7 Day Hospitals – Discussion7 Day Hospitals – Discussion

35. Extending 7 day
Pharmacy services
David Heller
Chief Pharmacist
Surrey and Sussex Healthcare NHS Trust
An Associated University Hospital of
Brighton and Sussex Medical School

36. Introduction
• Where did we start from?
• Why did we do it?
• How did we go about it?
• Designing the service
• Funding
• Results

37. Where did we start from
• 2014 introduced very basic Sunday service,
• dispensary only
• 30-40 items per week
• Voluntary for technicians and assistants
• Nurses queuing at Pharmacy
• 2016 increased to 2 pharmacists, 1 technician, 1 assistant
• Hours extending on Saturdays and Sundays, no breaks, no guaranteed
finish time

38. Why did we want to extend the
service?
• Better for patient safety, effectiveness and experience
• Better for pharmacy staff
• Breaks
• Reliable finish times
• Better Mondays
• Job satisfaction
• Better for clinical colleagues on wards
• Access to pharmacists and techs on wards
• No queuing for nurses
• Reliability

39. How did we go about it?
• Started talking in informal situations
• Group meetings Sept/Oct 2017
• Asked for views on 7 day services Oct 2017
• Asked for costings December 17
• Late December 17 given 4 weeks notice of winter pressures funding
• Jan 2018 started extended service

40. Designing the service
• Designing the service with the teams involved proved critical
• Almost everyone takes part
• 5 pharmacists
• 1 dispensary based
• 4 full time on wards
• Min 2 Medicines Management Technicians
• 3 other support staff

41. Service design
• Informatics crucial to prioritise patients
• Medicines Reconciliation all new patients wherever they are
• Patients with AKI
• Patients referred by the midweek team
• Discharges
• Requisitions from store to dispensary
• Urgent stock requests using online system
• All dispensing required

42. AKI report

43. Planned discharges

44. Weekend working list

45. How has it gone?
• Consultation with staff show they are content with the system
• Funding extended
• Quality fund number 1 priority
• Increased dispensing on Saturday matches fall on Monday
• Increase on Sunday not matched by fall elsewhere
• Need more portering!

46. TTOs processed in pharmacy
0
10
20
30
40
50
60
70
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

47. Saturday dispensing
0
50
100
150
200
250
300
350
400
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
Items
Weeks
2018 Saturdays
2017 Saturdays

48. Sunday dispensing
0
50
100
150
200
250
300
350
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
Items
Weeks
2017 Sundays
2018 Sundays

49. TTOs Saturday – received time
(after screening on wards)

50. TTOs Sunday – received time
(after screening on wards)

51. Discussionooon
Please raise your hand if you have a
question or comment-
or write it in the chat box to ‘all
participants’.
When speaking please let everyone know your
name, and your organisation
7 Day Hospitals – Discussion7 Day Hospitals – Discussion

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7 Day Hospitals – Advice and support
For advice and support, contact the Sustainable
Improvement Team
Sue Cottle, Programme Lead sue.cottle@nhs.net
Wendy Keating, Senior Improvement Manager wendy.keating@nhs.net
Lou James, Improvement Facilitator lou.james1@nhs.net
Thelma Daly, Improvement Manager thelma.daly@nhs.net
Suzanne Cullen, Improvement Manager suzanne.cullen@nhs.net
For general information vivrichards@nhs.net
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•
For more information: Contact: vivrichards@nhs.net
For other 7 day service resources:
https://improvement.nhs.uk/resources/seven-day-services/#resources
https://www.england.nhs.uk/seven-day-hospital-services/
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7 Day Hospitals – For more information7 Day Hospitals – Resources