Category: Community Care

Acute Care, Community Care, Digital Implementation, Featured, News

Winter is coming: how Doccla’s virtual ward pathways support Urgent and Emergency Care

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Tara Donnelly, Founder of Digital Care Limited, explains how Doccla is supporting NHS Urgent and Emergency Care through an innovative suite of virtual ward and remote patient monitoring technologies.

Emergency Departments (EDs) across the NHS in England have experienced another record-breaking year, both in terms of increased volumes of patients attending – more than 24 million emergency attendances – and decreases in performance against waiting time standards. Pressures on EDs are no longer seasonal but exist all year round, leading to adverse patient experiences. It is imperative that all those involved reimagine how Urgent and Emergency Care (UEC) services are delivered to support NHS colleagues who are bracing for a challenging winter ahead.

There is increased recognition that digital solutions could help to alleviate some of this burden. NHS England’s latest guidance to deliver the UEC Recovery Plan spotlights the expansion of virtual wards as a high impact intervention this winter. Doccla, a leading provider of virtual wards and remote patient monitoring, is working closely with its NHS partners to provide alternatives to admission and to relieve bed congestion by supporting early discharge. The team works with more than a third of integrated care boards, providing:

  • A customised suite of technology to help clinicians and carers monitor patients at home.
  • Clinical dashboards that enhance caseload management through holistic views of patient cohorts and visualisations of patient data trends over time.
  • Integration with electronic patient records to enable flow of coded data from the Doccla dashboard to the patient’s medical record during their stay on the virtual ward.
  • Access to multi-disciplinary clinicians with specialist training in remote monitoring.
  • An end-to-end logistics service that task-shifts administrative and non-clinical activity from busy clinicians.
  • Access to a patient support team, which uses a variety of accessibility tools to ensure patients from all demographics are aptly supported on virtual wards, from onboarding through to discharge.

Doccla’s technology has been pivotal in enhancing various admission avoidance pathways within UEC settings.

Remote monitoring available to community urgent response teams

Doccla’s technology is integrated within Hertfordshire Community NHS Trust’s (HCT) virtual ward service. Under the guidance of HCT’s Medical Director, Dr. Elizabeth Kendrick, the service has enabled the rapid assessment, diagnosis, early treatment and discharge of over 4,000 patients – recently winning a Parliamentary Award for its work.

Hertforshire Community Trust’s Hospital at Home service, using Doccla technology, has recently won a Parliamentary Award for its work.

Most recently, the technology has been deployed to HCT’s urgent care and response teams tackling ambulance wait times. Rather alarmingly, one in 10 ambulances spend more than an hour waiting outside hospitals. Joining forces with the East of England Ambulance Service, HCT equipped its community urgent response service with Doccla remote monitoring boxes so they could have an additional tool to support people to stay at home. Early evaluation of the pilot showed promising results, including:

  • Reduced ambulance conveyance rate to 33 per cent (from an anticipated 100per cent conveyance rate).
  • Reduced ambulance attendances by 18 per cent at East and North Herts NHS Trust.
  • Increased time available for crew to respond to acute emergency calls.
  • Reduced handover delays outside hospital.

Tackling surges in respiratory admissions this winter

Seasonal variations in respiratory admissions are a major contributor to pressures within emergency care settings over winter. There are 80 per cent more lung disease admissions in the winter months of December, January and February than there are in the warmer spring months of March, April and May.

Virtual wards provide an alternative mechanism for services to manage patient flow and to cope with the surge in respiratory admissions. The Doccla-supported ARI pathway at Northampton General Hospital (NGH) has demonstrated considerable efficiencies for the delivery of care. By supporting early discharge, NGH’s virtual ward service achieved:

  • 11 per cent reduction in length of stay.
  • 30 per cent reduction in bed days.

Likewise, tech-enabled remote monitoring enabled earlier detection of, and interventions for, deteriorating patients, resulting in a 15 per cent reduction in readmission.

While additional UEC funding has been injected into integrated care systems, allocation of monies is challenging when there are competing needs across care settings. It is paramount that the additional funding is maximised. NGH’s virtual ward service demonstrates a £13,000 per month saving (associated with the reduction in bed days) and more broadly, has enabled workforce capacity savings. Analysis in 2021 showed on non-tech enabled wards, there is 1 nurse per 8.3 patients on average. Doccla’s tech efficiency gains have expanded this to 1 nurse per 10 patients.

Augmenting SDEC services

Bristol, North Somerset and South Gloucestershire (BNSSG) is another example of how effective partnership between clinical and operational teams, in conjunction with Doccla’s innovative technology, can reduce admission rates. Between February and May this year alone, BNSSG’s NHS@Home service:

  • Provided an alternative to admission or supported earlier discharge 487 times.
  • Enabled local people to be cared for at home for an additional 4442 days
  • Supported cost savings of £1,479,186.
  • Avoided readmission for 87 per cent of patients.

In collaboration with Doccla’s remote monitoring technology, BNSSG NHS@Home teams are pioneering the use of remote monitoring for same day emergency care (SDEC) patients to avoid inpatient stays within North Bristol Trust – with the SDEC model contributing approximately 20 per cent of NBT’s weekly referrals to the NHS@Home service.

An example of a presenting condition being cared for in this way is the bacterial infection Cellulitis, which results in more than 100,000 hospital admissions per year in England alone. The new pathway has the patient set up for remote monitoring while in the hospital; they are given a Doccla box to take home and asked to send in their readings over the next few days, to indicate to the clinical teams whether or not the infection is under control. Given that 1.6 per cent of all NHS hospital admissions are due to Cellulitis, enabling speedy discharge or reduction of inpatient stays for patients with the condition has the potential to shift the dial on bed pressures this winter.

Conclusion

It feels important both for patients and the sustainability of the NHS that we do everything in our power to rapidly scale innovative solutions that are demonstrating impact in tackling pressures in Urgent and Emergency Care pressures.

As a trusted partner to health systems and providers, Doccla’s technology is being flexed in agile and impactful ways to support urgent care pathways this winter.

If this has sparked ideas that you are keen to action locally, please reach out to the Doccla team here. Doccla will be attending Public Policy Projects’ ICS Delivery Forum on 4th October to continue the conversation.

Tara Donnelly, Founder of Digital Care Limited
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Community Care, News, Primary Care

New report highlights how pharmacy can redefine role within NHS

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National Pharmacy Association

The National Pharmacy Association (NPA) has published a new report outlining how independent pharmacies are ready to redefine their role within the NHS. 

The NPA has published a medium-term prospectus for the development of pharmacy services, calling it a challenge to old ways of thinking and an opportunity to redefine the sector’s role in the NHS. 

It follows months of dialogue with NPA members about what a clinical future could look like for the sector. 

The document, Making Changes, Meeting Needs, will be shared with the King’s Fund and Nuffield Trust who are currently working on a new vision for the future on behalf of Community Pharmacy England. 

Among the ambitions in the NPA’s prospectus are: 

  1. Improve the management of long-term conditions such as asthma, hypertension, heart failure and diabetes. 
  2. Expand preventative interventions to help make the NHS a wellness, health-inequality reversing service. 
  3. Shift focus from a downstream dispensing role to an end-to-end prescription management role, with a focus on good pharmaceutical outcomes. 
  4. Become the go-to professionals for optimising the use of medicines, including upgraded Structured Medication Reviews and post-discharge reconciliation. 
  5. Offer prompt and accurate diagnosis, risk stratification based upon genotype and the capacity for personalised treatments. 
  6. Increase medicines safety right across the care pathway.
  7. Build on hospital touchpoints – preparing people going into hospital for elective care, give them a soft landing back into the community and reduce readmissions. 
  8. Dramatically improve access to primary care. 
Making changes, meeting needs
Credit: National Pharmacy Association

With informed policy-making and sufficient public investment, NHS community pharmacy could during the remainder of the 2020s develop much further as a clinical care and safe medicines supply service, in ways that will cost effectively benefit patients, public and the NHS, the document states. 

NPA Chair, Nick Kaye, said: “Building out from the existing portfolio of services, there are some major opportunities within this decade, encompassing prevention, medicines optimisation, long term medical conditions and urgent care. 

“We are seeking to challenge orthodoxies that have limited the sector’s scope for too long.  At the same time, these ideas are firmly planted in reality because our start-point is what our paymasters in the NHS want, not what we can dream up. 

“Some of this is about redrawing the borders of pharmacy practice – for example applying pharmacogenomics to pharmacist prescribing. 

“Other aspects are about re-imagining what is our domain as a sector; we are rightly based firmly in the community but our impact ought to be felt and formalised across the entire system, including hospitals.  We need to be ‘in the community but out of the box’. 

“We are confident that the large majority of NPA members – by their nature innovators – are open to the idea of ambitious, transformative change.” 

While pushing the boundaries of clinical service development, the NPA says it is also clear that the safe supply of medicines should continue to be a foundation stone upon which other pharmacy-based support is built. 

In a foreword to the document, Dr Claire Fuller, Chief Executive of the Surrey Heartlands Integrated Care System, praised the NPA for backing a “can-do agenda” for the sector. “This is the kind of thinking – based in an understanding of what commissioners need – that makes people like me sit up and take notice”, she said. 

Making Changes, Meeting Needs lists the enablers that would need to be in place in order to turn these ambitions into reality. They include digital connectivity, a boost to workforce and a supportive national contractual framework (in May, the NPA published its ‘New Deal for Community Pharmacy in England’ which describes such a framework). 

The NPA is inviting people to offer feedback on their report, please write to independentsvoice@npa.co.uk.

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Community Care, Population Health, Thought Leadership

Can ICSs unlock the value of private business to health equity?

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population health in business

New insight from Public Policy Projects (PPP) outlines how businesses can support health equity through community engagement, why they should, and how integrated care systems (ICSs) can support them.

The findings go on to suggest that should these community engagement strategies be co-designed by ICS members involved in the setting of priorities for the public sector in a local area. Private businesses can align their strategies with public bodies and with one another, maximising the value of their role as community stakeholders.  

The insight piece outlines how businesses can impact the health of a community – such as by implementing healthy workplace policies, implementing inclusive local recruitment practices, partnering with community organisations, investing in community development, implementing local procurement strategies, and advocating for health equity. The piece goes on to make the business case for community investment, outlining how investing in communities can increase community loyalty and trust, improve employee morale and retention, enhance brand visibility, and increase innovation. 

The value of community engagement to businesses, the document suggests, can be further grown through collaboration with the public sector. This can support better knowledge sharing, as a number of NHS trusts already oversee effective community engagement strategies, and enable initiatives from both the public and private sector to better support oneanother and accelerate the improvement of health equity within a region.  

Improving health outcomes in the community provides the following recommendations to business leaders and policymakers: 

  • Businesses should be incentivised to invest in communities – through recruitment, procurement and outreach – and should be encouraged to partner with other businesses and public bodies to improve the quality of data and insight. 
  • ICSs, local authorities, central government and businesses should explore opportunities to utilise ICPs as a forum for private, public and third sector stakeholders in a local area to communicate, establish shared priorities and create plans of action. 
  • In order to develop stronger guidance for businesses to collaborate with ICPs, there should be a tailored section within the Maturity Matrix for ICSs discussing partnerships with private businesses. 
  • Businesses should communicate regularly with other local stakeholders, including Health and Wellbeing Boards. These communications should ensure businesses are supporting local health equity ambitions by responding to Joint Strategic Needs Assessments. 
  • Businesses and local authorities alike should seek to grow their investment into tools to understand the impact of community engagement and the health value of social investment. 
  • Further guidance on partnerships within the ICS framework should be issued – with a specific focus on enabling effective public-private collaboration. The Department of Health and Social Care (DHSC) should collaborate with the Department of Work and Pensions to issue this guidance. 
  • ICSs and DHSC should seek to develop guidance for businesses to support local health outcomes through recruitment, procurement and outreach. This guidance should not be overly proscriptive, but should provide a clear idea of the relationship between various social determinants of health and business practices. 

Improving health outcomes in the community is the second instalment of the Population Health in Business series, which discusses the health creation value of business and suggest to business leaders and policymakers alike how they may re-envisage their roles, collaborate and deliver better outcomes.  

The roundtable that served as the evidence-base for this report was conducted in February 2023 and chaired by Professor Donna Hall CBE, Chair of New Local, Integrated Health and Care Systems Advisor for NHS England, and a woman once described as a “public service pioneer” by Mayor of Greater Manchester, Andy Burnham.

Professor Donna Hall CBE said of the series: “The three workshops by PPP have explored the practical ways businesses can support health and wellness in their local communities. We have had engagement from a wide range of businesses, public health experts and academics which has been a rich and diverse discussion. The report provides helpful support and advice to local health and care system leaders, businesses and communities on making the most of private employers as a key part of the local infrastructure to support breed health and wellness for all.”

The PHIB roundtable series has concluded, however the final insight summary and final report are still being written and will be launched in June 2023.  

Read the full insight piece here.

For further information about the report please contact eliot.gillings@publicpolicyprojects.com    

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Community Care, Health Inequality, Population Health, Thought Leadership

Prioritising local ‘business progression’ within ICS population health strategy

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population health in business

PPP’s Population Health in Business series examines the impact of businesses on health outcomes. The first roundtable examined the impact of the employee-employer relationship on health equity within a given region.

Integrated care systems should prioritise the development of local ‘business progression frameworks’ within population health strategy. This is according to a new recommendation from Public Policy Projects (PPP). 

Business progression frameworks, developed by ICS leaders and local authorities, can provide local businesses with clear guidance regarding how their employee health and wellbeing strategies can impact local health, thereby driving accountability. 

Employment can greatly impact an individual’s health, though this impact varies depending on the nature of the work and workplace environment. Variations in these health implications are significant contributors to health inequalities in the UK and can have a major effect on the impact of ICS population health strategy.  

Health inequalities have been found to exist within individual businesses, with poorer health outcomes typically experienced by those at lower occupational grades

The insights were uncovered during a roundtable of PPP’s Population Health in Business series, which convenes key experts, including ICS leaders, to examine the impact that businesses, and employment more broadly, have on health outcomes. The series makes practical recommendations for ICS and business leaders to collaborate to inform population health strategies and improve health outcomes at a community level.   

The series is chaired by Professor Donna Hall CBE, Integration and Transformation Advisor to NHS England. Commenting on the insights gathered so far, Professor Hall said: These sessions explore the practical ways in which businesses can support health and wellness in their local communities. We have had engagement from a wide range of businesses, public health experts and academics which has been a rich and diverse discussion. The report provides helpful support and advice to local health and care system leaders, businesses and communities on making the most of private employers as a key part of the local infrastructure to support breed health and wellness for all.”

Read the full insight piece from roundtable one here.

PPP has found that good employee health and wellbeing strategies and a positive workplace culture are associated with increased productivity and better staff retention – meaning that the quality of a business’s approach to employee health directly impacts their strength as an organisation. A positive workplace culture is one that fosters clear and open communication and strong co-working bonds. PPP also believes that businesses can influence the health and wellbeing of their employees through better pay, flexibility in location and working hours, and increased control over tasks and responsibilities.  

Health inequalities have been found to exist within individual businesses, with poorer health outcomes typically experienced by those at lower occupational grades. Businesses that incorporate health into every level of their corporate decision-making, and seek to prioritise those in greatest need, are more easily able to impact health equity than businesses that do not.   

How a progression framework is improving health outcomes in Leeds 

Leeds City Council’s ‘Business Anchor Progression Framework’ provides an example of what such a framework could look like. Broken down into four sections (employment; procurement; environment and assets; and corporate and community) the framework is “designed for businesses with a large or influential local presence who want to play a full anchor role locally and is a wide-ranging tool that considers the breadth of a company’s activities.”  

Anchor institutions can be defined as large organisations whose sustainability is connected to the populations they serve and who seek to utilise their assets and resources to support improvements in health equity and the overall quality of life within their local area. The framework used in Leeds poses questions to businesses such as “to what extent do you encourage the mental and physical health and wellbeing of staff through facilities, policy, culture and support?”  

The framework is primarily aimed at private sector businesses that have generally yet to be incorporated into UK anchor networks. The framework also asks businesses to grade their present status and their organisation’s ambitions on a scale of one to four and is intended to provide businesses with clarity on their responsibilities as community anchors and support them in identifying key areas of improvement.   

Read more analysis from PPP’s Population Health in Business series. 

Recommendations from roundtable 1 

  • ICSs should craft ‘business progression’ strategies to chart the progress of private businesses within their local system. These frameworks should share some universal objectives and metrics but must also be tailored to the specific needs of the system in question.   
  • Businesses should identify the key health conditions and inequities within their business and should share findings with their local ICS.  
  • Businesses should be further encouraged to submit case studies documenting their approaches to employee health and wellbeing, and their perceived success, to the DWP and their local ICBs.  
  • The DWP should support ICSs in developing ‘business progression’ frameworks by developing a more robust Voluntary Reporting Framework.    
  • Health equity considerations should be incorporated into corporate decision making at every level.   
  • An employee health and wellbeing strategy should include objectives for improving communication between employees, particularly between different seniority levels. Strategies should also view socialisation and the development of workplace ‘rituals’ as key to developing a healthy culture.   
  • Employee health and wellbeing strategies should target those at higher risk of health inequalities, particularly those at lower occupational grades. Strategies should prioritise interventions that help employees easily access support linked to improved social determinants of health and should be extended to contracted employees where possible.  
  • ICSs should encourage employers to re-evaluate their Employee Assistance Programmes (EAPs) to ensure support programmes are easy to use and deliver a clear benefit to employees.    
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Acute Care, Community Care, Thought Leadership

Non-emergency transport is crucial for winter resilience 

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ERS winter resilience

Seasonal pressures and existing backlogs look set to increase demand for non-emergency transport this winter. Writing for ICJ, ERS Medical’s Chief Executive Andrew Pooley, and Quality and Governance Director Simon Smith, outline why they are pushing hard for winter transport resilience.

The NHS was already experiencing significant pressures, even before this winter’s challenges. Although a smaller component of the NHS, non-emergency transport services (NEPTS), which provide transportation for patients with non-urgent conditions but who would struggle to travel independently, play a pivotal role in maintaining smooth patient flow.  

Last year, ERS Medical launched a campaign to raise awareness of non-emergency transport. The aim of this, in part, is to emphasise the importance of non-emergency transport and more importantly, to encourage the earlier booking of contingency winter patient transport shifts to support hospitals with patient discharge and alleviate some of the anticipated winter challenges.

Easing system pressure

Delays to patient discharge cause significant patient flow issues, and these are well documented. News headlines often focus on bottlenecks and delays via front door admissions, such as A&E, and the significant pressures being faced by emergency departments.  

However, if beds are not available in hospital wards where patients can be treated after assessment in A&E, there is less capacity for newer patients to be admitted. The traffic jam at the exit route now becomes a problem at the entry points for patients, as well as preventing ambulances from returning to the community, increasing already dangerously long ambulance response times.  

One of the main reasons for the patient flow crisis is the availability of social care. There is a direct correlation between the absence of an ongoing care package and higher rates of readmission. Further, discharging patients too early without any ongoing care and proper safeguards in place will often mean the patient is readmitted sooner or later. Poor discharge protocols can also lead to an increase in complaints and reputational damage for hospitals. It is no surprise then that discharge coordinators and healthcare staff have such a tough balancing act to manage, in addition to their workload challenges. 

The role of transport  

Transport can play a huge role in addressing the discharge backlog, and booking transport early is vital. This may sound simple enough, but transport is an often-overlooked aspect of the discharge process. When patients are ‘made ready’ for discharge, this is often the first point at which transport is considered. However, booking transport in advance, preferably the day or so before the patient will be ready to leave, is usually more efficient. While it is difficult to be a hundred per cent certain that a patient will be ready for discharge on a particular day, clinicians often have a good indication of when discharge might be feasible and appropriate.  

To this end, planning and communication are essential. Planning the transport in advance, booking it and then communicating with the provider if the plans change for any reason are crucial elements in the efficient discharge of patients. This ensures there are enough resources available in the system for trusts and integrated care systems to keep the patient flow running smoothly.  

One solution that is showing promise is to appoint specialist patient transport liaison officers (PTLOs) in hospitals. This “human” point of contact is a specially trained individual who can assess transport needs and then recommend the best approach on a case-by-case basis, often communicating with patients, hospital staff and families to keep everyone informed.  

Lessons from previous spikes in demand 

Contrary to conventional wisdom, one of the key insights from looking at our data (as illustrated below) is that spikes in winter demand often arise, not because of increased activity levels, but because of changes in booking behaviour, patient mobility, an increase in aborted journeys, and the subsequent need for more resources to accommodate these changes.  

 

Let’s take a hypothetical fleet of 10 vehicles servicing a local acute hospital. With the “normal” commissioned pre-planned booking behaviour and mobility mix, the activity matches resource and there are no service issues. Add in just one complex journey – for example, an obese patient that requires an additional crew to assess the property and support the journey – very quickly, that can reduce 10 per cent of available resource for more than half a day.  

Add in multiple issues – for example, bookings made at the last minute, or with incorrect mobility requirements, or patients’ drugs not being ready at the pickup time – and it is possible to see how demand outstrips built-in spare capacity and pressures build in the system. Integrated care boards (ICBs) should act with caution when being presented with supposedly easy fixes. The Uber model does not work with a regulated service that relies on trained staff and specialist equipment, and simply drawing on resources from outside the contract often fails because other services will also be under pressure, as they rarely hold spare capacity. The simple answer is to plan well in advance – it takes time to mobilise a fully compliant NEPTS ambulance crew, communicate with all stakeholders and educate healthcare staff about the correct use and limitations of the NEPTS service.  

Providers should also re-examine the point at which mobility assessments are carried out. When hospitals carry out patient mobility assessments, this is often done at a fixed, predetermined point. If a patient is independently mobile, but has been sitting and waiting for a doctor’s assessment, the patient’s mobility levels could deteriorate. When crews arrive to pick up a patient that has been booked on a seated vehicle to accommodate four patients, the crews undertake what is called a dynamic mobility assessment of the patient. They then establish whether or not the patient can walk independently, and whether they might now require a wheelchair or stretcher. This means that the vehicle originally booked to transport the patient is no longer suitable, and more, or different, resources are required.  

The reality is often different to the perceived activity levels  within NEPTS, where the ideal scenario is multiple patients in the same mobility category travelling in one vehicle. If transport is planned at the last minute for patients with the lowest mobility (patients who need stretchers), this blocks out a significant number of vehicles in one go, thereby increasing delays and placing a greater strain on existing resources.  

Of course, effectively balancing these factors comes down to proper planning, communication and funding contracts on actual resources needed, not just activity levels. This does not mean simply communicating with transport providers, but also between hospital departments.  

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Community Care, Health Inequality, News

NHS community pharmacies sound alarm as inflation bites

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community pharmacy

The National Pharmacy Association (NPA) has raised concerns about the future of the community pharmacy sector, with a new report highlighting the impacts of inflationary pressures

The NPA commissioned the investigation into the implications of inflation on community pharmacy commissioned in June 2022 following large spikes in inflationary pressures this year. Professors David Taylor of University College London and Panos Kanavos from the London School of Economics and Political Science were asked to investigate the capability of community pharmacy across the UK to purchase and dispense NHS and other medicines and to become more focused on the provision of clinical services.

The report, Protecting the UK Public Interests in NHS Community Pharmacy, was published in September 2022 and warns of several thousand community pharmacies in the UK having to close thanks to rising costs and ‘flat’ NHS pharmacy funding.

The overall number of community pharmacies in England has fallen by 600 since 2018, about 5 per cent of the total. This number was likely kept artificially low thanks to temporary additional payments that were made to pharmacies during the Covid-19 pandemic, while many pharmacies that remain open have only done so by accepting reduced incomes and incurring more debt.

Many have also reduced the services they offer, cutting loss-making discretionary services and reducing opening hours. A FOI request has revealed that between December 2020 and July 2022, 1600 pharmacies in England reduced their opening times by an average of six hours per week in a bid to cut costs.

Many of the pharmacies that remain under threat are located in more deprived areas, where further closures of pharmacies risks widening existing health inequalities. The report warns that serious damage could be done to the NHS’ medicine supply without urgent government action to help community pharmacies remain as viable going concerns.

However, the picture looks less grim outside of England, with initiatives in Scotland and Wales producing a more stable outlook for community pharmacies there. In Wales, shifts in the balance of NHS pharmacy fees towards providing clinical services, as opposed to dispensing medicines, are being introduced, while in Scotland, prescribing pharmacists are now able to diagnose and treat a variety of conditions that previously would have required GP intervention thanks to the Pharmacy First Plus scheme.

Inflation, inflation, inflation

The report comes after Ernst & Young (EY) were commissioned by the NPA to conduct a study of the funding, policy and economic environment for independent community pharmacies in England. This study was concluded in September 2020 and predicted a deficit of £500 million in community pharmacy funding by 2024. It also asserted that the current financial framework for the NHS pharmacy network was unsustainable.

According to figures from the NPA, the inflation adjusted value of NHS community pharmacy ‘global renumeration sum’ fell by 10 per cent between 2015 and 2017 (see Figure 1 below). It has remained at £2,592 million since then, with no annual allowance for inflation. As things stand, the proportion of English NHS funding allocated to pharmacies will have fallen in real terms by over one third in the period 2015-2024, falling from 2.4 per cent to 1.6 per cent. However, higher inflation rates and increased NHS outlays mean that the drop is likely to be larger.

Figure 1 (click to enlarge): The Community Pharmacy Global Sum in England to (projected) 2024 in current prices and at 2015 prices, CPI adjusted. Source: Professor David Taylor, Professor Panos Kanavos. Authors’ estimates based on ONS and NHS data.

The current Community Pharmacy Contract Framework for England was agreed upon for the period 2019-2024, before the pandemic and the recent inflation crisis. It would have been appropriate to expect a 2 per cent annual inflation rate when the ‘flat NHS funding’ contract sum was agreed upon. However, with inflation sitting at over 10 per cent, and expected to remain there for potentially one or two years, community pharmacies in England are now facing up to net funding shortfalls of 15 per cent in 2023 and 20-25 per cent in 2024, against what could have reasonably been expected in 2019.

Following the steep rise in inflationary pressures in 2022, the new report, Protecting the UK Public Interests in NHS Community Pharmacy, was commissioned by the NPA. It urges the new government to intervene to prevent further pharmacy closures and ensure the viability of the sector throughout the current period of economic turbulence.

The report does, however, point to some signs for long-term optimism, notably the fact that all new pharmacy graduates will qualify as prescribers by 2026. The government has recently announced its ambition for community pharmacy to assume some of the clinical services burden, thus relieving pressures on GP practices and A&E departments.

Such measures were also recommended by a recent Public Policy Projects report, ICS Futures, and the NPA say that that under the new integrated care systems, a transformation of community pharmacy’s role can be achieved, “given sufficient political, managerial and professional will to pursue the public’s best interests.”

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Community Care, Local Government, News

Paddington life sciences cluster to maximise benefits of industry partnerships   

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Paddington life sciences cluster

Imperial College Healthcare NHS Trust recently set out its vision for a new life sciences cluster in Paddington, founded on its growing partnerships with research, industry and community organisations around St Mary’s Hospital.

The Trust unveiled its ‘Paddington Life Sciences’ vision on a new website, featuring three initiatives already underway:

  • A new digital collaboration space, opening in autumn 2022, located at Sheldon Square, next to St Mary’s and Paddington station. Housing the National Institute for Health and Care Research (NIHR), Imperial Biomedical Research Centre’s (BRC) expanding digital health programme team. It will provide space for lectures, training, events and meetings. It will also benefit from additional investment in Imperial College Healthcare’s trusted data environment which has already helped to produce new clinical insights.
  • The creation of a new centre for clinical infection, a specialist clinical and translational research facility to complement Imperial College London’s new Institute of Infection. Together they will be one of only a few facilities in the world to offer ‘end-to-end’ innovation, from initial discovery to improved patient outcomes, for the management of infectious diseases as well as antimicrobial resistance.
  • Paddington Life Sciences Partners will bring together NHS, academic, local authority and life sciences industry partners with a commitment to the area to help ensure the delivery of significant social, health and commercial value as quickly as possible.

For the longer term, the Trust is progressing a full redevelopment of the St Mary’s estate as part of the government’s new hospital programme. As well as delivering a new, state-of-the-art hospital, the redevelopment is intended to create an additional 1.5 million square feet of cross-functional commercial and lab space for life sciences businesses to develop and grow.

Imperial College Healthcare Chief Executive Professor Tim Orchard said: “Research and innovation are fundamental to the clinical excellence our hospitals are renowned for, from the Nobel Prize-winning discoveries of penicillin, the chemical structure of antibodies and the invention of the electrocardiogram, to pioneering robotic surgery, HIV care and the clinical use of virtual reality technology. Most recently, we have played a key role in developing an understanding of Covid-19 and trialling a range of new treatments.

“We are now entering a new era of discovery, at an even more ambitious scale, by maximising the potential of our existing work areas and joining them up with new opportunities. With Imperial College London, we run one of the largest NIHR biomedical research centres, undertaking hundreds of clinical trials and analysing data from well over a million patient contacts each year. Through the pandemic, many more patients and staff have been encouraged to get involved in research and we are confident this trend will grow as we continue to deepen our relationships with local communities and organisations. We are working together to improve not just healthcare, but also health and wellbeing, creating synergies that will boost education, skills development and employment opportunities in some of the most deprived areas of the UK.

“The regeneration of Paddington is also drawing more and more life sciences and technology businesses to the area, attracted by investment in transport infrastructure and excellent national and international travel connections. This also means strong links to other life sciences hubs, including Imperial College London’s growing campus at White City, adjacent to another of our own campuses, Hammersmith Hospital, and the knowledge quarter in King’s Cross and Euston.”

Dr Bob Klaber, Imperial College Healthcare Director of Strategy, Research and Innovation added: “British life sciences firms raised £4.5bn in 2021, up from just £261m in 2012. But London has not yet reached its full potential to attract investment and innovation in the life sciences sector – MedCity’s 2021 London Life Sciences Real Estate Demand Report identified an estimated 500,000 square feet shortfall in innovation and lab space. Imperial College Healthcare is ideally placed to help fill that gap.”

There will be a formal launch of Paddington Life Sciences, and the new digital collaboration space, later this autumn.

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Community Care, News, Primary Care

Leading health charities highlight “untapped potential” of pharmacy services

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Untapped potential of pharmacy sector

Leading UK health charities have highlighted the untapped potential of pharmacy services in tackling the nation’s major health conditions. 

Just one in ten adults in Britain have turned to their local pharmacy for advice and information on lowering their risk of serious health conditions including cancer, heart disease and type 2 diabetes, according to a new YouGov survey.  

The survey, commissioned by the British Heart Foundation (BHF), Cancer Research UK, Diabetes UK and Tesco, suggests that many people could be missing out on opportunities to access free advice via their local pharmacies that could help them make life-changing improvements to their health.   

The findings come as the BHF, Cancer Research UK and Diabetes UK have been working with Tesco to deliver specialist training to Tesco pharmacists and pharmacy colleagues to support their conversations with the public. The training will help them provide more information and support as to how people can help lower their risk of these serious conditions through small changes to their day-to-day routine.  

The survey also found that, of those who had visited a pharmacist for health-related advice or checks, 43 per cent said talking to a pharmacist had eased their concerns around wasting their GP’s time.    

Meanwhile, 24 per cent of those who had visited a pharmacist for health-related advice or checks found it easier to speak to someone in a pharmacy than in other healthcare settings, while 53 per cent identified not having to book an appointment as a benefit of using a pharmacy for information and advice about a health-related concern.

The leading health charities say that supporting people to make lifestyle changes and seek referrals for concerning symptoms could “save thousands of lives” every year from some of the UK’s most prevalent and serious diseases.   

More than 7.6 million people in the UK are living with heart and circulatory diseases, while 4.9 million are living with diabetes, 90 per cent of which are cases of type 2 diabetes, and it’s estimated that almost three million people are living with cancer (2020). Yet, around four in 10 cases of cancer, many heart and circulatory diseases and up to five in 10 cases of type 2 diabetes could be prevented or delayed.   

Dan Howarth, Head of Care at Diabetes UK, said on behalf of the charities: “Thousands of lives could be saved every year through people making positive changes that lower their risk of type 2 diabetes, cancer, and heart and circulatory diseases.  

Far more people could be taking advantage of the advice and support available to them from their Tesco pharmacy while they do their weekly shop, this includes tips and information on stopping smoking and weight management services”  

The survey also found that only two per cent of adults in Britain had visited their pharmacist for a blood pressure check in the last twelve months, despite an estimated 4.8 million people in the UK living with undiagnosed high blood pressure.   

The three leading health charities, in partnership with Tesco, are encouraging people to use their local Tesco pharmacies for information and support on lowering their risk of cancer, type 2 diabetes, and heart and circulatory diseases.  

Tesco and the health charity partners hope that shoppers take advantage of the convenience of having their local pharmacist in store. Customers can easily seek advice when they do their weekly shop and get support for making positive changes or seeking information on concerning signs or symptoms.  

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Community Care, News, Social Care

Social care crisis leaves 500,000 adults waiting for care

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social care

More than half a million adults in England are waiting for social care assistance, says the Association of Directors of Adult Social Services (Adass), as staff shortages continue to impact the provision of care.

According to Adass’ research, the number of people waiting for either social care assessments, direct payments or reviews of their care has risen sharply over the last year. The research marks a 72 per cent rise in the numbers waiting for support, as similar research last year put the figure at about 294,000.

Adass president Sarah McClinton said the figures represent “a devastating impact on people’s lives,” while the government has said that reforming social care is a priority.

Published in May 2022, the Adass report, Waiting for Care, found that during the first three months of 2022, an average of 170,000 hours a week of home care could not be delivered due to workforce shortages, and that 61 per cent of councils were having to prioritise care assessments.

“The situation is getting worse”

The report states the capacity of the care sector to deliver on people’s needs has been sharply reduced, at the same time as England’s ageing population develops ever more complex care requirements.

It says that “despite staff working relentlessly over the last two years, levels of unmet, under-met or wrongly-met needs are increasing, and the situation is getting worse. The growing numbers of people needing care and the increasing complexity of their needs are far outstripping the capacity to meet them.”

The report also says that the government’s focus “of resources on acute hospitals without addressing care and support at home, means people deteriorate and even more will need hospital care.”

Adass argue that not only are people waiting longer for care, “but family carers are having to shoulder greater responsibility and are being asked to take paid or unpaid leave from work when care and support are not available for their family members.”

This was echoed by Helen Walker, Chief Executive of Carers UK, who has said the current state of social care is putting “even more pressure on even more families who are propping up a chronic shortage of services.”

Changes welcome, but not enough

The government states publicly that fixing social care in England is a priority, and the Health and Social Care Levy passed last month will see £5.4 billion invested into social care over the next three years, including £3.6 billion to reform the charging system for social care and a further £1.7 billion to begin “major improvements” to the sector. The added funding is cautiously welcomed, but critics argue the government needs to go further.

However, ADASS president Sarah McClinton said: “We have not seen the bounceback in services after the pandemic in the way we had hoped. In fact, the situation is getting worse rather than better. Social care is far from fixed.

“The Health and Social Care reforms go some way to tackle the issue of how much people contribute to the cost of their care, but it falls short in addressing social care’s most pressing issues: how we respond to rapidly increasing unmet need for essential care and support and resolve the workforce crisis by properly valuing care professionals.”

Responding to the ADASS report, Miriam Deakin, Director of Policy and Strategy at NHS Providers said: “This valuable report paints a worrying picture of unmet care needs and lays bare the pressures on the social care system, which are having a serious knock-on effect on individuals’ quality of life and independence, as well as the timely discharge of patients from hospital.

“Although hospital patients who are medically fit for discharge are made a priority for assessment, any delay to those assessments means a delay to people receiving the care they need and makes it difficult to maintain the flow of patients through the NHS.

“Equally worrying is the obvious need for more support to help people stay well and live independent lives in the community which would in many cases prevent, or delay, any need for hospital care.

“We must recognise the efforts of social care staff delivering more care in people’s homes over the last year and ensure they are paid appropriately to acknowledge their valued contribution.

“The ADASS report highlights once again the urgent need to properly fund and reform the adult social care system.”

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Community Care, Digital Implementation, News, Population Health, TPP

New digital maternity pathway goes live in Devon

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TPP's maternity software in action

TPP SystmOne Maternity technology goes live at Torbay and South Devon NHS Foundation, digitising the entire maternity pathway, from ante to postnatal care.

This week, Torbay and South Devon NHS Foundation Trust have gone live with TPP SystmOne Maternity. The system has enabled the Trust to digitise their entire maternity pathway, from antenatal through to postnatal care. It is being used by all midwives in the region, including those based at the hospital and those working in the community. More than 2,500 women will benefit from the new system every year, with their maternity care now centred on a complete, integrated digital care record.

Following the go-live, midwives now have instant access to all of the maternity data they need. For example, midwives working in postnatal care can easily view all antenatal care and delivery details. All medical and nursing notes are captured in a single record. This provides staff with the information required to make the best clinical decisions and improve safety for mothers and babies. Advanced functionality in the system is also supporting staff with the management of more complex pregnancies, through enhanced clinical decision support, alerts, and a complete maternity timeline.

TPP maternity
TPP SystmOne Maternity in use at Torbay Hospital

There has been strong clinical engagement throughout the project, from midwives, doctors and nurses. The teams have used TPP’s powerful Clinical Development Kit (CDK) functionality to develop exactly the data entry templates and visualisations they wanted. All staff members can quickly capture the information they need for a complete antenatal, labour, delivery and postnatal record. The Trust have also used CDK functionality to create customised safeguarding content, helping to support and protect the most vulnerable families. Staff are also benefiting from interactive inpatient screens in the system, allowing them to manage bed capacity and perform safe, efficient handovers.

The go-live has also included providing TPP’s smartphone application, Airmid, to all women under the maternity service. This is putting women at the very centre of their pregnancy journey. Airmid allows women to access their maternity records, manage their upcoming appointments, complete questionnaires at home, and receive personalised advice and education material. Airmid supports better engagement and seamless communication between women and their maternity care team.

SystmOne also provides significant improvements to integrated care across the region and to multidisciplinary working. For example, maternity staff can immediately access any important information entered by GPs. This is significantly improving patient experience. Women only have to tell their story once, without having to repeat themselves. GPs can directly refer into the maternity unit, improving efficiency across both services. Additionally, all new births are now automatically registered with regional Child Health services, with no extra burden placed on NHS staff.

Tracy Moss, Head of Strategic Systems’ Software Development at the Trust, said: “We are excited to be working with TPP to introduce a new maternity IT system here at Torbay and South Devon NHS Foundation Trust. The new system is expected to bring a wealth of clinical as well as efficiency benefits for our maternity teams and the wider organisation. The families we care for will also benefit from the system, as the new associated Airmid patient app will allow them to view their records, access information and be more involved in their care. Moving forward, we would like to continue to work with TPP to deploy other SystmOne products, both within our maternity unit and across our wider Torbay and South Devon organisation.”

Charlotte Knowles, Managing Director at TPP, said that “maternity services will always hold a particular place in my heart. Having had three babies, I know, from personal experience, what a superb job they do. We are delighted that the Trust are already seeing significant benefits for staff and patients from TPP Maternity. The dedication of the staff here has been truly inspiring. We are looking forward to working together to continue to make better use of technology to improve the experience and outcomes for pregnant women and their families.”

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