New study underway on joint clinical trials between health tech and primary care

By Integrated Care Journal

A groundbreaking feasibility study in Northumbria is exploring the potential of collaborative clinical trials between health tech providers and primary care, with early results showing significant lifestyle and self-management improvements.

A first-of-its-kind randomised control trial in Northumbria is exploring the feasibility of cost-effective collaborative clinical trials, using digital interventions to support people with hypertension and depression and/or anxiety. Over a 12-week period, the Innovate UK-backed research project is involving patients by using Holly Health’s digital coaching service at home, emulating the real-world use of the service.

Cardiovascular conditions are the biggest cause of early deaths worldwide and over 19 million UK adults are affected by hypertension. However, as stated in the NHS Long Term Plan, “cardiovascular disease is largely preventable and the single biggest area where the NHS can save lives”.

Managing and preventing hypertension through lifestyle changes, including an improved diet and increased exercise, is critical. However, for many patients, self-managing the required changes becomes more challenging when combined with conditions such as anxiety and depression. For this reason, the need for innovative and integrated solutions that address both physical and mental health aspects is paramount.

Holly Health’s digital tool has the transformative potential of addressing the challenges posed by the comorbidity, enhancing self-management, reducing NHS costs, and improving national health outcomes.

Dr Justine Norman, Clinical Director for Quality and Research at Northumbria Primary Care, expressed excitement about participating in this unique feasibility study, highlighting the team’s interest in understanding how patients engage with and benefit from an innovative digital approach that address both physical and mental health conditions. Dr Norman added,

“The response from patients to take part in the research has been really encouraging. Now, we’re looking ahead to the study which has concluded this month and analysing the outcomes which will form a bigger six-month trial to measure the longer-term impact for our patients.”

The main outcomes of the study indicate strong patient engagement and positive lifestyle impacts. After using Holly Health for 12 weeks, 64 per cent of patients found the service useful, 69 per cent said they benefited from the service and 92 per cent found it acceptable as a digital health intervention. The app has helped improve participants’ lifestyles in the following ways, including:
●      Changes to eating habits
●      Reduced alcohol intake
●      Increased physical activity
●      Using the app to prompt better behaviours/habits

One participant finds the app very valuable and has become an integral part of her daily routine. She finds the ‘discovery’ resources and the notifications extremely useful. She also enjoys the reward feature and being able to tick off/complete a “habit” once she has done it. As an exploratory analysis, the study will look into changes in GP appointments and prescriptions after six months of using Holly Health. As an exploratory analysis, the study will look into changes in GP appointments and prescriptions after six months of using Holly Health.

Daniela Beivide, Chief Science Officer at Holly Health pointed out that prior studies for isolated conditions have demonstrated the positive impact of digital interventions, including a reduction of demand on services. She commented,

“We’re just as excited as our study partner, Northumbria Primary Care, to be investigating whether the same impact can be applied to supporting people with physical and mental health comorbidities.

If successful, there is huge potential to efficiently and cost-effectively scale the service for large populations to reduce strain on NHS services and create significant change in the economy of the country. We’re proud to be part of this cutting-edge approach where digital health companies and the NHS can partner to research and implement solutions at low cost and an accelerated pace”.

Holly Health’s intuitive app provides intelligent AI-powered coaching, habit reminders, education, and in-the-moment support to encourage regular actions for blood pressure and mood management, which empower individuals and improve self-management abilities.

The feasibility study is part of a Future Economy 12-month project funded by Innovate UK that has also enabled Holly Health to develop innovative features within its app, such as the Ecological Momentary Assessment (EMA) feature that gathers real-time user data for current mood and stress levels which can then be used to provide a more relevant and personalised coaching experience.

Boehringer Ingelheim, Primary Care November 14, 2024

The value of partnerships in enabling holistic diabetes care

By Navodi Kuruppu

PPP’s Director of Market Access and Policy, Ameneh Saatchi, spoke with Naj Rotheram, Medical Lead for Partnerships at Boehringer Ingelheim, to discuss their view on primary care, partnerships and how they can best support the NHS in delivering a new holistic approach to diabetes care.

The Diabetes Care programme has been sponsored by Boehringer Ingelheim. Boehringer Ingelheim has had no influence over the agenda, programme development, content or selection of faculty. This Editorial was written by PPP but features content from an interview with Boehringer Ingelheim. Boehringer Ingelheim has therefore reviewed the content for factual accuracy only.

Since their establishment in 1885, Boehringer Ingelheim has evolved into a leading manufacturer of pharmaceutical drugs for both human and animal healthcare. As a research-driven company operating in the UK among many other countries, Boehringer Ingelheim aims to support the NHS in improving clinical outcomes, access to evidence-based care and the quality of life.^[1] To make this happen in diabetes care, Boehringer Ingelheim researches and develops innovative medications to support patients throughout their care journey.^[2]

Naj Rotheram is Medical Lead for Partnerships at Boehringer Ingelheim. Having worked in the NHS for fifteen years before joining industry thirteen years ago, her experience makes her well-placed to understand how the NHS can deliver successful holistic care to people with diabetes. In her current capacity, Naj collaborates closely with the NHS across all disease areas, including diabetes, to address challenges and improve patient outcomes.

Developing preventative, holistic care

Naj describes a now familiar picture of the NHS: a system burdened by resource constraints, backlogs, workforce pressure, low morale – issues that have been further exacerbated following the COVID-19 pandemic. These challenges have dominated health discourse in recent years, and were recently highlighted in Lord Darzi’s independent investigation, with political figures warning that the system will collapse without reform. In view of this fact, Naj has long advocated for a structural transformation within integrated care systems (ICSs) to enable entire care pathways to deliver care collaboratively and holistically, treating patients as a whole rather than focusing on a single diagnosis.

“The long-term goal of structural transformation is to support better integrated care and therefore a better patient experience, hopefully across the entire pathway and better working together. But it does take time for that integrated way of working to embed itself.”

ICSs were set up with the aim of improving health and care services, prioritising a focus on prevention, better outcomes and reducing health inequalities. The power of prevention in diabetes care has already been demonstrated by the NHS-funded Diabetes Prevention Programme, which has been shown to reduce the risk of type 2 developing by 40 per cent. Yet, a study by The King’s Fund has found that local systems are at risk of going ‘off-track’ due to pressures on services, intense political scrutiny, and extremely difficult economic circumstances – and the impact these conditions are having on the ability of local, regional and national leaders to act.^[3]

The challenge for ICSs is reflected in diabetes prevalence and linked co-morbidity figures, which are continuing to rise. Since 1996, the number of people with diabetes in the UK has risen from 1.4 million to more than 4.8 million and is estimated to reach 5.3 million by 2025.^[4] The challenge of a growing at-risk cohort is compounded by an ageing population, and the complexities linked with long-term diabetes management, including complications and multimorbidity cases. Recent data from the 2023 National Diabetes Audit shows that more than 3.5 million people registered with a GP were identified with non-diabetic hyperglycaemia, also known as pre-diabetes. ^[5][6]

Diabetes often “starts with one diagnosis,” explains Naj, “and then accumulates a host of other health risks and problems”. In fact, diabetes is the leading cause of blindness in working-age adults, and around 10 per cent of diabetes patients will develop leg ulcers at some point in their lives.^[7][8] Naj’s ideal vision is a model of localised care, centred on early diagnosis, better prevention and early intervention, thereby reducing the risk of these complications developing. Central to this approach is including patient perspectives to better understand their experiences. Naj also emphasises the importance of involving primary care professionals, ICS leaders, commissioners, and national policymakers in the development of multidisciplinary, holistic care pathways.

“Patients want to be treated by someone who considers the impact that disease might have on their heart, on the kidneys, on their brain, on their eyes. They say, ‘please look after me as a whole person,’ but the NHS isn’t necessarily well set up for that.”
-Naj Rotheram

Diabetes outcomes are significantly impacted by health inequality, with rates of undiagnosed diabetes being twice as high in areas in the lowest Index of Multiple Deprivation quintile compared to the top.^[9] Naj stressed the importance of harnessing and embedding data-driven insights from population health management (PHM) into diabetes care pathways to allow systems to identify, and target interventions towards, underserved communities. An example of this is the Joint Working Project between Boehringer Ingelheim Limited and Salford Care Organisation.^[10] The project aims to implement an integrated, neighbourhood-based, holistic diabetes service to address the complex needs of patients with cardio-renal-metabolic (CRM) diseases in Salford. By employing a workforce with diverse skillsets, and using data to identify individuals with the greatest needs, the project has successfully engaged communities within Salford’s population that have traditionally been reluctant to participate in healthcare.

“Utilising the insights at a very local level can help us understand the challenges affecting specific areas and allow us to develop programmes and care pathways.”
-Naj Rotheram

ICSs have a range of assets available to build more holistic, preventative diabetes care. Utilising all of general practice, community pharmacy, dental services, and optometry, primary care is in a strong position to deliver comprehensive, holistic diabetes care. However, Naj points out that current support for primary care is inadequate due to limited resources and high patient volumes – leading to a more reactive rather than a preventative approach. This means that primary care is often an underutilised preventative asset.

To remedy this, Naj advocates for greater support in terms of resources, training and action on workforce sustainability. “Primary care should feel valued; they are working on issues that matter to patients,” says Naj. “These primary care healthcare professionals are making a difference at a community level, and this long-term holistic focus is the reason why they entered the profession in the first place.” Naj also discusses the importance of supporting and valuing the workforce’s skills, by addressing discrepancies in workforce development, job reimbursement, and fair pay. An international survey has found that primary care doctors in 10 high income nations say that they are overworked, demoralised, and undervalued. ^[11]

The value of partnership

Another often underutilised asset in improving diabetes care is industry partnership. The NHS and pharmaceutical industry have an opportunity through partnership to redesign local and national pathways, enabling better collaboration for the patient’s benefit. Alongside clinical and care pathway knowledge, industry partners offer a range of practical resources and expertise relevant to NHS system ambitions, including project management, stakeholder involvement and multidisciplinary team mobilisation.^[12] Naj has been intimately involved in this work, and posits partnerships as one way of promoting ethical practices and to provide highly regulated and standardised settings in which the NHS and industry can operate. Naj believes that partnerships can help to improve trust between the NHS and industry through greater transparency regarding all parties’ actions, long-term motivations and impacts. For this reason, the NHS could rely more on the “tremendous” skills and resources that industry brings, which extend beyond just the financial resources it provides.

We need to embrace working together and pooling those skills and those resources to overcome some of the NHS challenges that we are collectively facing.
-Naj Rotheram

PPP’s Diabetes Care Programme 2024 has uncovered fascinating insights and developed vitally important recommendations to improve the delivery of diabetes care. Stakeholders and experts present across the roundtables have consistently highlighted the need to move away from treating diabetes as a single diagnosis and condition to treating the whole patient in holistic terms.

The theme of holistic care has shaped the basis of 2025 Diabetes Care Programme, Holistic approaches to diabetes care: treating the whole patient, to discuss the challenges and opportunities for a holistic approach to care that treats the ‘whole’ patient and not just their diabetes. The series will feature a set of roundtables to create insights and strategies for holistic approaches to diabetes management and long-term conditions. We will address key questions including:
• How can systems balance personalisation and population health management to ensure we get population health rights, while meeting the individual needs of people?
• What role can technology, data and digital play in reducing inequalities for those with the highest needs?
• What innovations are game changers and are they sustainable?
• How do we develop our prevention and risk strategy, to break down siloed disease working so that cardio, renal, and metabolic condition are joined-up effectively within the health and care system?
• Where are the overlaps within the multi-morbid patient population and how can we create a one-stop shop in the community?
• How significant is genetic predisposition in causing diabetes compared to dietary and environmental factors?

If your organisation would like to learn more about getting involved in this innovative programme, then please contact Ameneh.saatchi@publicpolicyprojects.com to find out more.

References

[1] https://medical.boehringer-ingelheim.com/uk/nhs-partnering
[2] https://www.boehringer-ingelheim.com/uk/human-health
[3] https://www.kingsfund.org.uk/insight-and-analysis/reports/integrated-care-systems-workforce
[4] https://www.diabetes.org.uk/about-us/about-the-charity/our-strategy/statistics
[5] https://www.england.nhs.uk/2024/06/nhs-identifies-over-half-a-million-more-people-at-risk-of-type-2-diabetes-in-a-year/
[6] https://www.endocrine.org/patient-engagement/endocrine-library/diabetes-and-older-adults
[7] https://www.cdc.gov/diabetes/diabetes-complications/diabetes-and-vision-loss.html
[8] https://www.england.nhs.uk/north/wp-content/uploads/sites/5/2018/05/NWCSN_Diabetes_Footcare_Final_Report_2017-1.pdf
[9] https://assets.publishing.service.gov.uk/media/66e1b49e3b0c9e88544a0049/Lord-Darzi-Independent-Investigation-of-the-National-Health-Service-in-England.pdf
[10] https://www.boehringer-ingelheim.com/uk/salford-crm-joint-working-summary
[11] https://www.bmj.com/content/382/bmj.p1925
[12] https://www.nhsconfed.org/publications/partnering-purpose-ICS-industry

All news

NHS-backed study shows 73% reduction in GP waiting times using AI triage system

By Integrated Care Journal

An independent, NHS-funded evaluation has validated the transformative impact of an AI-powered Smart Triage system on primary care delivery in England.

The Groves Medical Centre, a leading family GP practice in Surrey and South West London, has achieved unprecedented improvements to patient access, practice capacity and sustainable staff working patterns after implementing Smart Triage.

Smart Triage, an AI-powered autonomous patient triaging system developed by health technology company Rapid Health, was implemented at The Groves Medical Centre in October 2023. The system has transformed patient access, enabling equitable and safe care based on clinical need rather than on a first-come-first-served basis.

An independent real-world evaluation, funded by Health Innovation Kent Surrey Sussex – one of 15 health innovation networks across England – and conducted by Unity Insights, has measured the impact of autonomous patient triage between October 2023 and February 2024. The evaluation assessed the system’s acceptability, implementation, effectiveness, and impact on health inequalities.

Key findings of the evaluation include:

Patient waiting times reduced by 73 per cent, from 11 to 3 days, for pre-bookable appointments
The practice had 47 per cent fewer phone calls at peak hours, with a 58 per cent reduction in the maximum number of calls, all but eliminating the “8am rush”
Same-day appointment requests fell from over 62 per cent to 19 per cent, significantly expanding the capacity for pre-bookable appointments
70 per cent fewer patients needed a repeat appointment, having received the right care on their first visit
85 per cent of appointments booked via the new system were delivered face-to-face, a 60 per cent increase compared to the pre-implementation period
Only 18 per cent of all patient requests were initiated over the phone after the system was implemented versus 88 per cent prior to it being implemented
91 per cent of appointments were automatically allocated without staff or clinical intervention

These changes have culminated in a better overall experience for patients at The Groves Medical Centre. GPs now spend 15 minutes with patients, rather than 10 – a 50 per cent increase. Additionally, the practice has achieved an 8 per cent increase in the number of appointments delivered per working day without hiring additional staff. Patients now have a wider selection of appointment slots to choose from, with an average of 61 slots available per patient appointment request. This has resulted in a 14 per cent reduction in patient no-shows, despite the practice already maintaining low DNA (did not attend) rates.

In contrast to traditional online consultation and triage tools that only collect information, Smart Triage fully automates the patient navigation process from the initial contact with their GP practice. Whether requesting care online, by phone, or in person, patients are guided through a series of questions based on their concerns. The system then assesses their symptoms and directs the patient to the most suitable care, even enabling immediate self-booking into the right appointments. This streamlined process empowers patients to access care at their convenience while relieving the practice from direct involvement in each request. This is the first time a study has proven an autonomous clinical system is safe and effective in doing this process end to end.

Dr Andrea Fensom, GP Partner at Groves Medical Centre, remarked: “Smart Triage has completely changed how we work. It has not only optimised our resources but increased patient access. Feedback shows that patients find it easy to use our online tool and it’s convenient for them, giving them multiple options for appointments where safe to do so and booking them with the most appropriate clinician for their problem. We are all very proud of these results.”

Jake Kennerson, Group Manager at Groves Medical Centre, added, “The positive outcomes we’ve seen in such a short period are a testament to the effectiveness of this innovative system. There’s been a significant decrease in the number of patients requiring same-day appointments and wait times have been drastically reduced. All of this change was achieved during the peak winter months and without any additional staff. If others were to adopt a similar approach, it could lead to transformative results for patients and the NHS as a whole”.

Carmelo Insalaco, CEO of Rapid Health, expressed his pride in the system’s success: “We’re really proud to see the extraordinary impact of autonomous patient triage at The Groves Medical Centre. These results reflect what we consistently observe with our customers across the country – the remarkable potential for Smart Triage to dramatically enhance patient access and choice, while solving the persistent challenges of lengthy waiting lists and disruptive morning bottlenecks. We look forward to further collaboration and expansion across the wider NHS to benefit more patients and healthcare providers”.

By implementing the software, GP practices and Primary Care Networks (PCNs) can improve patient access, reduce workload, unlock capacity and manage patient demand more effectively. With better access for patients online, call volumes are reduced and peaks in demand can be smoothed out, eventually eliminating the ‘8am rush’. This ultimately enhances and automates the Modern General Practice Access Model which was introduced by NHS England last year.

Hall Green Health’s new ‘Check and Cancel’ telephony system optimising appointment management

By Integrated Care Journal

The new ‘Check and Cancel’ feature was integrated into the practice’s existing cloud-telephony system, reducing the number of missed appointments and boosting patient access to GP services.

Hall Green Health (HGH), a large family practice within the NHS Birmingham and Solihull Clinical Commissioning Group, has recently achieved substantial success with the implementation of its ‘Check and Cancel’ system within its Surgery Connect Cloud-telephony framework.

This new approach to appointment management has not only improved patient accessibility but has also significantly reduced administrative burdens and missed appointments (DNAs), a critical issue in the industry.

The need for innovation

With a patient population of approximately 28,500, Hall Green Health, like GP practices across the country, has been undertaking the long journey toward digital transformation. One of the pressing challenges faced by the practice was the inefficiency in managing appointments. Traditional methods, which often relied on phone calls during limited office hours, led to a high number of missed appointments.

According to NHS England, the financial impact of patient no-shows is substantial, with the average nine-minute GP consultation costing £42. In just one month, these missed appointments cost the NHS well over £7 million in the Birmingham and Solihull region. HGH recognised the need for a solution that would not only make appointment management more efficient but also ensure that patients who are not as digitally literate or lack digital access could still easily manage their appointments. The ‘Check and Cancel’ system was introduced in March 2024 to address these challenges head-on.

Implementing ‘Check and Cancel’

The ‘Check and Cancel’ feature was integrated into HGH’s existing cloud-telephony system, providing patients with a 24/7 service to verify or cancel their appointments. This system was designed with simplicity and user-friendliness in mind, allowing patients to navigate the call flow without needing assistance from the practice staff.

Jamal Syed, Operations Manager at Hall Green Health, described the implementation process as swift and seamless. “Within 15 minutes of working out where to put it, it was successfully set up to work with our slot types and tested ready for patients to use,” Syed noted. This quick integration was critical in ensuring that the system could start delivering benefits immediately.

Positive outcomes and impact

The introduction of the ‘Check and Cancel’ system brought about immediate and measurable improvements in appointment management at Hall Green Health. By providing patients with round-the-clock access to manage their appointments, the system significantly reduced the number of missed appointments. In July 2024 alone, 292 appointments were checked, and 92 were cancelled using the system.

The system’s impact extended beyond just reducing missed appointments. It also proved to be a valuable tool in saving time for both patients and staff. Based on average call durations, the system saved the practice approximately 10 hours and 53 minutes in July 2024. “This time-saving aspect is particularly beneficial during the morning rush when the administrative workload is typically at its peak,” Syed added.

Patient and staff satisfaction

The success of the ‘Check and Cancel’ system was not only reflected in the numbers but also in the feedback from users. Of the 26 users who reviewed the system in July, 76.2 per cent expressed their willingness to use it again, and 47.8 per cent reported that the system saved them time; with an overall satisfaction rating of 3.71 out of 5, these early results are promising.

The ability to handle appointment-related queries efficiently and independently contributed to a higher level of patient satisfaction. For many patients, particularly those unable to access digital services during regular hours, the system offered a convenient and reliable alternative. “The significant number of appointments checked and cancelled indicates that patients utilised the system effectively, potentially reducing the number of missed appointments,” said a representative from HGH.

Future prospects and conclusions

The ‘Check and Cancel’ system at Hall Green Health exemplifies the potential of digital innovations in healthcare to enhance service delivery and patient satisfaction. By automating key aspects of appointment management, the system has not only relieved the administrative burden on staff but also empowered patients to take control of their healthcare needs.

Looking forward, the architecture used to build this system provides a strong foundation for future developments. As healthcare practices continue to face immense pressures, the ability to further automate and streamline tasks, particularly those involving patient verification, will be crucial. Hall Green Health’s success with this system highlights the importance of integrating simple, user-friendly digital solutions into healthcare practices to improve efficiency, reduce costs, and enhance patient care.

The implementation of the ‘Check and Cancel’ system at Hall Green Health has not only improved appointment accessibility and reduced missed appointments but also set a new standard for how digital solutions can be effectively integrated into primary care practices and its journey provides a blueprint for other practices aiming to embrace the future of healthcare.

Pharmacy First service agreed as Recovery Plan set to launch

By Gabriel Blaazer

Negotiations have concluded around the implementation of the Pharmacy First scheme, which is now set to launch in full on 31st January 2024.

The government, NHS England, and Community Pharmacy England (CPE), which represents all community pharmacy owners in England, have reached agreement regarding the launch of the new national Pharmacy First service, set out in this year’s Delivery plan for recovering access to primary care.

CPE’s Committee unanimously accepted the proposed deal, which outlines how the £645 million investment pledged in the Delivery plan will be used to support the rollout of expanded community pharmacy services. The agreement was reached following months of negotiation between CPE, the Department of Health and Social Care and NHS England.

Public Policy Projects has recently advocated for an expansion of pharmacy services in England in its report, Driving true value from medicines and pharmacy, which was chaired by Yousaf Ahmad, ICS Chief Pharmacist and Director of Medicines Optimisation at Frimley Health and Care Integrated Care System.

It is now confirmed that the Pharmacy First services will be launched on 31st January 2024 as an Advanced Service, subject to the required IT infrastructure being in place. Under the new service, pharmacists will be able to offer advice and prescribe treatment for seven minor ailments, including sore throats, insect bites and uncomplicated urinary tract infections for women. Patients will be able to access the service without an appointment, as well as via referrals from NHS 111 and GPs.

Following consultations with pharmacists, patients with symptoms indicative of the seven conditions covered will be offered advice and prescription-only treatments where necessary, under a Patient Group Direction (PGD). CPE hopes that in the future, independent prescribers will be empowered to complete episodes of care without requiring a PGD.

As per CPE, the following stipulations have also been agreed:

The writing-off of previous funding over-delivery worth £112 million for CPCF Years 3, 4 and 5. If this money had been re-claimed from pharmacy owners over a year, it would have resulted in a reduction in the Single Activity Fee of around 10 pence per item.
Protecting baseline CPCF funding: the new money will be accessible as soon as possible rather than risk further over-delivery against Year 5 CPCF funding – the writing off of some Year 5 projected over-delivery supports this.
The inclusion of an upfront payment for of £2000 for Pharmacy First to support pharmacy owners to prepare and build capacity for the new service.
Increasing service fees to support ongoing capacity to deliver Pharmacy First, and for an uplift in fees across all services.
Reducing activity thresholds at the start of the scheme to “more achievable levels”.

The National Pharmacy Association (NPA) has welcomed the announcement, while also repeating calls for an increase in core funding for the community pharmacy contract to underpin sustainable future growth for the sector. NPA Chair, Nick Kaye, said: “We welcome this commitment to invest in a nationwide Pharmacy First service for common conditions. The new funding, whilst welcome, will not in itself solve the financial crisis in community pharmacy, but it is a substantial investment in a key service that could be a stepping stone to more.

“NHS England have put their faith in us, having seen community pharmacy successfully deliver other clinical services at scale. I’ve no doubt that pharmacies will once again deliver an impressive return on investment for the health service.

Highstreet pharmacist Boots has also welcomed the announcement pharmacy reforms. The chain announced today that it will roll out the NHS Pharmacy Contraception Service, allowing pharmacists to provide contraceptive advice and prescriptions, in the coming months. The service has already been successfully piloted in 22 stores in England.

The NHS Blood Pressure Check Service will also be expanded to most Boots stores in England, allowing pharmacists to check patients’ blood pressure and provide advice on reducing their risk of cardiovascular disease. Boots has said that the new and expanded NHS services will be good news for patients, pharmacy teams and GPs alike.

Seb James, Managing Director of Boots UK & Ireland, said: “We welcome the government’s announcement of plans to launch new contraception and minor ailments services in England, which will make life easier for patients to access the care and medicines they need quickly and help reduce GP wait lists.

“We have been working with our pharmacy teams in stores to roll out these new services to patients in England. We are already commissioned to deliver similar services for the NHS in Scotland and Wales and these are very popular with our patients and pharmacy team members.

“The free NHS blood pressure checks that we offer at most of our stores in England can save lives by spotting potential cardiovascular problems at an early stage, which also helps to reduce the burden on the NHS longer term.”

Not just for Christmas: Winter clinics a shining example of innovation we cannot overlook

By Dr Owain Rhys Hughes

Amid news that no funding is expected for community acute respiratory hubs this winter, Dr Owain Rhys Hughes explains why these are a shining beacon of innovation that the NHS cannot afford to overlook.

As winter fast approaches, the NHS is gearing up for another incredibly tough season. Waiting lists have hit a new record high of 7.8 million people and ongoing staff shortages continue to pile pressure on overstretched services. Innovation has a vital role to play in supporting the NHS to navigate these periods of intensified pressure. The winter clinics that provided lifeline support during last year’s winter months, which are yet to receive repeat funding for this year, are a shining example of the importance of such innovation – and the danger in overlooking it.

While primary care services deal with an existing backlog of appointments and referrals, the additional influx of patients expected to hit GP surgeries during the winter months – due to spikes in cold and flu complaints, for example – threatens to be overwhelming. Expanding the capacity and resources of primary, community and secondary care during this period is therefore essential. Winter clinics provided a crucial first line of defence for patients experiencing cold and flu symptoms last year. This deflected pressure from GPs and emergency services, boosting their capacity to see the patients they really needed to see.

Without initiatives like these, which facilitate the joined-up collaboration desperately needed to ease pressure on individual services and streamline patient triage, the NHS is facing a winter of unprecedented strain. A lack of capacity within primary care could leave many patients turning to A&E for support. In turn, this could place excessive pressure on secondary care, pushing up wait times for those in most urgent need of treatment.

We cannot afford to overlook the vital necessity of innovation that can unlock and support more collaborative care delivery and boost clinical capacity where it is needed most.

Winter clinics are just one example of the value and potential of such innovation during times of excessive pressure and need. There is a wealth of holistic and tech-powered solutions offering the tools for wider collaboration and more effective clinical communication. Harnessing these is essential to providing the infrastructure and support needed to ensure that the NHS can continue delivering exceptional levels of care amid growing strain.

Streamlining referrals into secondary care and introducing new sites for care delivery and diagnosis is a key way in which innovation is helping to do this. The rapid rollout of Community Diagnostic Centres (CDCs) across the health service is providing additional capacity and working to help reduce the number of patients being sent into secondary care for diagnostic tests and consultation. This is not only helping to diagnose illnesses such as cancer sooner, but is also allowing for triage to a wider range of services, ensuring only those who really need to be seen in urgent care are sent into hospital.

Another way in which diagnosis and referrals are being streamlined to free up capacity is through the introduction of digital advice and guidance. The use of digital tools to connect clinicians across different services can enable GPs and community clinicians to contact specialist consultants in real-time. This allows for advice and guidance to be easily and securely shared, and joint referral decisions to be made. As a result, the number of unnecessary referrals into secondary care can be reduced. Meanwhile, patients can be triaged to the most appropriate form of care sooner, avoiding repeat referrals and additional admin for GPs, boosting their capacity to spend with patients.

In my role at Cinapsis, I’ve seen this have an incredibly positive impact. Through our work in Norfolk and Waveney, for example, we’ve seen the use of digital advice and guidance reduce the wait time for specialist advice from 50 weeks to just 48 hours. This benefit has a knock-on effect by reducing the number of patients entering secondary care when they don’t need to. It also saves GPs time previously spent on copious admin and processing unnecessary referrals, freeing them up to see a higher number of patients.

As each new winter brings a fresh wave of increased pressure on our NHS, we must do everything we can to brace for and reduce the strain it puts services under. We cannot remove this pressure altogether; but we must embrace innovation wherever possible to facilitate the cross-service collaboration and vital communication needed to help clinicians unlock capacity and manage heightened patient demand.

Dr Owain Rhys Hughes, Founder and CEO, Cynapsis

Pioneering diabetes prehab service launches in Wirral

By Integrated Care Journal

Service uses population health data to identify those most at risk of having surgery postponed

One Wirral CIC, a non-profit community interest company that proactively helps to bridge gaps in health services and support for local communities, has launched a ground-breaking diabetes prehabilitation service to reduce surgery postponements, tackle waiting lists, and improve postoperative outcomes for patients. The service uses population health tools and analysis of hospital waiting lists to identify and support those most at risk of having surgery postponed.

Since April 2023, the service has supported two Primary Care Networks – Moreton and Meols PCN and North Coast Alliance PCN, funded by the North West Coast Clinical Networks. However, the service will now be extended across Wirral to all Primary Care Networks. The goal is for the approach to be adopted nationally.

The diabetes prehabilitation service uses the Cheshire & Merseyside Combined Intelligence for Population Health Action (CIPHA) population health management system, on Graphnet Health’s CareCentric platform. CIPHA surgical waiting lists at Wirral’s Arrowe Park Hospital are used to identify diabetic patients who are awaiting surgery and have a HbA1C (hemoglobin A1C – a test commonly used to diagnose diabetes and prediabetes) over 69mmol/mol or a BMI above 40.

The early identification of patients at risk of having their surgery postponed removes the need for GP surgeries to make referrals. The service also receives referrals directly from secondary care, for people that have had their surgery postponed, and have diabetic risk factors.

Once identified, patients are contacted within 48 hours and booked in for an appointment with a diabetes prehabilitation health coach, in a local community setting, such as a library. If a person’s HbA1c is over 69, they are automatically booked in for an appointment with a diabetes specialist nurse, who will look at medicines management and optimisation. Once they have seen the health coach and nurse, they commence a personalised prehabilitation lifestyle plan, which they follow up until surgery, whether that is a matter of weeks or months.

Lucy Holmes, Wellbeing Lead at One Wirral CIC, explained: “The population health and data-driven approach means we are able to contact the right people at the right time and give them the best intervention before their procedure, without anyone slipping through the net. We look at their lifestyle and they’re encouraged to participate in activities, including the free diabetes exercise sessions that are held in the community each week. Their medications are also assessed. It means we’re looking at a person from a holistic point of view, not just clinically and not just non-clinically. It’s a true community-based, multi-disciplinary team approach.

“We’re so pleased to be able to roll this out across Wirral, but it’s an approach that could easily be lifted and shifted. We would love to see it adopted nationally, because we have seen the many benefits of getting people fit before surgery.”

Dr Dave Thomas, Wirral Diabetes GP Lead, added: “With diabetes, we know that if someone is living with excess weight or their sugar levels are very high, then that comes with additional surgical risks, higher complication rates, they’re more likely to have a longer hospital stay, and they’re more likely to generally have a poorer outcome. So, a service where we’re getting people fit and healthy, and optimising their diabetes care prior to their operation can only benefit the patients. From a Wirral-wide point of view, it’s going to help reduce surgical waiting times, reduce complication rates, and it will allow us to reduce hospital stays.

“This really is a fantastic service. We haven’t seen anything like it anywhere else, which is really exciting and hugely positive for the patients that we’re supporting.”

To hear more about the benefits of the diabetes prehabilitation service, please click the video link: Wirral Diabetes Prehabilitation Service | How It’s Changing Lives.

New report from PPP calls for a pharmacy-led transformation of health and care

By David Duffy

PPP’s report stresses the need to support and empower the pharmacy sector and align its priorities with system-level health and care objectives.

A new report from PPP calls on integrated care systems (ICSs) to harness the unique capabilities of the pharmacy sector and implement a pharmacy-led transformation of health and care delivery. The report was launched at PPP’s ICS Delivery Forum event in London on Wednesday 1st of November 2023.

The report, Driving true value from medicines and pharmacy, is chaired by Yousaf Ahmad, ICS Chief Pharmacist and Director of Medicines Optimisation at Frimley Health and Care Integrated Care System, and is the culmination of three roundtable events attended by key stakeholders from across the pharmacy sector and ICS leadership. Insight from these roundtables has also been accepted as evidence in the Health and Care Select Committee’s recent inquiry into the future of the pharmacy sector.

Emphasising the connectedness of pharmacy and local communities, the report calls for the value of pharmacy to be recognised beyond its potential to produce financial savings, and emphasises the need to leverage its diverse workforce, locally situated premises and unique patient knowledge in the delivery of system-level priorities.

It also concludes that the pharmacy profession must better articulate its value to constituent parts of ICSs, and that they require support to develop their voice, vision and leadership to meaningfully contribute to the delivery of integrated care. The report suggests that to enable this, primary care network (PCN) leadership must become more diverse to include the representation of pharmacy, and that pharmacy ambassadors should be expanded upon to provide inspiration to new recruits.

The report recommends that the NHS undertake regular regional reviews of the impact of the Additional Roles Reimbursement Scheme, so as to ensure that the local pharmacy workforce is not unnecessarily depleted while ensuring effective support for general practice. The report also calls for ICSs to establish more effective pharmacy leadership development programmes to enhance the sector’s influence at system level.

The report outlines major barriers to the progression of the pharmacy sector, including workforce pressures, outdated IT infrastructure and contractual mechanisms that hamper efforts at major reform. Although noting that the government has set out to address issues around workforce and digital maturity via the NHS Long Term Plan and the Delivery Plan for Recovering Access to Primary Care, it argues that ICSs have the power to go further by shifting to integrated, outcomes-focused contractual models. These, the report says, would enable the community pharmacy sector to focus on improving health outcomes and addressing health inequalities in partnership with wider primary care service provision.

Left to right: Ursula Montgomery, Michael Lennox, David Tamby Rajah, Yousaf Ahmad.

Driving true value from medicines and pharmacy has been published in the week after the government published its response to the Health and Social Care Committee’s expert panel on the evaluation of the government’s commitments to pharmacy in England. In its response, the government didn’t recognise the expert panel’s overall rating of ‘requires improvement’ as being reflective of progress to date, but stressed its commitment to enabling pharmacy to maintain a central role in the NHS.

Report chair Yousaf Ahmad, ICS Chief Pharmacist and Director of Medicines Optimisation, Frimley Health and Care Integrated Care System, said: “This report underscores the critical linkage between medicines optimisation and integrated care. While cost savings are a compelling aspect of effective medicines optimisation and of pharmacy, the true value of medicines and the pharmacy team encompasses the entirety of health and care delivery.”

The National Pharmacy Association’s (NPA) Local Integration Lead, Michael Lennox, said: “As one of the stakeholders involved in the development of this report, the NPA welcomes its publication.

“You can draw a straight line from key NHS reports like Fuller and Hewitt to this excellent new document about engaging community pharmacy in integrated care systems,” Mr Lennox said. “The NPA has been involved in all of these strategically significant reports and our recently published prospectus for future services features prominently in this latest document.

“This report has some useful recommendations for NHS England, including that the impact of the Additional Roles Reimbursement Scheme is placed under constant review for each region, ensuring that the local community pharmacy workforce is not unnecessarily depleted. There are challenges for pharmacy leaders too, for example, the need to focus on improving health outcomes in partnership with the wider primary care team.”

David Tamby Rajah, Pharmacy Consultant, Community Pharmacy South West London, said: “This report reiterates the key role pharmacy can play in the newly introduced ICSs, the importance of successfully integrating community pharmacy, and the value of pharmacy to the NHS Primary care recovery plan, medicines optimisation, and their connection to local communities.

“The importance of population health management to pharmacy is highlighted as we plan for the future. This is the right time for all pharmacy sectors to have a joined-up conversation and seek further collaboration to support the challenges the NHS now faces.”

The full report can be downloaded here.

New report highlights how pharmacy can redefine role within NHS

By Integrated Care Journal

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:

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

Pharmacies could free up more than 30m GP appointments, Company Chemists’ Association says

By Gabriel Blaazer

Report calls on government to “go further and faster” in giving more capability to pharmacy to prescribe prescription-only medicines and reduce pressure on general practice.

A new report from the Company Chemists’ Association (CCA), whose members include Asda, Boots, LloydsPharmacy, Morrisons, Rowlands Pharmacy and Superdrug, has urged the government to be bolder in its plans to expand pharmacy services, announced in May as part of its Delivery plan for recovering access to primary care.

Included within the Department of Health and Social Care’s (DHSC) plans is £645m to enable the expansion of pharmacy services in England over two years, intended to help relieve pressure on GPs – including an approach it dubs Pharmacy First.

This includes ambitions for community pharmacies to be able to supply prescription-only medicines for seven minor health conditions (Pharmacy First), increase their provision of the oral contraception and blood pressure testing services, and the delivery of improved IT system connectivity between general practice and community pharmacy in England.

The measures are expected to free up an additional 10 million GP appointments per year once scaled – equivalent to around 3 per cent of all appointments – but the CCA have urged the government to move faster and be “bolder” in their plans and accelerate plans to train pharmacists in England to act as ‘independent prescribers.

By their own estimates, the CCA expect the plans for Pharmacy First will free up around 6m appointments annually. They estimate that a more ambitious Pharmacy First service could free up 30m+ GP appointments per year, five times as many as in the government’s current plans.

In their new report, Pharmacy first and independent prescribing, the CCA argue that giving community pharmacy additional capability to supply non-prescription medicines and additional prescription-only medicines is a necessary and urgent step.

“There are an estimated 23,000 pharmacists currently in England without independent prescriber qualifications. A simple extrapolation of the plans currently in place indicate that it will take until 2040 to train the entire workforce. We need 95 per cent of community pharmacists to be trained as independent prescribers by 2030,” said Malcolm Harrison, Chief Executive of the CCA.

The CCA argue that their recommendations would effectively create 11,000 urgent care centres in England. With an estimated 90 per cent of the population located within a 20-minute walk of a local pharmacy, they believe that a “Pharmacy First” approach could transform access to care and help address under-provision of clinical services in certain areas. They say, for example, that “ambitious commissioning could position pharmacies as the ‘go-to’ place for urgent and emergency care”.

Alongside the expansion of prescribing capabilities and certain clinical services, the CCA are also calling for:

A fairer funding framework for community pharmacies. Community pharmacy is chronically underfunded. The current annual funding shortfall equates to more than £67,000 per pharmacy in England. The funding announced in the recent Delivery Plan is new money for new activity and does not address the historic underfunding of the sector.
A bold approach to harnessing Pharmacist Independent Prescribing. All pharmacists registering after 2026 will be independent prescribers (IP). There are an estimated 23,000 pharmacists currently in England without IP qualifications. Under current plans, it will take until 2040 to train the entire workforce.
A flexible and future-looking legal and regulatory framework that enables pharmacists and pharmacies to deliver and safe and effectively of medicines and to provide appropriate clinical care directly to patients.

Malcolm Harrison added: “Government plans to rollout Pharmacy First are welcome, but are only a drop in the ocean. Under current plans, pharmacies are expected to free up 6m GP appointments annually – but our analysis shows pharmacies could do five times this number.

“Action to address the historic underfunding of pharmacies and a roadmap to utilise the clinical skills of pharmacists are essential to achieving this. The Covid-19 vaccination programme showed what pharmacies can do when the Government places its faith and investment in pharmacies. An investment in community pharmacy is an investment in greater capacity for the NHS, enhanced resilience in primary care and better patient outcomes.”

A spokesperson for DHSC said: “Community pharmacies play a vital role in the NHS and we are providing them with an additional £645m investment that could free up as many as 10m GP appointments a year. This is on top of the agreed annual £2.6bn of funding set out in the pharmacy framework.

“We are also taking a range of actions to modernise and enable better use of resources and automation, allowing pharmacists to provide more care for patients.

“We are working closely with NHSE and Community Pharmacy England to launch Pharmacy First by the end of 2023 and will share an update on timings shortly.”