Transcript presentation - Guild of Healthcare Pharmacists

Guild of Healthcare Pharmacists and
United Kingdom Clinical Pharmacy Association
11th Joint National Conference
Lifting the Lid: Facing the difficulties of
maintaining and enhancing standards
The Queens Hotel, Leeds
Friday 15th to Sunday 17th May 2015
Guild of Healthcare Pharmacists and
United Kingdom Clinical Pharmacy Association
How should pharmacy provide a 7 day service?
Ursula Gotel
GHP Regional Representative - London & Eastern
Highly Specialist Pharmacist – Emergency Medicine
Martin Pratt
GHP Regional Representative - West Midlands
Director of Pharmacy
The Guild of Healthcare Pharmacists exists to defend the interests of its individual members, in the workplace,
in negotiation and through prompting innovation and advancement of pharmacy practice
www.ghp.org.uk
Learning Outcomes
By the end of this session you should be able to:
1. identify the costs of implementing a 7 day service
2. debate the HR requirements and implications in changing to a 7day service
3. appraise the potential service improvements delivered by a 7day
service and ways to measure and quality assure these
The Guild of Healthcare Pharmacists exists to defend the interests of its individual members, in the workplace,
in negotiation and through prompting innovation and advancement of pharmacy practice
www.ghp.org.uk
Background
In 2012 the coalition government set out a £20billion savings target - Nicholson
Challenge
7 day NHS services required…
 last 10 years has seen 37% rise in hospital attendance
 older patients, more co-morbidities
 patient care outside of ‘normal working hours’ system/staff focused
 not patient focused
 weekends pose particular problems, weekday evenings/nights too
NHS England Seven Days a Week Forum – high quality care 7/7
 10 clinical standards – urgent and emergency care
 need for change is ‘compelling’
 … but with current unsocial hours payments is financially unsustainable….
RCP Future Hospital Commission recommends
hospital services deliver high quality care sustainable 24-7
Trust launches Healthy Heros
Trust board announces introduction of 7-day pharmacy service
you have A&E with PAMI but not trauma services
Your current service includes
• Clinical
• Dispensary
• Formulary and Medicines information
• Governance and Safety
• On-call
• Out-patients (not outsourced)
• Pharmacy manufacturing unit
• Stock and Distribution
Q: What services / tasks do
you need to provide 7days a week?
Healthy Heros
7- day pharmacy service
The Trust Board want you to introduce the 7-day service
with zero additional cost
Q: What is your response?
Q: What are your reasons / what is the evidence?
RPS: 7 Day Services in Hospital Pharmacy
Services need to deliver optimum medicines management & patient focused care
Variability outside of normal working hours…. particularly weekends
 increased in missed doses
 prescription errors
 lack of medicines reconciliation
 delayed discharge due to waiting for discharge medication
Move to 7 day pharmacy services meeting May 2014 – 4 themes
1. Joining up hospital and community pharmacy services
2. Pharmacy workforce and ways of working
3. Targeting where to deliver seven day services
4. Affordability and building a case at organisational level
Progress requires
 context driven service change i.e. based on local need
 sharing experience, tools and tactics
 engaging with networks
 strong leadership
Organisations with 7-day service
Most hospitals have a 7-day service for supply, expansion needed in other
areas
• Guy’s and St Thomas: Jan 2014
 new Medicine & Surgery clinical pharmacy service
 extended Operational services
• Sunderland: Mar 2015
 integrated medicines management
 weekday - ¾ pharmacist per ward, ½ technician
 IMM DH, MR, discharge (all Rx changes identified & GP informed)
 funded from CCG - £0.75M
Weekend – adm & discharge, 50% usual work, so staffed 50%
• Kings College London, PTWR (med) & MAU (4hrs) Sat & Sun
• RPS cases - Birmingham Children's, Central Manchester University
Hospital, Cambridge, Walsall
Clinical services have been expanded… some technical services too…
Organisations with 7-day service
How did they do it?
• time preparing the ground
• winds of change
• willingness of staff
Engage and consult with staff …..
…..is it management vs. staff OR management & staff?
Q: Change management policy – what’s yours?
very important as leads to level of consultation required with staff….
Change management policies
In response to a need for change Management should consider:
 The risks, sensitivities and implications of the change, i.e. whether it is Minor* (no effect of
T&Cs or job losses) or Major* (significant impact on T&Cs and / or likely to result in a
workforce reduction)
 Gaining provisional authorisation from Senior Management
 Involving HR / Staff Representatives / Other relevant parties (e.g. Patient groups)
Major change
Consider HR advice
& refer to Trust
Guidance on
Consultation
templates
If staff oppose the
change
Formal consultation paper
(Refer to HR Manager, Senior
Management & Trust Guidance
on Consultation templates)
Minor change
Informal consultation
(Discussions with staff & local staff representatives)
 Agree in partnership the process for
implementation
 Involve staff at the earliest opportunity
 Allow time for staff to consider options before
implementing any changes
 Retain notes of any discussions & confirm
arrangements in writing
Copies of consultation document
to Staff Side Chair (1 week in
advance of formal consultation)
(To review the consultation paper, consider
Staff side feedback & agree the consultation
process)
End of consultation
Meet with staff to launch period
of consultation (This is usually 30
(Consider feedback from affected
GSTFT Organisational Changestaff
Policy
and Procedure
3: Trust
Consultation Flowchart
& review
this againstAppendix
the
daysChange
& furtherManagement
individual meetings
original proposal)
should be offered to staff during it)
Staff Consultation
Guy’s and St Thomas’ consultation documents
• Clinical Services
• Operational Services
Q: What do you think were the most important issues for staff?
Formal response to consultations
Important areas
1. Rosters – Frequency? Q: how will you roster the 7-days, how will this
affect part-time staff?
2. Flexible working request – circulate example Q: what is your policy?
How will you manage it when a member of staff asks not to work
Sundays?
3. Annual leave – Staff member requests leave for a rostered weekend Q:
how will you manage requests for rostered weekends?
4. Pensions – are supplements pensionable Q: how will this affect my
pension if I work 37.5hrs over 5 or 7 days?
5. Equality impact assessment – Q: who will do this, why is it important?
References from this page taken from Master Reference / Resources
Service Evaluation
Business planning….
Q: What will be improved?
Q: What will you measure?
Health effects of working shifts
Effects
• Biological – circadian rhythm, GI, CV effects
• Psychological - sleep & stress
• Individual - family & social life
All workers potentially at risk, higher risk groups
• young & old
• Pregnant
• pre-existing health conditions (e.g. diabetes)
Increasing link to excessive risk of Ca ( risk of breast Ca = cat 2A carcinogen)
How will this affect your service
• Sustainability
• Recruitment and retention
• Will you still love me when I’m 65?
The Guild of Healthcare Pharmacists exists to defend the interests of its individual members, in the workplace,
in negotiation and through prompting innovation and advancement of pharmacy practice
www.ghp.org.uk
Learning Outcomes
By the end of this session you should be able to:
1. identify the costs of implementing a 7 day service
2. debate the HR requirements and implications in changing to a 7day service
3. appraise the potential service improvements delivered by a 7day
service and ways to measure and quality assure these
The Guild of Healthcare Pharmacists exists to defend the interests of its individual members, in the workplace,
in negotiation and through prompting innovation and advancement of pharmacy practice
www.ghp.org.uk
References and Resources
1. NHS terms and conditions of service Amendment Number 35, Mar 2015
http://www.nhsemployers.org/~/media/Employers/Documents/Pay%20and%20reward/AfC_tc_of_service_handbook_fb.pdf
2.Evidence for the NHS Pay Review Body, Dec 2014
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/393071/DH_Evidence_to_NHSPRB.pdf
3. Seven Day Services in Hospital Pharmacy: Giving patients the care they deserve, Aug 2014
http://www.rpharms.com/support-pdfs/rps---seven-day-report.pdf
4. Chapman C. The seven-day challenge 2014
http://www.pharmaceutical-journal.com/publications/clinical-pharmacist/pharmacists-must-prepare-for-new-ways-of-working-in-the-seven-daychallenge/20065814.article
5. The Kings Fund. The NHS Productivity Challenge May 2014
http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/the-nhs-productivity-challenge-kingsfund-may14.pdf
6. Sonnetag S et al. Exhaustion and lack of psychological detachemnt from work during off-job time: moderate efects of time pressure and leisure experiences,
2014
https://www.researchgate.net/publication/260873755_Exhaustion_and_Lack_of_Psychological_Detachment_From_Work_During_OffJob_Time_Moderator_Effects_of_Time_Pressure_and_Leisure_Experiences
7. NHS services, Seven Days a Week Forum Summary of Initial findings, Dec 2013
http://www.england.nhs.uk/wp-content/uploads/2013/12/forum-summary-report.pdf4
8. Quality and Safety Programme Urgent Care. London Quality Standards, Feb 2013
http://www.londonhp.nhs.uk/wp-content/uploads/2013/03/Urgent-care-standards_FINAL-Feb2013.pdf
9. Weekend hospitalization and additional risk of death: An analysis of inpatient data 2012
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3284293/
10. Society for Acute Medicine 4 day Weekend Survey. Society for Acute Medicine, Mar 2011
http://www.acutemedicine.org.uk/index.php?option=com_content&view=article&id=86:four-day-weekends&catid=2:news&Itemid=10
11..The Nicolson Challenge’ Public Expenditure Health Committee Contents – 5 Healthcare 2010
http://www.publications.parliament.uk/pa/cm201011/cmselect/cmhealth/512/51208.htm
12. Aylin, P et al: Weekend mortality for emergency admissions, Jan 2010
http://qualitysafety.bmj.com/content/early/2010/01/22/qshc.2008.028639.full
13. NICE/NPSA. Technical patient safety solutions for medicines reconciliation on admission of adults to hospital. DoH Dec 2007
http://www.npsa.nhs.uk/corporate/news/guidance-to-improve-medicines-reconciliation/
14. Harrington JM. Health effects of shift work and extended hours of work, 2001
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1740027/pdf/v058p00068.pdf
Unite factsheet: Equality Impact Assessments (JN5658) HB270213
http://www.unitetheunion.org/afc
Unite Health and Safety Briefing Shift work and night work 2013
http://www.unitetheunion.org/uploaded/documents/ShiftandNightWork%2011-4950.pdf
Health and Safety Executive. Working Time regulations
http://www.hse.gov.uk/contact/faqs/workingtimedirective.htm
The Guild of Healthcare Pharmacists exists to defend the interests of its individual members, in the workplace,
in negotiation and through prompting innovation and advancement of pharmacy practice
www.ghp.org.uk