1. NHS reforms and impact on Pharmacy

2. Objective Update on the NHS reforms and Public Health and Education Landscapes Outline new structures, organisations and relationships

3. Nicholson Challenge QIPP Care Pathways Outcomes framework Integration Information Health Budget=£80bn NHS = £60bn Prescriptions & Meds = £12bn Public Health =£4bn Education = £4bn National Commissioning Board Public Health England Commissioning Sectors (4) Clinical Commissioning Groups (>200) Field Force Teams (20) Local Professional Networks (20) Health & Wellbeing Boards (152) LETBs (15-25) Clinical Senates (15) Clinical Leaders Networks (?) Liberating the NHS; Equity and Excellence Public Health; Healthy Lives, Healthy People Social Services; Funding of Care Health & Social Care Bill Liberating the NHS: Developing the Healthcare Workforce PolicyStructure StrategyFunding ©PharmacyVoice September 2011 Key drivers of reform

4. National Commissioning Board Clinical Senates Public Health England Commissioning Sectors (4) Field Force Teams Local Professional Networks Clinical Commissioning Groups Local Authorities Health & Wellbeing Boards SHAs (10) PCTs (151) Monitor Clinical Leadership Networks NHS Foundation Trusts LPCs (84) LOCs (82) LDCs (90) Government Secretary of State for HealthSecretary of State for Communities and Local Government PCTs Clusters (50) GP Practices LMCs (100) Healthwatch England Health Education England CQC Authorisation process Direct relationship Advising/influencing To be abolished 2013 © PharmacyVoice January 2012 LETBs

5. Public Health England

6. Education and Training System 6

7. Commissioning environment 7

8. Commissioning pharmacy services Public healthNHSSocial care  Smoking cessation  Weight management  Early diagnosis of cancer  NHS Health Checks  Needle exchanges  Sexual health- EHC  Screening – pregnancy testing, Chlamydia  Dispensing medicines  Overseeing medicines compliance  Long term conditions management  Medicine Use Reviews (MURs)  Self-care patient support  Supplementary prescribing  Primary care navigation  New medicines service  Medication reviews  Nutritional support  Palliative care  Support for care at home

9. Development of NHS Commissioning Board NCB NHS North Field Force Teams LPNsNHS South Field Force Teams LPNsNHS East Field Force Teams LPNsNHS London Field Force Teams LPNs

10. The LPN and their supporting networks would also coordinate input and engagement with all providers and performers locally Core Clinical Commissioning Team (commissioning managers, clinical quality and network leaders, public health) Local clinicians (‘pool’ of clinical expertise for ‘task and finish’ projects, quality improvement, pathway re- design, strategic development and planning) All primary care providers (influence, communications, roll out, embedding) Relationship with the NHS CB through local teams Clinical engagement and leadership Local variation where justified by health needs Consistency in approach to commissioning

11. We envisage LPNs working as an integral part of the NHS CB field force, developing close working relationships with CCGs and HWBs Health & Wellbeing Boards Clinical Commissioning Groups Strategy, policy, contract, procedure and assurance of achievement of outcomes Implementation and development plans to reflect local circumstances Local intelligence, clinical expertise, innovation and development of integrated care pathways Peer support, peer review and benchmarking Maximising performance NHSCB national NHSCB local Local professional networks Informing needs, demand, supply in primary, community and secondary care Aggregation of need and assurance of performance LETBs

12. Specific functions where pharmacy local professional networks could add most value to commissioning locally To ensure local implementation of NHSCB Medicines Optimisation strategy where it relates to pharmaceutical services Improving and Assuring Quality Develop PNA in partnership with local H&W Boards and develop and implement strategy to ensure identified needs are met Planning and Designing Local Care Pathways and Pharmaceutical Services Clinical and Professional Leadership and Engagement

13. Specific elements to be tested over the coming months include: Structure and size Functions and scale of delivery Cost and value Relationships with local health economy and HWBs Cultural change Manager/clinician partnerships Practicalities of setting one up – appointments process, engagement, arrangements Incentives to engage Conflicts of interest and how to overcome Clinical capacity and capability and any development needs

14. Key milestones 1407/06/2016

15. Engaging stakeholders

16. Local Professional Networks PharmacyDentistryOptometry Local Professional Committees LPCs (84)LDCs (130)LOCs (88)