1. Medicines Optimisation and Improving Inhaler Technique through Community Pharmacy
Dipesh Raghwani and Peter Marks
PM to introduce everyone and domestics etc and let’s have an ice-breaker

2. What the session will cover:
Welcome and Introductions
Presentation 1: Medicines optimisation in COPD/ Asthma
Opportunities for Community Pharmacy
Service outline and service specification
Roles and responsibilities
PharmOutcomes
Resources
Workshop exercise:
In-Check and Inhaler devices – Demonstration – table top exercise
Presentation 2: How to make the most of the service - delivery support
Relationship to the quality payments
Top tips for delivery – Make this a successful service
Utilisation of the wider pharmacy team
All attendees will have full service spec
Someone (Lou?) to go through roles/must dos etc

3. Introductions Background Role at GMLPC Housekeeping Mobile Phones
Background
Role at GMLPC
Housekeeping
Mobile Phones
Feedback
There ae post-it notes on all your tables. Please write down your questions as we go along and save them for the Q&A session at the end

4. Principles of Medicines Optimisation
There ae post-it notes on all your tables. Please write down your questions as we go along and save them for the Q&A session at the end

5. Opportunities in CP NMS MUR (tMUR, dMUR) Inhaler Technique
NMS
MUR (tMUR, dMUR)
Inhaler Technique
Flu vaccination (including carers)
Smoking Cessation
Public Health Interventions
DoC Services
Building Loyalty
There ae post-it notes on all your tables. Please write down your questions as we go along and save them for the Q&A session at the end

6. Opportunities with COPD
There ae post-it notes on all your tables. Please write down your questions as we go along and save them for the Q&A session at the end

7. Opportunities with Asthma
There ae post-it notes on all your tables. Please write down your questions as we go along and save them for the Q&A session at the end

8. There ae post-it notes on all your tables
There ae post-it notes on all your tables. Please write down your questions as we go along and save them for the Q&A session at the end

9. There ae post-it notes on all your tables
There ae post-it notes on all your tables. Please write down your questions as we go along and save them for the Q&A session at the end

10. Improving Inhaler Technique through Community Pharmacy Service
There ae post-it notes on all your tables. Please write down your questions as we go along and save them for the Q&A session at the end

11. Service Description Pharmacist review with patient only
Pharmacist review with patient only
The pharmacist will assess disease control, inhaler technique and provide health promotion information
Eligible patients follow up review 6-8 weeks later.
Face to face service in the pharmacy
Recording on PharmOutcomes
There ae post-it notes on all your tables. Please write down your questions as we go along and save them for the Q&A session at the end

12. Service Outline

13. Service Outline

14. Service Outline Payment
A payment of £10 will be made on completion of the initial assessment and a further payment of £7 on completion of the follow-up. A minimum of 5 consultations must be completed before the first payment is made.
A £10.00 payment will be made on completion of the initial assessment and a further £7.00 payment will be made on completion of the follow up, if clinically necessary. However payment will only be made once the pharmacy has completed an initial 5 consultations in full. No payment will be made if the required information has not been recorded on PharmOutcomes.
Pharmoutcomes will generate the invoices for payment.
Payment shall be made by BCAS.

15. Roles and responsibilities
Training requirements:
All pharmacists providing the service are to self-declare their competence using the ‘Declaration of Competence for Improving Inhaler Technique through Community Pharmacy’ available at Pharmacist should ensure they re-accredit in line with the requirements of the ‘Declaration of Competence’. This is usually every three years.

16. Resources and podcasts
Visit our website!
The GMLPC website holds a list of resources you can utilise to deliver this service effectively. We have included this information in your training pack. You can look us up on:
Greater Manchester LPC:
Podcasts
In addition there are podcasts available and these can be found here: (it is the 1st hit)
Tell the website addresses and where on the website this is.
Podcasts—please write down “Greater Manchester Inhaler Technique” and it is the 1st hit. We will send pharmacies stickers with this on to give to patients. Advie to stick on asthma/COPD management plan

17. Resources and podcasts
A number of podcasts are available – The links are available on our LPC website
MDI, Autohaler, Accuhaler, Easibreathe, Easyhaler, Turbohaler, Small & Large volume spacers  
Respimat
Breezhaler
Ellipta
Novolizer
Handihaler

18. Resources and podcasts
You will also find additional information and resource on the LPC websites from the following:
Nice Guidance
BTS Guidance
GMMMG
Charities including: Please check their websites
British Lung Foundation
Asthma UK
Smoke free
Cancer Research UK
Be Clear on Cancer
Websites:
Patient.co.uk – Asthma
Patient.co.uk – COPD

19. Workshop Exercise

20. Workshop Exercise Demonstration of basic types of inhalers
Time for you to get involved with hands- on practice!
DON’T BE SHY
Demostrate MDI (gentle & deep) and Accuhaler (forceful & deep) Emphasie that with an MDI, it does the work for the patient, where as with DPI the patient does all the work.
Which of the new inhalers would you like us demonstrate—please practice at your table.
It is an important part of this service that when appropriate, the pharmacist will advice the patient’s GP of a more appropriate device.

21. Recap You should be aware how to use: In-Check Dial Inhaler devices
Various available resources
Demostrate MDI (gentle & deep) and Accuhaler (forceful & deep) Emphasie that with an MDI, it does the work for the patient, where as with DPI the patient does all the work.
Which of the new inhalers would you like us demonstrate—please practice at your table.
It is an important part of this service that when appropriate, the pharmacist will advice the patient’s GP of a more appropriate device.

22. How to make the most out of the service

23. How to make the most out of the service
Involve the whole pharmacy team in identifying patients
Make sure that you have all your resources ready
For the 1st time we have agreement from the NHS to use the whole team…counter staff will be helping to recruit Patients.
We need your help to prove that OUR profession can deliver services that improve patient outcomes

24. Relationship to Quality Payments
The Greater Manchester Inhaler service links well to the Quality Payment around Asthma referral.
What’s required The Quality Payments guidance states:
“On the day of the review, the pharmacy can show evidence of asthma patients, for whom more than 6 short acting bronchodilator inhalers were dispensed without any corticosteroid inhaler within a 6 month period, are referred to an appropriate health care professional for an asthma review.”
You can claim 10 points at both review dates but if you didn’t claim 10 points at 28th April 2017, you will miss out on them; you cannot claim 20 points at 24th November instead.
Income available 2 x 10 = 20 Quality Payments points i.e. £1,280.

25. Top tips for successful service delivery
Whole team involvement
Prepared paperwork
Have a good system for follow-up
Identify your challenges and be prepared to address them
All apply even if you do not deliver the service directly
Use MUR/ NMS top tips PSNC

26. Top tips for successful service delivery
Challenge 1: My patients say they don’t want these services
Patients may be reluctant to receive services for a variety of reasons, including lack of time or feeling that they don’t need help beyond that given by their GP. Try some of the following:
Don’t force it
Go beyond the GP - explain how services support GPs’ work
Think about your terminology: many patients will be receptive to the offer of "a chat about medicines" but may be put off by words like "service" and "review".
Use prompts: consider using patient queries or even planned GP reviews as triggers to offer services,
e) Sell the benefits: emphasise the potential benefits of services
Use MUR/ NMS top tips PSNC

27. Top tips for successful service delivery
Challenge 2: I’m too busy to stand at the counter looking for patients!
Utilise your whole team!
Make the most of your PMR system: many PMR systems can flag patients who are likely to be eligible for the service
Organise training: Ensure your staff are fully briefed
Use MUR/ NMS top tips PSNC

28. Top tips for successful service delivery
Challenge 3: How can I reach patients who don’t collect their own medicines?
Take-home materials: Have materials ready for patients to take home
Be flexible: Ensure you are open to communicate in various ways – Text, , phone etc
Use MUR/ NMS top tips PSNC

29. Top tips for successful service delivery
Challenge 4: How can I balance unpredictable workloads with consultations?
Plan your days: booking calls and appointments for times when the pharmacy tends to be less busy and use your wider team
Work in time slots: if you are agreeing to call a patient, ask for convenient time slots (e.g. 5-7pm) rather than a specific time
Be flexible: Ensure there is always someone able to provide the service
Use MUR/ NMS top tips PSNC

30. Top tips for successful service delivery
Challenge 5: My patients forget appointments and don’t answer the phone!
Remind them: giving patients an appointment card or other written reminder of their planned consultation can be helpful
Embrace technology: if patients have requested a call at a certain time or booked a follow up appointment, you could remind them about this beforehand with an or even a text message.
The right number: Ensure you have the right contact details and more than one way of getting in touch
Use MUR/ NMS top tips PSNC

31. Top tips for successful service delivery
Challenge 6: My local GPs just aren’t interested in these services
GPs are often difficult to win over when it comes to pharmacy services, sometimes because they’re under too much pressure to be interested, and sometimes because they don’t see the value. Keep these facts in mind in any dealings with them and try the following.
Think about the team: Engage the whole GP team
Work together: Work with pharmacies that are engaging with the same GP.
Value their time: Try and find a way that works for them.
Don’t undersell yourself: Take the time to inform them of the benefits and successes of the service
Be concise: appropriate feedback and referral back to GPs
Keep up the momentum: if referrals from a practice are low, or start to dwindle, speak to them again
Use MUR/ NMS top tips PSNC

32. EOI forms
EOI Process
Potential for review of participating pharmacies in the New Year
Can demonstrate delivery without being part of the service
There ae post-it notes on all your tables. Please write down your questions as we go along and save them for the Q&A session at the end

33. How can I make this work for my pharmacy?

34. Contact us: Greater Manchester LPC – Support Team
Our website holds FAQs about the service and additional resources.
We are also at the end of an or phone, so please do not hesitate to contact us with any queries you may have on the details below:
Greater Manchester LPC – Support Team
Dipesh Raghwani – Clinical Lead /

35. Any questions?

36. Thanks for Listening
Best of Luck