1. Black Country and
West Birmingham STP
Integrated Pharmacy and Medicines Optimisation Regional Engagement Event

2. Welcome and Introductions
Housekeeping
Wifi access
Plan for the day
Please tweet!
#IPMO

3. Plan for the day Time Item Lead 10.00 – 10.10 BCWB STP Update
Dr Helen Hibbs MBE - SRO BCWB STP
10.10 – 10.20
Pharmacy and Medicines Optimisation in a Collaborative System
Richard Cattell - DCPhO, NHSE/I
10.20 – 10.30
Integrating Pharmacy and Medicines Optimisation into an ICS and PCNs
Richard Seal - Regional Pharmacist, NHSE/I
10.30 – 10.40
IPMO in the BCWB STP
Ruckie Kahlon / Dr Duncan Jenkins - STP Pharmacy Leadership Group Co-chairs
10.40 – 10.45
Black Country IPMO Pilot Programme Lead Role
Michelle Haddock / Satnaam Singh Nandra - IPMO Programme Managers
10.45 – 11.10
IMPO Black Country Plan on a Page; Work stream Headlines:
Project Workstream Leads
Transfer of Care Around Medicines
Workforce
Safety
STOMP and LD
Polypharmacy
11.10 – 11.25
Break
11.25 – 12.55
Planning for the Black Country (World Cafés)
PLG members to facilitate peer review of BCWB IPMO plans
Opportunities for regional collaboration
Pharmacy Leadership Group
12.55 – 13.00
Close
Dr Jonathan Odum - Chair STP CLG
13.00 – 14.00
Lunch and Networking

4. Black Country & West Birmingham STP/Integrated Care System Update
Dr Helen Hibbs MBE
Senior Responsible Officer, Black Country and West Birmingham STP

5. Our vision

6. Leadership and governance
Over the last three years, the STP has provided us with a framework to transform our local health and care system in the Black Country and West Birmingham. It has enabled us to act systematically and together - to agree and address common challenges in a way that we could not as individual organisations.
Senior Responsible Officer, Dr Helen Hibbs Independent Chair, Jonathan Fellows
Portfolio Director, Alastair McIntyre
STP Programme Management Office (PMO) Team
STP Clinical Leadership Group – monthly
Establishing clear, robust and manageable processes to provide clinical leadership and assurance across work programmes
STP Partnership Board - quarterly
Sets the vision, strategy and pace of STP development
Overseas the delivery of the Partnership
Ensures effective collaborative working
STP Health Partnership Board - monthly
Identifies and advances collaborative priorities across the health system
Overseas delivery of national NHS targets
Aligns integrated, place-based delivery in each locality

7. Future model for delivering integrated care
Networks
Place
System
Region
NHS England will continue to directly commission some services at a national and regional level, including most specialised services.
The STP Partnership sets the vision, strategy and pace of system wide development. It will oversea the delivery of the Partnership and ensures effective collaborative working.
This is supported by:
STP Health Partnership Board
Black Country Joint Commissioning Collaborative
STP Clinical Leadership Group
Our five places support the integration of health and care services focussed around the patient. This includes: acute, community mental health, local authority and voluntary sector services.
Services wrapped around and delivered by GP Primary Care Networks

8. Our Integrated Care System (ICS) Roadmap
Our ICS roadmap is structured around five key workstreams. The roadmap outlines the activities, milestones, delivery and resources to ensure we are on track to reach ICS status by 2021

9. Progress to date across the STP
Joint plans for workforce development from HEE budget
NEW Specialist Community Perinatal Mental Health Service Launched
NEW Black Country Pathology Service
Plans to develop a BCWB Academy

10. Black Country & West Birmingham Clinical Strategy
Building on our strong place-based integration and financial performance, clinical leaders have developed an STP clinical strategy, which is clinically led.
It will make a difference to local patients by:
Reducing unwarranted variation and duplication across health and care services
Helping to address the triple aim: improve people’s health, improve the quality of services and deliver financial stability.
Ensuring the services we deliver are of the highest quality and sustainable.
Ensuring clinical services are delivered with a workforce equipped to deliver.

11. Clinical priorities
Our clinical leaders have identified 12 priority areas:
Cancer
Mental Health
Learning Disability Services
Maternity and Neonates
Children and Young People
Urgent and Emergency Care
Cardiovascular Disease
Pathology and Interventional Radiology
Primary Care
Musculoskeletal conditions
Respiratory Disorders
Frailty

12. Long Term Plan – Implementation
Our local five year plan will be aligned with the following principles:
Clinically-led
Locally owned
Realistic workforce planning
Financially balanced
Delivery of all commitments in the Long Term Plan and national access standards
Phased based on local need
Reducing local health inequalities and unwarranted variation
Focussed on prevention
Engaged with Local Authorities
Driving innovation

13. Long Term Plan - Delivery
Foundation plans for years one and two:
Transforming out of hospital care and fully integrated community based care
Reducing Pressure on emergency hospital services
Giving People more control over their health and personalised care
Digitally enabled primary and outpatient care
Better care for major health conditions: improving cancer outcomes, Mental Health, shorter waits for planned care
All areas to become ICS by 2021
Focus on population health management

14. Long Term Plan - Delivery
Staged implementation years two and five:
More NHS action on prevention
Strong start in life for children and young people
Learning disabilities and autism
Better care for major health conditions CVD, Stroke, Diabetes, Respiratory Disease
Research and development
Genomics
Volunteering

15. Local medicines optimisation priorities
Transfer of care around medicines (TCAM)
Medicine reconciliation and improving communication after discharge
Medicine Safety
Hospital admissions related to medicine
Mental Health and Learning Disabilities
Stopping over medicating people (STOMP)
Workforce
Pharmacy workforce review
Polypharmacy (over prescribing)
Medicine reviews to help patients on multi-medications

16. Pharmacy and Medicines Optimisation in a Collaborative System
Richard Cattell, Deputy Chief Pharmaceutical Officer
24 July 2019
NHS England and NHS Improvement

17. The NHS Long Term Plan outlines the ambitions for the NHS and clinical pharmacy has never been more important Medicines are at the heart of the key themes of cancer, cardiovascular disease, diabetes, respiratory medicine and stroke care
WHO Medication Without Harm…..Rethinking Medicine……Me and My Medicines……Choosing Wisely…..
Realistic Medicine…..Canadian Deprescribing Network…..English Deprescribing Network

18. NHS Long Term Plan sets the context and themes for us all for 2019-2029
The NHS Long Term Plan is about integrating services around the patient more effectively, and making inroads into the major ‘killer’ diseases and causes of ill health. Its three main ambitions:
1. Making sure everyone gets the best start in life
2. Delivering world class care for major health problems
3. Supporting people to age well
Ambitions underpinned by action to overcome specific challenges:
Personalised care, Prevention and health inequalities, Workforce,
Data and digital technology, Delivering better value
18 l NHS England and NHS Improvement

19. NHS Long Term Plan direction of travel for pharmacy
Primary care networks
Significant investment in primary care networks, to develop multidisciplinary community teams to deliver services
Urgent care
A consistent offer for out-of-hospital urgent care
Prevention and inequalities
An increasing emphasis on prevention, with a focus on obesity, smoking, tobacco, alcohol and air pollution
Medicines optimisation
Clinical pharmacists doing appropriate structured medication reviews
Antimicrobial stewardship and medicines safety in all pharmacy teams
Workforce development and reform
Substantially expand the number of clinical pharmacists and provide/assure training
Make greater use of community pharmacists’ skills and opportunities to engage patients

20. Development of PCNs by July 2019 and ICSs by April 2021
The aim is integrated medicines optimisation led by clinical pharmacists
Development of PCNs by July 2019 and ICSs by April 2021
2019/20:
AMR National Action Plan
GP contract Quality Improvement module on prescribing safety
National Patient Safety Strategy – Medicines Safety Programme
Public Health England Review into Dependence Forming Medicines
Integrated Urgent Care – roll out of NHS Community Pharmacist Consultation Service
Community Pharmacy Contractual Framework
2020/21:
GP contract national service requirements including Structured Medications Review and Optimisation and Enhanced Health in Care Homes
National Overprescribing Review report
Supported by Interim People Plan, published June 2019, and final plan due in Autumn 2019

21. Framework for system-wide pharmacy integration is via the PCN
NHSE / NHSI
CPhO and Deputy CPhOs
Medicines and Pharmacy Policy Directors
DHSC
National
HEE
PHE
Regional Medicines Optimisation Committees
Regional Chief Pharmacists
Pharmacy Deans
Regional
Controlled Drug Accountable Officers
Specialist Pharmacy Service
Clinical Directors of Pharmacy and Medicines
ICS
Long Term Plan Implementation
PCN Clinical Directors
PCN Clinical Pharmacy Team
Local integrated
Care
CCG Pharmacy Team
Specialist Pharmacy Team
Acute
Mental health
Patient
Urgent Care Pharmacy Team
Community Pharmacy Team
21 l NHS England and NHS Improvement

22. Vision for the integrated clinical pharmacy team
All pharmacists and pharmacy technicians supporting patients are part of the multi-professional team in a PCN
Clinical pharmacists are a central part of the PCN team
Community pharmacy teams deliver consistent, high-quality minor illness care and support the public to live healthier lives
Community pharmacists have capacity to deliver more clinical care
Hospital and mental health pharmacists continue to be part of specialist teams and extend their practice into primary care, including providing consultant pharmacist support
CCG pharmacy teams leading on population health
Consistent delivery of these goals will require clinical and professional leadership across the health and care system, by Regional Chief Pharmacists and proposed Clinical Directors of Pharmacy and Medicines in each ICS
22 l NHS England and NHS Improvement

23. Workforce planning and development are priorities
Interim People Plan – The Vision for Pharmacy:
Ensure the initial education and training of pharmacists and pharmacy technicians creates the right workforce in the right place
Introduce new approaches to cross-sector pre-registration and postgraduate clinical training pathways
Deliver a cross-sector foundation programme for all newly-registered pharmacists
Intention to develop a professional framework for pharmacy technicians
Reform undergraduate and pre-registration training
Create routes to progress to higher levels of practice
Appointment of senior and experienced NHS pharmacists as clinical directors of pharmacy and medicines optimisation in each ICS
Enable ICSs to deliver the NHS Long Term Plan through national and local management of workforce demand and supply
Attract more, and a wider pool of, people to the pharmacy professions by improving the image and reputation of the pharmacy professions
Key IPP themes:
Making the NHS the best place to work
Improving the leadership culture
Tackling the nursing challenge
Delivering 21st century care
A system wide board will oversee the delivery of the NHS Long Term Plan pharmacy workforce plans, to enable a focus on the key activities, and ensure engagement with stakeholders

24. Advancing Pharmacy Education and Training Review report
1. NHS pharmacy workforce needs to continue to meet the highest professional standards, underpinned by a rigorous, more clinically-focused, career-long framework of training and education to benefit patients 2. Recommendations based on an analysis of existing evidence and reflecting best practice across the career stages 3. Timely in considering the supporting infrastructure to deliver the NHS Long Term Plan 4. Transformational changes for foundation level pharmacists to equip with skills for the vision in the NHS Long Term Plan 5. GPhC review of initial education and training shows need to ensure that newly registered pharmacists are ready for multidisciplinary teams and working flexibly in patient facing roles 6. Opportunities to stretch to advanced and consultant practice 7. Pharmacy technicians to embrace new training and roles too
24 l NHS England and NHS Improvement

25. Integrating Pharmacy and Medicines Optimisation into an ICS and PCNs
Richard Seal, Regional Chief Pharmacist (Midlands and East)
24 July 2019
NHS England and NHS Improvement

26. Working together to deliver medicines optimisation
RMOCs:
Important role as move towards system approach
Focus is on medicines optimisation programmes – best value biologics; polypharmacy; AMR; shared care
Variation between and within regions
Ensure alignment with APCs
Secondary care:
Electronic Prescribing and Medicines Administration rollout
Getting it Right First Time
Clinical research
Primary care:
Clinical pharmacists in PCNs
Structured medications review and optimisation
Enhanced health in care homes
New Medicines Service
Social prescribing
26 l NHS England and NHS Improvement

27. Role of the clinical pharmacy team in a PCN
Clinical pharmacists:
18-month training programme to ensure competence and confidence to consult directly with patients, working in a multi-professional team
Supported to become independent prescribers
Undertaking structured medication reviews, improving medicine optimisation and safety, improving antimicrobial stewardship, supporting care homes, as well as running practice clinics
Advocates of medicines optimisation and safety and embed principles of shared decision-making
Provide a focal point for collaborative working across the different pharmacy providers including hospital, mental health and community pharmacy
Teams will be supervised by a senior clinical pharmacist, to support professional and career development at a network level
Posts are clinical and person-facing
Will receive support and supervision to allow them to do the job safely and confidently
27 l NHS England and NHS Improvement

28. Network contract service requirements
National Service Requirements
1) Structured medications review and optimisation
2) Enhanced Health in Care Homes
3) Anticipatory care (requirements for high-need patients, joint with community services)
4) Personalised care
5) Supporting early cancer diagnosis
National Service Requirements
6) CVD prevention and diagnosis
7) Locally agreed action to tackle inequalities
Many will include direct involvement of clinical pharmacists
Collaboration with providers, including community services and community pharmacy, to deliver
Will include standard national processes, metrics and expected quantified benefits for patients
Designed with stakeholders, and part of the formal contract negotiations
Published 2020 as part of changes to Network DES Specification

29. Education and training for PCN clinical pharmacists
Clinical pharmacists employed through the network contract funding will either be already undertaking, need to enrol in or have qualified from an accredited training pathway
NHSE&I and HEE have arranged a new Primary Care Pharmacy Education Programme to allow all clinical pharmacists in PCNs to access and complete an accredited training pathway if required
All appointed undergo a robust learning needs assessment with their education supervisor to plan development  
While some will have done other qualifications, this content may not align fully with the outcomes required of a PCN pharmacist
No need to repeat education but NHSE/NHSI needs to be assured, e.g. a person may need to revisit learning (not repeat a qualification) and develop a plan and portfolio to build skills
Primary Care Pharmacy Workforce Survey completed:
To capture the national educational needs of the pharmacy workforce in primary care

30. Role of the clinical pharmacy team in a PCN: Community pharmacy
Community pharmacy will focus more on its clinical role managing the minor illness aspects of urgent care, and supporting patients to prevent ill health
It will need to have strong links with PCN clinical pharmacists
Working with GPs to deliver their obligations under the network contract DES:
There could be a delivery role in areas such as CVD early detection and prevention and awareness of cancer symptoms
Some community pharmacists could be recruited to work in PCN clinical pharmacist roles, for which they would do the additional 18-month training, and which would not involve dispensing
Community pharmacy providers could be providers of clinical pharmacists to PCNs
Key areas of focus:
Urgent care and minor illness
Prevention and public health
Supporting medicines optimisation and safety

31. NHS Community Pharmacist Consultation Service (CPCS)
Fast and convenient access to clinical advice for patients with minor illnesses
NHS111 referral to a community pharmacist:
4 pilot sites – North East, East Midlands, London, Devon
Now rolling out to all community pharmacies from 1 October 2019
GP practice referral to a community pharmacist:
Pilot sites being developed through to March 2020
First phase: 5 sites Summer 2019: Cheshire and Merseyside STP, Lancashire and South Cumbria ICS, North East and North Cumbria ICS, Greater Manchester ICS, Bristol, North Somerset and South Gloucestershire STP – 30 practices and 67 pharmacies
Second phase in Sept/Oct 2019
Commission nationally from April 2020 if it demonstrates value for money
NHS Long Term Plan signals rollout across England, subject to contract negotiations
Initial design work underway with NHS Digital to develop 111Online referral pathway to CPCS
CPCS national stakeholder group involves BMA and RCGP
National evaluation is ongoing
Estimate up to 6% of all GP consultations (up to 20m appointments a year) could be safely transferred to a community pharmacist [GPFV]
31 l NHS England and NHS Improvement

32. The development of the Integrating Pharmacy and Medicines Optimisation into an ICS programme
ICSs set up to coordinate services, agree system-wide priorities, and plan collectively how to improve the health of the local population
IPMO programme to develop the principles for integration for pharmacy and to test different models
ICSs benefit from considering medicines optimisation and pharmacy activities as a cross-cutting theme, rather than as a standalone item or as ‘medicines management’
Needs strategic coordination in an ICS, encompassing local knowledge of the population, processes and relationships and, critically, a willingness to work beyond the natural walls of individual organisations
Senior NHS pharmacists, from across NHS settings, to set the direction for the local system to ensure there is collaboration
Their expertise vitally important in supporting ICS boards and programmes on the use of the pharmacy workforce and medicines optimisation
32 l NHS England and NHS Improvement

33. IPMO Programme – outline
A project to establish an ICS Clinical Director of Pharmacy and Medicines who is accountable for, and the governance structure for decision-making about, NHS-funded pharmacy and medicines optimisation across an ICS and its PCNs
Black Country STP (Midlands)
Cumbria and North East STP (North East)
Dorset ICS (South West)
Hertfordshire & West Essex STP (Central & East)
Lancashire & South Cumbria ICS (North West)
South East London STP (London)
Surrey Heartlands ICS (South East)
Developing the potential to link PCNs and clinical, community and hospital pharmacy together across the NHS system through a clinical and professional leadership function
Pilots developing plans for delivery of national priorities and contribution to ICS priorities and for a flexible clinical pharmacy workforce across a PCN
33 l NHS England and NHS Improvement

34. IPMO Programme – progress and next steps
NHS pharmacy system developments:
Regional chief pharmacists, RMOCs and pharmacy deans: Working with and supporting teams across England
ICS leadership: Seven Integrating Pharmacy and Medicines Optimisation into an ICS pilots completed; framework developed and next steps agreed for development of Clinical Director posts
Primary care networks:
900+ pharmacists in Clinical Pharmacists in General Practice scheme offered transition to PCN workforce scheme
Up to 6 additional clinical pharmacists will be appointed in each PCN by 2024
Some PCNs appointing pharmacists as clinical directors
IPMO next steps:
Framework due to be published in August 2019
Including 7 case studies from the ICS pilots
Further develop governance framework for IPMO and evaluate
Pilot project to continue for two years and roll-out to other STP/ICSs
Regional chief pharmacists continue to lead
34 l NHS England and NHS Improvement

35. Engaging with PCNs
Expectation that practices will work collaboratively with others, dependent on the needs of the local population
Network Agreement outlines how practice(s) and other partners work together
PCN engagement with pharmacy likely to take place from July 2019 onwards
For community pharmacy – working through the LPC which would work with the LMC to facilitate community pharmacies to develop and negotiate a coherent offer
Chief pharmacists in providers and CCGs, should begin talking to CCG heads of primary care and PCN clinical directors to discuss how they can work with the PCN
Clinical pharmacists who are transitioned into PCNs and new PCN clinical pharmacists are encouraged to work with other pharmacists in general practice and community pharmacy teams
Network Contract DES will be amended from 2020/21 to include collaboration with non-GP providers as a requirement 

36. Engage with us
Sign up for the quarterly Pharmacy and Medicines Bulletin:
Recording of ‘Working with Pharmacy’ webinar – request access to the site via
Upcoming pharmacy podcast at
Primary care networks: A briefing for pharmacy teams:
Primary Care Pharmacy Education Pathway:
English Deprescribing Network:
Raise awareness and skills around deprescribing among healthcare professionals and highlight the need for it to be part of appropriate patient care
Increase the use of shared decision-making when agreeing treatment options with patients
Contribute to the development of a national strategy to avoid harm caused by inappropriate polypharmacy
network/
@EDeprescribeN

37. IPMO in the Black Country and West Birmingham STP
Ruckie Kahlon
Associate Director of Medicines Optimisation and Chief Pharmacist
Dr Duncan Jenkins
Specialist in Pharmaceutical Public Health

38. IPMO in the Black Country and West Birmingham STP
Our STP footprint and member organisations

39. STP Pharmacy Leadership Group
Primary Care Medicines Management
Acute Trust Pharmacy
Services
Mental Health Pharmacy
Teams
Community Pharmacy
Pharmacy Integration
The Integrated Pharmacy Medicines Optimisation pilot will produce the following outputs in 2019/20:
Describes how pharmacy interacts with each part of the system
A pharmacy and medicines leadership structure
A “plan on a page” for delivery of national priorities related to pharmacy and medicines optimisation
A “plan on a page” for developing a flexible clinical pharmacy workforce over the next two years
A stakeholder engagement plan.

40. IPMO in the Black Country and West Birmingham STP
How it all began…
Why the Black Country and West Birmingham STP
Historical strong collaborative approach and shared vision
Birth of Strategic Pharmacy Leadership Group
Our model demonstrates system leadership that is collaborative and crosses boundaries

41. IPMO in the Black Country and West Birmingham STP
Identification of local work streams with short and longer-term goals
Project prioritisation!
Future-proofing post-IPMO pilot?

42. Clinical Strategy and STP Working Groups
Respiratory (pharmacy subgroup)
Primary Care
Frailty/ EOL
Clinical Support Service – Interventional Radiology and Pathology
Diabetes
Mental Health
MSK
Learning Disability
Children and Young People
Maternity
CVD Prevention
Urgent and Emergency Care
Cancer
Pharmacy Leadership Group actively assessing opportunities to link into the clinical work-streams

43. Michelle Haddock and Satnaam Nandra IPMO Programme Co-managers
The IPMO Programme Manager’s Perspective
Michelle Haddock and Satnaam Nandra
IPMO Programme Co-managers

44. Programme Manager Role
IPMO pilot site privilege!
Funded 0.8 WTE via Pharmacy Integration Fund until Feb 2020
Joint-programme managers seconded; primary care and secondary care expertise
Maintained links with own Organisations strengthens role
Provide project leadership and expertise across all work streams
Collaborate across the STP footprint ensuring:
Consistency
Harmonised approach
Communication
Develop understanding of local requirements for integration sustainability
Fantastic challenge and opportunity to standardise medicines optimisation across the STP – scaling great practice to support patient care!

45. IPMO Immediate Priorities
STOMP LD
Medicines Safety
TCAM
Polypharmacy
Pharmacy Workforce
IPMO Programme Leads
Opportunities
Challenges
Clinical Leadership Group
Pharmacy Leadership Group
IPMO Work Stream Leads
Local Pharmaceutical Committees
STP Programme Leads
External Stakeholders
Black Country STP Board

46. Dr Duncan Jenkins Specialist in Pharmaceutical Public Health
Workstream Headlines
Workforce
Dr Duncan Jenkins
Specialist in Pharmaceutical Public Health

48. Transfer of Care Around Medicines (TCAM)
Workstream Headlines
Transfer of Care Around Medicines (TCAM)
Hemant Patel
Head of Medicines Optimisation
Wolverhampton Clinical Commissioning Group

49. Transfer of Care Around Medicines (TCAM)
Current issue….The problem
Patient discharged with a change in medicines
Practices records not updated promptly
Pt and pharmacy not aware of correct regimen.
Pharmacy dispense old / original Rx
Increase risk = increase risk of re-admission
Practice issue new Rx.
Initial supply = waste of effort, time, medicines, money!
The journey – What did we need to do?
Identify key stakeholders
Task and Finish Groups
Collaborating with partners, CCGs, Trusts, LPC
Linked with AHSN
Share vision, problems, solutions
STP Digital board sign off and support.
Possible future ---The solution
Share information with pts pharmacy
Refer pt to Pharmacy on discharge
E-discharge summary sent to pharmacy
Pharmacist conducts review with pt
Correct medicines used as prescribed
Plans – Implementation
Launch events planned
All 4 trusts have signed up
Each trust to refer minimum No. of pts
Measure outcomes :-
reduction in readmissions / length of stay
Decrease waste & costs

50. Medicines Safety Clair Huckerby
Workstream Headlines
Medicines Safety
Clair Huckerby
Consultant Pharmacist Primary Care
Dudley Clinical Commissioning Group

51. Blueprint for safety (monitoring &learning) in the BCSTP
Managing drugs and devices safety alerts
Population Health approach to prioritising medicines safety related interventions
Medicines safety
Blueprint for safety (monitoring &learning) in the BCSTP
Collaboration across the system
Learning from sodium valproate
COMMUNICATION
Segmenting the population to prioritise interventions
Targeted medication review and systems
PINCER
EMIS LIBRARY, ECLIPSE
DAWN, INR star, ICE
HARMS: GI Bleeds
Changing culture
Learning from AKI work
Medicines Safety Dashboard (NHSE)
276 patients on anticoag +a/platelet + no GI protection
409 patients over 75 on NSAID without GI protection……….
Reporting errors and incidents
System wide error reporting
STP intervention day
Sharing learning
BCSTP Safety newsletter
Collaboration between STP MSO’s
Progress update- matrix approach to developing a Blueprint for improving medicines safety in the BCSTP
The focus
GI (NSAIDS, anticoag and antiplatelets - PPI)
Medication Safety Indicators show that Black Country STP is above the England average.
Implement a search into GP systems to highlight potential patients who are on NSAIDs, antiplatelets and anticoag but do not have PPI cover
Aim is to reduce the admission related to GI bleeds.
Drug safety alerts
Implement a standardised STP wide process for action and reporting on medicines related drug safety alerts.
Link in with existing safety teams.
Task and Finish Group established
Linked with ASHN re PINCER
Collaborating with LPC
Interrogate the Datix and NRLS data – Link in with NHSE
Outcomes
Identify patients via GP systems on anticoag and antiplatelets + NSAID’s without PPI (PINCER search or locally built searches)
Identify patients entering the hospital on NSAID’s without PPI and as above
Standardised STP wide process for action and reporting on medicines related drug safety alert

52. Chief Pharmacist, Black Country Partnership NHS Foundation Trust
Workstream Headlines
STOMP and LD
Gurjinder Bhella
Chief Pharmacist, Black Country Partnership NHS Foundation Trust

53. Mental Health & LD - STopping Over Medicating People with Learning Difficulties (STOMP LD)
Progress update
The focus
STOMP LD is a national as well as an STP priority.
Target cohorts of patients on the GP LD register who may benefit from a specialist review
Educational/awareness sessions for primary care clinicians, patients and carers.
Task and Finish Group established
Linked with ASHN re STOMP
Collaboration with Primary care and Secondary Care Teams
Provide best patient care across the interface
Outcomes
Identify LD patients would have not been reviewed
Identify patients who are multiple medicines who would benefit from a review
Identify patients who may benefit from additional psychological support
Map out LD services available across the STP
Identify LD specialists working across the STP region (primary and secondary care)

54. National agenda Key outputs/markers Changing culture
Population Health approach to improving quality of life and reducing potential harm
STOMP LD
Improve the quality of life and reduce potential harm across the BCWBSTP
NHS-E Initiative
PHE data suggest 30K-35K learning disability, autism or both are taking a prescribed antipsychotic, an antidepressant or both without appropriate clinical indications
Targeted medication review and systems
EMIS, ECLIPSE
SystmOne
Secondary care collaboration, guidance development, targeted medication review as part of admission.
Key outputs/markers
Changing culture
7177 LD patients across BCWBSTP
Immediate Outputs
STOMP STAMP Pledge – all sign up and pledge
Risk stratified system search's – identify potential pts for LD requiring a specialist review
Non pharmacological treatment of options and how to access – STP wide
Educational sessions for primary care and carers – STP wide event
Intermediate Outputs
Support Medicines and Pharmacy related aspects – TCP review
Shared decision making – patient/carer centred
‘Patient Review not Medication Review’
STP wide upskilling of pharmacy and primary care workforce
Collaboration and upskilling community pharmacy teams
LD service secondary care – review complex patients

55. Sumaira Tabassum Head of Medicines Management NHS Walsall CCG
Workstream Headlines
Polypharmacy
Sumaira Tabassum
Head of Medicines Management
NHS Walsall CCG

56. Polypharmacy (over prescribing)
Progress update
The focus
National and local IPMO priority.
BSA polypharmacy dashboard will be analysed.
Linked to the national over prescribing work stream
Task and Finish Group established
Link in with ASHN and Polypharmacy work stream (DRFAT) and PINCER (collaboration with ASHN)
Collaborating with LPC
Explore potential overlap with Care Homes review team.
Explore Secondary care medicines team overlap
Outcomes
Reduce admission related to overuse of medication
De-prescribe inappropriate medication where clinically appropriate
Reduce medication tablet burden where clinically appropriate

57. Optimal use of medicines across the BCWBSTP
National agenda
Population Health approach to Optimal use of medicines
Polypharmacy
Optimal use of medicines across the BCWBSTP
Collaboration across the system
WHO, Matt Hancock review
Local review
Lots of great work (targeted poly pharmacy review, HARMS med reviews, Care home review, High opioid burden) use and build.
Local expertise – use to upskill
Targeted medication review and systems
EMIS, ECLIPSE
Systm 1
Secondary care collaboration, guidance development, targeted med review as part of admission.
Key outputs/markers
Changing culture
National metrics
Immediate
ACB>12 = 31 pts across the BCWBSTP
Dual Anticoag + Antiplat = 49 pts across the BCWBSTP
Intermediate term
BCWBSTP wide Medication review policy and template
Long term
Pts Rxed 20 or more unique medicines = 387 pts across the BCWBSTP
Shared decision making – patient centred reviews
IMPACT training
Collaboration with community pharmacy to support targeted med reviews.
Efficient use of POD’s – targeted medication reviews

58. West Birmingham IPMO Regional Event
Black Country and
West Birmingham IPMO Regional Event
Refreshments

59. Interactive Workshops
World Cafés
Interactive Workshops
15 minute interactive workshops which will focus on key themes within each workstream

60. World Cafés – For discussion
Workforce
How can we enable a joined up workforce?
Medicines Safety
What barriers exist to reporting medicines-related incidents?
What would good look like/where would we like to be?
TCAM
What are the barriers to implementing TCAM and service improvements?
How do we ensure service sustainability?
Polypharmacy
What has worked well in your area?
What were the main barriers (if any)?
Secondary care and Polypharmacy reviews?
Community pharmacy and Polypharmacy reviews – MUR?
STOMP LD
What do you think has /would work well in your area?
What do you think are /were the main barriers (if any)?
What do you think we should include / consider as part of specialist STOMP/STAMP reviews?
Discuss the role for community pharmacy and STOMP/STAMP reviews? – MUR?
How should we engage patients, families and carers in the STOMP campaign?

61. The Royal Wolverhampton NHS Trust
Event close and thanks
Dr Jonathan Odum
Medical Director
The Royal Wolverhampton NHS Trust
and STP CLG Chair

62. West Birmingham IPMO Regional Event
Black Country and
West Birmingham IPMO Regional Event
Lunch and Networking