1. “Review of Lymphoedema Garment Provision: FP-10 Project” Gillian McCollum Lymphoedema Lead Belfast HSC Trust 18 Feb 2009

2. Presentation Outline Background Background Aims and objectives of project Aims and objectives of project Anticipated outcomes of project Anticipated outcomes of project Process Process Key outcomes Key outcomes Future plans Future plans Summary Summary

3. Background Lymphoedema garments worn on a life long basis – 2 provided every 6 months Lymphoedema garments worn on a life long basis – 2 provided every 6 months Service in Belfast City Hospital managing patients from all over the region Service in Belfast City Hospital managing patients from all over the region Increasing prevalence Increasing prevalence

4. Background 2006/07: £30K spent on lymphoedema G&S in Belfast Trust (no specific G&S budget for lymphoedema) 2006/07: £30K spent on lymphoedema G&S in Belfast Trust (no specific G&S budget for lymphoedema) Increase in order turn around times Increase in order turn around times (on average 8 weeks) Greater range of lymphoedema garments available on FP-10 Greater range of lymphoedema garments available on FP-10

5. Background CSR 2008/09 – 2010/11: CSR 2008/09 – 2010/11: Belfast Trust: £343m (3% pa) efficiency savings over next 3 years New ways of working New ways of working

6. Main Aims of Project Reduce lymphoedema service garment expenditure Reduce lymphoedema service garment expenditure Ensure patients have timely access to compression garments Ensure patients have timely access to compression garments

7. Objectives of the Project Change current practice by instigating the use of FP-10 prescription Change current practice by instigating the use of FP-10 prescription Develop efficient system of obtaining compression garments on drug tariff Develop efficient system of obtaining compression garments on drug tariff

8. Anticipated Outcomes Decrease lymphoedema service expenditure Decrease lymphoedema service expenditure Shared funding of garments Shared funding of garments Increase GP/pharmacist awareness Increase GP/pharmacist awareness Decrease waiting time for garments Decrease waiting time for garments Maximise benefits of CDT Maximise benefits of CDT Increase patient satisfaction Increase patient satisfaction

9. Process Consultation with stakeholders Consultation with stakeholders Benchmarking Benchmarking Standardised prescription request form/letter to GP Standardised prescription request form/letter to GP Data collection form for audit Data collection form for audit Education re FP-10 system Education re FP-10 system Patient criteria Patient criteria

10. PRESCRIPTION GARMENTS RECORD Patient name & Tel contact details DateGP Practice & Pharmacy Number & full description of garment (to allow for costing) 2 week follow up call comments: Mrs J Smith 028 9099 9999 4/03/08Dr Brown Dunluce HC Alliance Pharmacy Combined armsleeve with grip top, standard length, size IV, CL II (x1) Pt has received garment

11. K ey Outcomes: Initial Audit Two Week Follow Up Comments

12. Key Outcomes Waiting Time: 30% of patients received 30% of patients received garment by 2 week follow up All patients received garment All patients received garment by end of 10 week period

13. Key Outcomes Expenditure: £1,752 savings for £1,752 savings for lymphoedema service (over 10 weeks) Projected annual savings Projected annual savings of £9,110

14. Next Steps Refined local FP-10 process Refined local FP-10 process Further consultation with GPs and pharmacists Further consultation with GPs and pharmacists Promotion of drug tariff usage throughout region Promotion of drug tariff usage throughout region Re-audit after 6 months: Re-audit after 6 months: 10 week period (July – Sept 2008)

15. Key Outcomes: Re-audit

16. Re-Audit – Key Outcomes Waiting Time: 75% received garment within 2 weeks 75% received garment within 2 weeks Range of time to get garment on FP-10: Range of time to get garment on FP-10: 1 day – 3 weeks (average of 4 days)

17. Re-Audit – Key Outcomes Expenditure: 62% increase in the number of FP-10 requests 62% increase in the number of FP-10 requests £2,968 savings for BCH lymphoedema service (over 10 weeks) £2,968 savings for BCH lymphoedema service (over 10 weeks) Projected annual savings of £15,434 Projected annual savings of £15,434

18. Future Plans Increase awareness Increase awareness Audit admin time involved - business case for admin support Audit admin time involved - business case for admin support Extended scope practitioner Extended scope practitioner Patient satisfaction questionnaire Patient satisfaction questionnaire Potentially decrease number of face to face reviews Potentially decrease number of face to face reviews

19. Summary Life-long management: Life-long management: major implications on service funding Need to identify more efficient and effective ways of working Need to identify more efficient and effective ways of working Local drug tariff ordering system improved over a 6 month period Local drug tariff ordering system improved over a 6 month period

20. Summary The utilisation of FP-10 to obtain lymphoedema garments resulted in significant savings for the BCH service and has the potential to greatly reduce patient waiting time for garments The utilisation of FP-10 to obtain lymphoedema garments resulted in significant savings for the BCH service and has the potential to greatly reduce patient waiting time for garments

21. For a full list of garments available on FP-10 go to: www.nhsbsa.nhs.uk/prescriptions and click on drug tariff, then electronic drug tariff, then Part lXA appliances – lymphoedema garments