1. Community pharmacy flu vaccination services- preparing for 2014/15

2. Seasonal Influenza An integrated approach to service delivery Kevin Noble MRPharmS – Partner, Pinnacle Health LLP

3. Content INTRODUCTION AND CONTENT Background NHS Service commissioning 2013/14 Service models Uptake profile Referral profile Private influenza vaccination service outcomes Barriers to service delivery Competency & maintaining a skilled workforce

4. Targets NHS TARGETS 2013 NHS aspirational targets: 1.To reach or exceed 75% uptake for people aged 65 years and over as recommended by WHO 2.To reach or exceed 75% uptake for people under 65 years with clinical risk factors 2012/13 Achievement Over 65s: 73.4%Under 65s: 51.3% Q. What can we do to improve uptake to achieve targets?

5. Analysis of NHS data from 3 Discrete Areas 2013/14 Season COMMISSIONING MODELS APPLIED Commissioning model applied. Patients were over 16 years in all areas Area (No of providers)Target groupsStart date Total Vaccinated Area 1 (113) All risk groups*1 st October 20135260 Area 2 (146) Under 65s with risk factors 15 th October 20132043 Area 3 (208) Under 65s with risk factors 1 st November 2013 2613 *Excluded pregnant ladies Data from three commissioning areas has been analysed to examine the impact on uptake of vaccination & engagement

6. Analysis of NHS data from 3 areas 2013/14 ENGAGEMENT AND UPTAKE Uptake profile Numbers vaccinated Area (No of providers) Over 65 yearsUnder 65 years with co-morbidity First time vaccinated Area 1(113) 3495 (66%)1765 (34%)488 (9%) Area 2(146) 02043 (100%)372 (18%) Area 3(208) 02613 (100%)606 (23%) AreaAverage under-65 vaccinated per provider Area 115.6 vaccinations per provider (46.5 ave total cohort) Area 213.9 vaccinations per provider Area 312.5 vaccinations per provider Applying a no restrictions to risk groups approach for those wishing to access pharmacy services produces higher numbers of vaccinations in all risk groups

7. Analysis of NHS data from 3 areas 2013/14 ENGAGEMENT AND UPTAKE Uptake profile through life of service MonthArea 1 (Oct 1 st ) Area 2 (Oct 15 th )Area 3 (Nov 1 st ) October 36097450 Novembe r 12689221685 Decembe r 302266642 January 68108193 February 12292 March 101 Barriers to service provision Area 2 – Late preparation of service agreement for sign off Area 3 – LMC opposition to service caused service delay of 1 month Uptake of vaccination is at its peak in October. Early commissioning of service is essential to maximise uptake

8. Analysis of NHS data from 3 areas 2013/14 ENGAGEMENT AND UPTAKE Days of the week attendance MonthArea 1 (Oct 1 st ) Area 2 (Oct 15 th ) Area 3 (Nov 1 st ) Sunday 502629 Monday 970365502 Tuesday 893347504 Wednesday 920317421 Thursday 995375430 Friday 1047352517 Saturday 385261210 Uptake peaks Mon to Fri – pharmacy offers opportunistic service delivery without appointment. Attractive to those in full time employment as difficult to attend appointments, less likely to attend weekend clinics Consideration – The retirement age is increasing. Many over 65s in this situation Higher levels of service delivery are seen Monday to Friday. Pharmacies provide opportunistic access to vaccination without an appointment

9. Analysis of NHS data from 3 areas 2013/14 ANALYSIS OF REASONS FOR ATTENDANCE Reasons for Pharmacy attendance Reason for attendanceArea 1Area 2Area 3 Did not attend GP because Work commitments100277312 Transport issues811522 Other commitments21311646 Previous experience402817 GP unable to provide service96107120 No GP clinic dates available705958 Unable to attend Occ Health060 Prefer pharmacy1330197151 More convenient327311341760 Unwilling to say142018 In all three areas, significant numbers of patients reported a preference for pharmacy stating convenience as a major factor

10. Analysis of NHS data from 3 areas 2013/14 Analysis of Referral into service AreaSelf referralPharmacyGP practice Area 12718243884 (1.6%) Area 21266556160 (7.8%) Area 313681074114 (4.4%) Collaborative working can improve uptake of vaccine Referrals from GP practice low in all areas as percentage of total REFERRAL METHOD A collaborative workforce will refer to other providers in periods when services are unavailable. Improved collaboration will improve uptake

11. Private influenza vaccination outcomes Information gathered from 139 service providers where both NHS and private service available Patient profile Numbers vaccinated Over 65 years301 (11%) Chronic heart disease41 (1.5%) Chronic liver disease3 (0.1%) Chronic renal disease7 (0.3%) Chronic respiratory disease130 (4.7%) Diabetes64 (2.3%) Immunosuppressed15 (0.5%) Neurological condition15 (0.5%) Main carer21 (0.8%) Private patient2193 (79.9%) PRIVATE FLU VACCINATION SERVICE OUTCOMES – PATIENT PROFILES Significant numbers of NHS eligible patients access private services. These patients are not accounted for in DH returns via ImmForm

12. Private influenza vaccination outcomes Reasons given by NHS eligible patients for Pharmacy attendance Reason for attendanceNumbers Unable to attend GP - Work57 Unable to attend GP - Transport19 Unable to attend GP - Other commitments14 Unable to attend GP - previous experience3 Unable to attend Occ Health1 Prefer pharmacy226 More convenient287 GP unable to provide service14 Unwilling to say6 No GP clinic dates available15 PRIVATE FLU VACCINATION OUTCOMES Patients eligible for NHS vaccination pay to access vaccination services rather than engage with existing models of service delivery

13. Barriers to service provision BARRIERS Chaotic approach to service commissioning Limited access to service for certain risk groups Opposition to commissioning decisions by other Heath Care Professionals resulting in delayed implementation – October key month for uptake Unclear guidance for providers limits levels of provider engagement Commissioning must be patient centred and offer choice if the main objective is to maximise uptake Commissionin g intentions must be well planned and set out in a timely manner allowing providers to prepare to meet service quality criteria

14. Maintaining a Competent Workforce & Sustainable services COMPETENCY Provider competency criteria set by NHS England 2013/14 1.Completion of recognised training course 2. Annual basic life support and anaphylaxis update 3. Evidence 40 patients vaccinated last season Area 1Area 2Area 3 Number of providers vaccinating more than 40 people 42/1138/1468/208 Allowing all risk groups to access service creates more sustainable services Allowing all risk groups to access pharmacy services improves levels of engagement as a more confident workforce is produced. This in turn improves sustainability of services

15. Conclusion Q. How can we make changes to service models to improve uptake of vaccination? A. Improve provider choice and make services more accessible How can this be achieved? Integrating community pharmacies as a service provider has: i.Met with high approval ratings from those accessing vaccination services at these sites ii.The main reasons for use were more convenient or simply preference as a provider. iii.Higher numbers of older people are now still in full time employment passed the national retirement age. Limiting access to opportunistic services on the grounds of age will have a negative impact on uptake in this patient group. iv.Area 1 service model demonstrates the maintenance of a competent workforce as higher numbers of patients are vaccinated at provider sites. CONCLUSIONS Pharmacy flu vaccination services receive high approval ratings from service users. Convenience of access is the most common reason given for using these services

16. Exemplar Business Case BUILDING THE BUSINESS CASE Your starter for ten… … but it needs localisation Pinnacle Health developed this exemplar business case for use by LPCs and Area Teams to reduce the commissioning burden and allow timely service delivery

17. Exemplar Business Case BUILDING THE BUSINESS CASE Key statistics prepared for you … but they need to be used in the document Pinnacle Health developed this exemplar business case for use by LPCs and Area Teams to reduce the commissioning burden and allow timely service delivery

18. Exemplar Business Case BUILDING THE BUSINESS CASE Step 1 – The task ahead for the commissioners … can be found in the Appendix Pinnacle Health developed this exemplar business case for use by LPCs and Area Teams to reduce the commissioning burden and allow timely service delivery

19. Exemplar Business Case BUILDING THE BUSINESS CASE Make it visual… … by using historical data Pinnacle Health developed this exemplar business case for use by LPCs and Area Teams to reduce the commissioning burden and allow timely service delivery

20. Exemplar Business Case for 2014 BUILDING THE BUSINESS CASE Final figures not yet available from PHE We will convert historical “PCT” to “AT” data Refresh document with new intelligence But don’t wait if you have the opportunity to engage Pinnacle Health developed this exemplar business case for use by LPCs and Area Teams to reduce the commissioning burden and allow timely service delivery

21. The Difference We Made THE DIFFERENCE WE MADE Provisional figures to 31 January 2014 Early Commissioning, Early Delivery & Full Cohort gets the best results for patients and populations Pinnacle Health developed this exemplar business case for use by LPCs and Area Teams to reduce the commissioning burden and allow timely service delivery Over 65sUnder 65s Area 1 Early, Full Cohort 73.5% -> 73.9%53.8% -> 56.9% Area 2 Middle, Under 65s 73.1% -> 73.0%47.8% -> 49.2% Area 3 Late, Under 65s 75.4% -> 75.3%56.0% -> 56.9%

22. Table discussion- making the case locally

23. Table discussion- how to overcome barriers once the service is commissioned