Clinical Services

CASE STUDY: IMPROVING PRESCRIPTION MANAGEMENT EFFICIENCY

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Surgery name: Kelvedon and Feering Health Centre & Dickens Place Group, Essex.

Service provision period: Aug 2019 to June 2022

Practice size: 8,000 patients in total

History:

The practice approached us for help with prescription & document management. Previously using another organisation for pharmacist support but did not see the improvements that they had hoped for.

They used our services six hours a day, five days a week between the two practices and we were receiving up to 90 prescription-related tasks per day when we started.

Our Interventions:

The key problems that we identified were that repeat templates were not being authorised appropriately at every contact and the outstanding reviews/monitoring were not being arranged.

When we took over, our aim was to get the surgery organised and improve the efficiency of their processes so that work is not duplicated.

We synchronised the repeat templates, requested outstanding monitoring & reviews at each contact when processing prescription tasks.

Outcome:

The number of tasks were reducing each month as the same patient requests were no longer returning each month. After 12 months, the daily prescription task count was down to approximately 40/day which allowed us to offer medication review & chronic condition review services in the additional time we had to spare.

We switched patients to repeat dispensing where appropriate during reviews which took the pressure off the prescription clerks. We also implemented a blood pressure protocol for staff members including non-clinical staff members such as receptionists to follow so that readings were entered correctly into the patient records and follow-ups were put in place for those patients that needed it.

After almost three years, the practice was well organised & was able to manage the workload on their own as the two GP partners were now working full time at the practice and they no longer needed our support at the moment.

Comments from the practice:

“You have been an immense help for us when we needed it the most over the past 2-3 years, we are very grateful and feel fortunate that we managed to find you, we don't have any criticism of your service or your professionalism.

It hasn't been an easy or lightly taken decision. Circumstances as you are aware have changed, now Ric and I work 5 full days here and we are trying to develop a reliable prescriptions team.

We wish you and your team all the best and who knows, we might be working together again at some point.”

Dr V Gil-Robles (GP Partner)

We appreciate the expertise and help CPS has provided for us over the last few years. I have enjoyed working with you. It has been difficult for us to take this decision which is purely for business reasons. In future, we may be in a situation that might allow us to work together again.”

“Dr R Pinto-Wright (GP Partner)

CASE STUDY: ALLEVIATING GP WORKLOAD

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Surgery name: Orchard Surgery, Horsham, West Sussex.

Practice size: 9,100 patients

Service provision period: February 2022 to Current

History:

The practice asked for our help with prescription & document management. Although they had access to a PCN pharmacist, more than 100 tasks/letters were being sent each day to GPs to complete in between seeing patients. The practice had never used an organisation like ours before for support so they wanted to trial the service to assess whether it suits them.

Our Interventions:

The aim was for us to take this workload off the GPs.

The problems we identified were that most of the patients' repeat templates were not aligned, regular medications were issued as acutes rather than being added to the repeat template and there was no robust recall system for annual reviews in place.  

The practice used our services eight hours/day, five days a week and we set up a ledger for the pharmacists to work off.  

We also helped set up birth-month reviews and provided training on setting up RDs so that it is offered to all suitable patients.

Outcome:

The GPs felt relief after the first two weeks, and after two months they were only receiving a few medication-related tasks each day.

The GPs were no longer staying late to clear the tasks and were going home earlier than they used to.

The prescription and document management services are still ongoing, and the surgery has since been using us for medication review clinics as well. The aim of the medication review clinics is to synchronise all the repeat medication and complete all the monitoring and reviews so that all medication is reauthorised for 12 months. 

Comments from the practice:

“The service has been fantastic; all the GPs have really felt the difference since you’ve taken over. The trial has been great, and we definitely want to continue using your services.”

Dr Emma Woodcock (GP Partner)

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CASE STUDY: Maximising Efficiency with the Use of a Pharmacy Technician to Reduce PCN Workload

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PCN name: South Stevenage PCN
Service provision period: December 2022 - present
PCN list size: 56,000 patients in total

History:

The Primary Care Network (PCN) was in need of an in-house Pharmacy Technician to help reduce the workload of their clinicians. With no time to spare, they decided to approach us for support. The South Stevenage PCN needed an experienced Pharmacy Technician to provide support to the clinicians.

Our Interventions:

After a meeting with the PCN, we were able to identify their exact requirements and provided the PCN with an experienced Pharmacy Technician who could hit the ground running and provide the PCN with immediate support. The Technician was able to quickly get up to speed with the PCN's processes and procedures and was able to provide the necessary support to the clinicians. 
The South Stevenage PCN tasks vary depending on the practice. At Knebworth, the technician reviews Clinical Letters and attaches a Pharmacy Technician Template to the patient's record. At Bedwell, the technician focuses on 'Waiting Lists' and requesting blood monitoring, and texting patients to book SMRs. At King George, the technician covers 'Reauthorising' task lists, checking BP, Blood Monitoring, and Reviews. At Shephall, the technician covers the 'Pharmacist' task group which includes prescription queries and requests. 

Outcome:

The South Stevenage PCN have seen a marked improvement in the workload of their clinicians since the introduction of a Pharmacy Technician from our service. The PCN have been so pleased with the results that they have decided to take on an additional Pharmacy Technician from us. This case study demonstrates the value of using a Pharmacy Technician to reduce the workload of clinicians and improve patient care.

Comments from the practice:

“So far, we’ve had great success with Mandeep’s role. The four practices are seeing great benefit from a workload point of view, and the pharmacists are seeing great capability in Mandeep’s performance and competency with her work complete. The benefits have been so much that we have decided to recruit through CPS again, rather than directly for a PCN post. I look forward to further future collaborations."

Rahil Bhatt, Senior Clinical Pharmacist

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CASE STUDY: Optimizing Asthma Management with Clinical Pharmacists in Forest 8 PCN

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Introduction:

Forest 8 Primary Care Network (PCN), with a list size of 50,000 patients, when the end of the financial year was approaching, faced challenges in meeting their Impact & Investment Fund (IIF) targets for asthma management, specifically RESP-01 and RESP-02. To address these challenges, the PCN sought the support of our clinical services to optimize asthma treatment for their patients.
The contract was signed at the end of January. Our services ran for 5 weeks from February-March.

Objective:

The primary objective was to improve the IIF targets for RESP-01 (Percentage of patients on the QOF Asthma Register who were regularly prescribed an inhaled corticosteroid over the previous 12 months) and RESP-02 (Percentage of patients on the QOF Asthma Register who received six or more SABA inhaler prescriptions over the previous 12 months).
Method:
Our clinical pharmacists were placed across eight GP surgery sites within Forest 8 PCN to support the achievement of RESP-01 and RESP-02 targets. A suite of clinical searches was used to identify asthma patients who were underordering their inhaled corticosteroids or overordering their SABA inhalers. These patients were then reviewed by the clinical pharmacists, and clinically appropriate interventions were made to optimize their medication.

Outcome:

Over a five-week period, our clinical pharmacists achieved the following results:
RESP-01: Improved from 53.25% to 77%, indicating a significant increase in the percentage of patients on the QOF Asthma Register who were regularly prescribed an inhaled corticosteroid over the previous 12 months.
RESP-02: Improved from 16.73% to 13.75%, reflecting a reduction in the percentage of patients on the QOF Asthma Register who received six or more SABA inhaler prescriptions over the previous 12 months

Conclusion:

Our clinical services played a pivotal role in effectively enhancing asthma management in Forest 8 PCN by addressing the challenges faced in meeting the RESP-01 and RESP-02 IIF targets. The successful improvement in these targets demonstrates the value of integrating remote clinical pharmacists into primary care teams, as they are well-equipped to identify and optimise medication regimens for patients with asthma. This case study highlights the potential of leveraging the expertise of clinical pharmacists to not only achieve better health outcomes for asthma patients but also to extend this approach to other chronic diseases managed within primary care settings. Ultimately, this collaborative approach has the potential to lead to more efficient healthcare delivery and improved patient satisfaction.

Comments from the practice:

“I had a very positive experience working with CPS Pharmacists for our IIF-targeted service. They supported practices with inhaler changes and provided a service that was efficient and effective in meeting the needs of our practices, while also prioritizing patient safety.

Additionally, they were very flexible which is very important as every practice in PCN is unique and require a personal plan. CPS Pharmacists were able to adapt to our needs and provide us regular updates on progress towards meeting targets. 
Overall, I would recommend their service to other practices."

Suzia Riasat, PCN Liaison Manager

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CASE STUDY: Lakeside @ St Neots Diabetes Case Study: Improving Patient Outcomes Through Comprehensive Annual Reviews

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Background:

Lakeside at St Neots Surgery, with a diabetes register of 1,345 patients, approached our clinical services team to conduct annual Diabetes reviews (DM QOF) to manage their patients on the diabetes register effectively.

Objective:

Our primary objectives were to optimize medications, check eligibility for a statin, and complete Diabetes annual reviews for patients to support the practice in meeting QOF indicators DM006, DM014, DM019, DM020, DM021, DM022, and DM023.
Method:
Our Clinical Pharmacist was set up to work remotely in the surgery. Patients were booked for their annual Diabetes review, and blood pressure, foot check, and blood tests were conducted before the appointment. During the consultation, the pharmacist:
•  Reviewed patients' HbA1c and optimized their anti-diabetic medication according to National and Local guidelines (DM020 and DM021).
•  Referred newly diagnosed patients to the Structured Educational Programme within a timely manner (DM014).
•  Reviewed blood pressure readings and initiated or up-titrated anti-hypertensives as required (DM019).
•  Discussed and initiated statin therapy where appropriate for patients with established CVD or those with a CVD risk score of over 10% (DM022 and DM023).
•  Ensured that patients with a diagnosis of nephropathy (clinical proteinuria) or micro-albuminuria were treated with an ACE-I (or ARBs) (DM006).

Outcome:

Over a one-year period, our pharmacist completed 1,016 annual diabetic reviews for the practice, resulting in the following achievements:
DM006: Achievement thresholds 57-97% (Practice achievement 98.6%)
DM014: Achievement thresholds 40-90% (Practice achievement 57.1%)
DM019: Achievement thresholds 38-78% (Practice achievement 58.4%)
DM020: Achievement thresholds 35-75% (Practice achievement 53.5%)
DM021: Achievement thresholds 52-92% (Practice achievement 78.1%)
DM022: Achievement thresholds 50-90% (Practice achievement 91.2%)
DM023: Achievement thresholds 50-90% (Practice achievement 92.8%)
These results led the practice to achieve the threshold for all QOF DM indicators and meet the upper threshold for DM006, DM022, and DM023. The practice has been so impressed with the outcomes that they plan to roll this out to other practices within the PCN.

Conclusion:

Our clinical services team, through comprehensive annual Diabetes reviews, has significantly improved patient outcomes and helped Lakeside at St Neots Surgery meet and exceed various QOF indicators. This successful collaboration highlights the value and impact of our services on patient care and management.

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CASE STUDY: Enhancing Primary Care Outcomes through a Hub Model - North Solihull PCN

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Background:

In January 2024, North Solihull Primary Care Network (PCN), comprising 10 practices with a patient list size of 77,347, sought our expertise to optimise their Additional Roles Reimbursement Scheme (ARRS) funding. Their goal was to improve Quality and Outcomes Framework (QOF) achievement, long-term condition management, particularly focusing on cholesterol, asthma, and hypertension. Utilising an established hub model, the PCN aimed to streamline ARRS roles, enhancing collaboration and efficiency across practices.

Challenge:

The PCN faced the dual challenge of underutilised ARRS funding and the need to elevate care standards in managing long-term conditions. They required clinical support to efficiently deploy resources and improve patient outcomes in line with QOF indicators.

Solution:

We introduced a comprehensive intervention strategy, deploying 10 pharmacists over three months to focus on key areas: cholesterol, asthma, hypertension, heart failure, stroke/transient ischaemic attack (TIA), chronic obstructive pulmonary disease (COPD), and secondary prevention of coronary heart disease (CHD).

Key Interventions:

Asthma: Targeting AST 007 patients for annual reviews, our pharmacists ensured accurate clinical coding and treatment optimisation, including follow-up appointments.

COPD: Annual reviews were conducted using appropriate templates for maximum QOF points, with therapy optimisation and referrals for pulmonary rehabilitation where necessary.

Cholesterol and Lipid Management: Focusing on CHOL001, DM022, and DM023 indicators, patients were offered statin therapy or alternative treatments, ensuring comprehensive risk management for cardiovascular events.

Stroke/TIA and CHD: Targeting STIA007 and CHD005, suitable patients were offered antiplatelet or anticoagulant therapies, with meticulous coding for QOF achievement.

Heart Failure: Addressing HF007, annual reviews included functional capacity assessment and medication optimisation.

Hypertension: Focusing on HYP008 and HYP009, pharmacists adjusted treatments for uncontrolled blood pressure, scheduling follow-up appointments to ensure target achievement.

Outcomes:

This targeted approach not only met but exceeded QOF long-term condition (LTC) targets for the 3 key clinical areas that we set out to achieve ahead of the three-month goal, allowing further utilisation of pharmacists for other QOF condition areas, Structured Medication Reviews (SMRs) and letter processing.

Conclusion:

The successful collaboration with North Solihull PCN underscores the efficacy of the hub model in leveraging ARRS funding for QOF improvement. By focusing on strategic interventions and resource optimisation, we demonstrated our ability to enhance care quality and efficiency, setting a benchmark for future engagements in primary care settings.

Comments from the practice:

“I’ve been really impressed with the flexibility shown by your team. The impact on our practice workload has been noticeable.”

Tara Shah, PCN Clinical Director, North Solihull PCN

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