Background

The COVID-19 pandemic has introduced unprecedented rapid change in the NHS resulting in:

• A widespread shift to remote management, reducing face-to-face appointments

• Surging clinical demand linked to coronavirus infection

• Severe disruption to routine practice in all clinical areas, e.g. cancer and long-term conditions.

• Problematic access to medicines, that would normally be prescribed and dispensed by the hospital outpatient pharmacy

While the pandemic has been challenging it has also been a catalyst for change, particularly in the transformation of outpatients’ management. Since March 2020, for example, UCLH has implemented video and telephone clinics, now covering around 50% of its outpatient clinics. This
work prompted the publication of the ‘UCLH Outpatient Transformation Strategy 2021-2026: An integrated future for outpatients’. The ambition is to design integrated ways of working collaboratively, to overcome the challenges noted above, for example with the use of ‘one stop clinics’. One of the aims of this strategy is “to identify a way for hospital doctors to prescribe from community pharmacies”.

Under current NHS systems it is not possible for a hospital only medicine/ patient access scheme (PAS) to be purchased by community pharmacy and reimbursed, however with the setup of shared systems and budgets under new ICS structures, there is more impetus to resolve this. This project is an ideal opportunity to test if new models of care are achievable, bringing together key stakeholders (including representation from Pfizer and Alliance) to work together to find and then pilot/test solutions. Funding pathways are in scope and must address cash flow, access to credit and risk in ownership as obstacles to community pharmacies purchasing and handling high priced medicines.

This issue is affecting all hospitals nationally, not just within UCLPartners geography. 

 

Project

In phase one of the project UCLPartners, Pfizer Ltd. and Alliance healthcare collaboration successfully demonstrated the ability to bring together relevant stakeholders, including patients, to create a shared purpose for innovation and improvement in outpatient medicines provision. Findings from Phase 1 provided invaluable insights and demonstrated a commitment from the NCL (North Central London) system, Pfizer and Alliance, to move the project into Phase 2. Please see Phase 1 report for further detail.

As part of Phase 2, the overarching collaboration will:
Pfizer will provide £50,000+VAT to support funding and employ a part time Senior Pharmacist to run the project, as well as 114 hours of Pfizer colleagues’ expertise time to support the project through all phases of delivery from planning to proof of concept development.

Alliance Healthcare will provide £7500+ VAT to support the funding and employ a part time Senior Pharmacist. This will be coupled with 114 hours of Alliance Healthcare colleagues’ expertise to aid the project through all phases of delivery from planning to proof of concept development.

UCLPartners will provide 544 hours of UCLPartners colleagues’ expertise time to support the duration of the project through all phases of delivery from planning to proof of concept development.

 

Benefits

Benefits for Patients/Population/User Groups

• Better access to medicines and treatments.

• Healthcare support at a local level.

• Continuity of care from hospital into primary care.

• Reduction of unnecessary hospital visits.

• Improved equity of access (e.g. lower cost barriers to access care in community settings).

• Improved adherence to medicines through new model of care.

Assumed benefits for the NHS (to be tested during Phase 2)

• A shift to community dispensing of shared care ‘low tech’ drug items offers increased cost visibility and financial control for the system.
• Community dispensing better supports the widespread shift to remote management of patients.
• Prioritisation of equity of access.
• Utilisation of capacity and clinical competencies in community pharmacy.

Benefits for Pfizer

• Understanding new patient pathways for accessing hospital only medicines in the community.

• Understanding of how we improve access to our medicines.

• Channels to distribute our medicines through, which will get to patients in a safe, robust and convenient way.

Benefits for Alliance Healthcare

• Understanding skills and processes community pharmacy must develop to support patients using hospital only medicines in the community

• Understanding how wholesale services might adapt to enable community dispensing points to access hospital only medicines

• Understanding how homecare services might adapt to support community pharmacies in the management of patients using complex hospital medicines and in the variation of homecare services to improve access to treatment in the community, e.g. community infusion clinics

Outcomes

As part of Phase 2, our patient and pathway mapping will allow us to identify the most appropriate pathways for intervention, developing a proof-of-concept plan to include:

• Cost predictions.
• Assessment of the opportunity available within the chosen pathway in terms of cost savings, patient safety, administrative burden etc.
• Training needs requirement for changes.
• Assessment of digital systems required to implement change.
• Comprehensive risk identification.
• Early feedback from stakeholders including prescribers within secondary and community pharmacy, patients, ICS and Trust operational teams, suppliers and homecare delivery partners.
• Final assessment of the feasibility of intervention within the chosen pathway.

This proof of concept will provide a tangible plan for the system to test the feasibility of an intervention within a real-world setting.