Sunderland Case Study

Summary

• Had ambitious plans to rapidly expand the workforce
• Recognised they needed structured framework to ensure standardised delivery of the clinical pharmacist and technician role across their PCNs
• Sought expertise from Soar Beyond to help with their vision
• Soar Beyond commissioned to deliver 4D Accelerator sessions with senior pharmacists, enabling the use the SMART platform to quickly create a map of baseline competencies and capabilities which highlighted and identified training and development needs

Situation

Sunderland GP Alliance, a federation made up of six primary care networks, with a population size of 250,000 across 36 practices.

The federation had an ambition of recruiting and mobilising 50 pharmacists from a current team of six within a 6-month period. They recognised that it was not only important but essential to assure that there was a safe and standardised deployment when the pharmacists were coming from a range of different backgrounds and levels of experience.

If this was not done in a systematic and standardised way, it would lead to variation in quality of delivery of service across the federation, impacting patient care.

Task

To safely grow, develop and train the pharmacy workforce and measure the impact over the contract

Action

• A set of competencies were created utilising the Soar Beyond Circle of Competence tool.
• SMART was utilised to manage and assess competencies, as well as help with development planning across the team. This was done remotely due to the COVID-19 pandemic.
• THE SMART capability mapping tool was utilised to help identify any gaps in knowledge, this resulted in the identification of growth area, management of frail and elderly patients
• A customised training and upskilling programme was developed to help build knowledge in this area

Result

Within 18 months of starting the process Sunderland Alliance federation developed and retained a strong and confident pharmacy team. This was seen by the:

• Visual shift in competence on the Circle of Competence tool
• Systematic quality improvement of clinical delivery
• Improvement in patient outcomes for both frail and older patients

North London Productivity Case Study

Summary

• Practice overwhelmed with prescription burden
• Unmanageable workload -> no GP capacity to support pharmacists
• Understood their own limitation and sought support from Soar Beyond
• With support from a senior pharmacist and the SMART platform the practice has achieved a 50% reduction in prescription workload

Situation

Practice based in North London (11,000 list size) faced similar problems to many -workforce crisis, with the lack of GPs and nurses, and an increase in workload due to the growing demands of the population. The practice was overwhelmed with the prescription workload and decided to take on and eventually increase the pharmacist capacity within the practice to manage this. The practice went from 0.8 WTE to 2 (made up of three pharmacists) and although the process was refined, and the pharmacists led on the prescription process the workload was still unmanageable. The GPs recognised there was a mix of capability and competence between the pharmacists, and a lack of capacity from themselves to provide adequate support to train and upskill the pharmacists. There was also a sense of the pharmacists taking too long – ‘GPs used to do this much faster’ creating anxiety and dissatisfaction within the team. The practice commissioned Soar Beyond to provide them with support and structure through the SMART platform and additional supervision support through a senior Soar Beyond pharmacist.

Task   

• Review individual pharmacist competence and create a development plan for each of them in line with the practice needs.
• Review prescription process and implement systematic change across the practice to improve workload

Action

• Baseline competency assessment completed for each pharmacist focused on practice needs around prescription management
• Detailed plan created to address prescription workload through a system review with the SMART 4D™ repeat prescribing toolkit
• Incorporated proactive medication review and QOF reviews
• Implemented a process to identify patients who would be suitable for eRD
• Clarity of roles and accountabilities across the practice for each step of the prescribing process
• Half a day a week mentoring and support provided by a senior Soar Beyond pharmacists, allowing for a focused checkpoint on progress on development plans and prescribing process

Result

• All pharmacists are clear on their deliverables for the practice with a clear development plan in place
• Standardised process implemented across the practice to manage the repeat prescribing process which included clarity of roles across the practice for each step of the process.
• All the pharmacists feel supported and valued due to the impact they have made on the prescribing process
• The coordinated approach of developing the pharmacists and empowering them to take on the repeat prescribing process with a dedicated approach to medication review has led to a 50% reduction in prescription workload

“Soar Beyond has co-ordinated a proactive approach to support our practice to implement a pharmacist led programme, to develop a systematised repeat prescribing process including a proactive medication review & QOF process which has significantly reduced the entire practice prescription workload by 50% not only for the pharmacists but also our practice admin. team. We are now able to recommend and replicate a process across the PCN”

 Meena Thakur, Clinical Lead, East Harrow PCN

Oxfordshire Productivity Case Study

Summary

• Practice keen to recruit but not sure where to start
• No previous experience of working with pharmacists
• Requested help from Soar Beyond with a 4D Strategy Workshop and recruitment support
• Pharmacist recruited with clarity of role and deliverable’s from the start

Situation

Three practices in Didcot joined to form Didcot Primary Care Network with a patient population of over 43,000. Despite the practices being local to each other, each practice had different population needs. Although they had good informal relationships, they had no previous experience of working together in an organised way.

The practices all had:

• similar issues regarding workload and capacity
• a good mix of healthcare professionals and a desire to work closely to make the PCN structure successful for their staff and patients
• a clear rationale for investing in a pharmacist with the funding available; however,

None of the practices had any previous experience of working with a pharmacist other than CCG practice-based pharmacists

There were concerns that the PCN’s lack of experience and knowledge of background, skills, and training of a clinical pharmacist could lead to common pitfalls they were hearing from other PCNs and they didn’t want to recruit the wrong candidate for their PCN needs.

Task

The PCN needed to recruit and employ an effective pharmacist who could hit the ground running and start prescribing, running medication reviews, and delivering the income generation and clinical requirements of the directed enhanced service in an equitable way across the three practices. PCN staff sought external expertise from Soar Beyond, to accelerate the process and guide them.

Action

Soar Beyond ran a facilitated diagnostic session in July 2019 with participation across the three practices. This session helped staff to:

• understand what the practice pharmacist can do and how they would add value
• collate the needs of the individual and collective practices, and manage practice expectations
• identify the specific skillset of the clinical pharmacist they wanted to recruit. Staff decided that the candidate needed the leadership skills to work autonomously so that they would require less intensive support.

The PCN therefore sought a more senior pharmacist with an existing independent prescriber qualification and relevant experience to support and drive the PCN agenda, even though this would require additional ‘top-up funding’ by the practices. Staff outsourced the recruitment and support to Soar Beyond to ensure they would find the right candidate.

Soar Beyond supported the practice by:

• advertising to attract a clinical pharmacist with the right skillset, as well as screening and testing candidates for fit with the defined criteria
• designing and leading a rigorous needs-based interview with GP participation
• helping the PCN to sell the role to potential pharmacist candidates
• supporting the PCN to employ and agree suitable terms and conditions.

Result

After a thorough screening and interview process, a suitably experienced candidate was interviewed in September 2019 with an offer made to start work in January 2020. The delay in start date was due to a lengthy notice period, which is typical for skilled professionals—something that should be considered when beginning recruitment.

The benefits for the PCN, practices, and pharmacist included:

• clarity of expectations and deliverables among practice staff
• a clear and structured 90-day induction plan with agreed KPIs aligned to the PCN’s needs and priorities, such as streamlining the repeat prescribing process across practices
• a structured development plan aligned to PCN’s goals and to the pharmacist’s existing competencies
• a supported pharmacist, without the practice being overburdened, who is well placed to upskill the remainder of the clinical and non-clinical team members
• access to the Soar Beyond SMART platform, which includes a suite of online resource, toolkits, and other implementation resources to enable the pharmacists to roll out new processes efficiently and effectively, without having to ’reinvent the wheel’.

The PCN has commissioned additional senior pharmacist support from Soar Beyond to provide regular coaching calls to ensure development and progress is kept on track through KPI reporting and deployment of milestones.

Conclusion

Although the whole process took 6 months, this was accelerated using external support and expertise, and prevented Didcot PCN encountering common pitfalls experienced by other PCNs, such as taking on inadequately experienced pharmacists or those that require significant support and supervision.

‘Working through the recruitment and induction process with the support of Soar Beyond has been strategically invaluable in terms of aligning my vision and values with those of the PCN Clinical Director and member practices. In my experience so far, this very alignment is crucial in effectively delivering the PCN Pharmacist role at scale.’ 

Ziad A Laklouk; PCN Pharmacist, Didcot PCN

South East Oxford PCN Pharmacy Team Strategy

Summary

• PCN keen to grow pharmacy team
• Struggled to recruit following two rounds of recruitment activities
• Requested a consultation and demo from Soar Beyond
• Vision and strategy in development and recruitment underway with one post already filled

“We requested a consultation and demo from Soar Beyond and we immediately saw how they could help. Through their support I could see we could bring the PCN together to have a shared vision of what the pharmacy team could deliver to improve workload and capacity for the clinical team but to also improve standards and patient care.

We initially commissioned them to support with recruitment and the 4D Strategy Workshops but subsequently also took on the SMART platform to enable and empower our senior pharmacist to take a lead on service delivery. With KPI monitoring and development planning modules it would support the pharmacists regardless of previous background and training ensuring a standardised approached to delivery.

We have so far successfully recruited one pharmacist and Soar Beyond are working hard to fill the other two roles to meet this years target. We are in the early days of using the platform but the initial strategy session has provided focus and we are looking forward to the second in the series.”

Dr Kathryn Brown

GP and PCN Clinical Director, South East Oxford Health Alliance PCN