Partnership case studies

Betsi Cadwaladr University Health Board Pharmacy & Medicines Management Clinical Programme Groups (CPG) Partnership Working Initiative

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Project rationale

Each University Health Board in Wales has a statutory duty to develop a three year strategic plan.

Betsi Cadwaladr University Health Board is the largest health organisation in Wales, providing healthcare services to a population of around 676,000 people across the six counties of North Wales, as well as some parts of mid Wales, Cheshire and Shropshire. It employs around 16,100 staff and has a budget of around £1.2 billion.¹

The financial and operational challenges of 2013/14, together with the introduction of more robust planning required new ways of working and new ways of thinking.

In order to ensure that the University Health Board’s strategic plan was robustly developed and successfully delivered, there was an additional need for the development of operational plans at a Clinical Programme Group (CPG) level.

To support the University Health Board’s three year strategic plan, the Pharmacy & Medicines Management CPG along with other CPGs within the organisation were charged for the first time with the development of their own strategies and plans.

The aim of this externally facilitated project was to support the CPG in the process of developing their one year operational plan and to begin to consider what was required to develop three year rolling strategic plans.

Desired Outcomes
 

• Development of a one year operational plan for 2014/15
• Begin to consider the CPG strategic priorities for the next three years

Agreed objectives
 

The objectives of the project were aligned to:

• Achieving the priorities defined within the University Health Boards three year strategic plan
• Prudent healthcare principles
• Redesign and improvement of patient pathways
• Financial and service sustainability
• Achievement of some of the CPG’s £8 million efficiency targets

Facilitation methodology
 

The facilitators led four dedicated sessions over the 13 months of the project

• three one day events
• one intense two day solution focused thinking event

The CPG team were set a task of developing their plans based on; MUST DO IMPERATIVES ONLY 
This challenged historical ways of working at both an individual and team level

The facilitators supported the team in:

• Agreeing four priority areas for 2014/15 – condensing their original list of over 30
• Developing robust enabling plans to support implementation
• Working at pace and at scale

The facilitators encouraged the CPG team to:

• Challenge historical ways of thinking
• Develop integrated plans that spanned the entire system supported by the CPG not just discreet areas of it i.e. community and acute teams, manufacturing and acute teams worked together for the first time
• Work on fewer more achievable priorities
• Develop plans that were truly patient centered
• Develop plans that delivered sustained long term improvements

The facilitators consistently:

• Challenged the achievability and delivery of the CPG plans
• Encouraged the CPG team to look beyond the obvious whilst always concentrating on the imperatives

Outcomes achieved
 

The project delivered more outcomes than were initially planned

Quantitative

• Development of a one year operational plan for 2014/15
• Delivery of 60% of the targets set out in the plan for 2014/15
• Development of a three year rolling strategic plan for the CPG
• Development of an outline operational plan for 2015/16

Qualitative

• Realignment of operational and strategic priorities
• Introduction of a new way of working
• Establishment of an ‘imperative led’ decision making framework
• Establishment of a peer review approach to all of the CPG plans has led to the delivery of leaner, achievable integrated plans

Innovative ways of working moving forward

The approach;

• Was applied to all operational activities of the CPG
• Supports the CPG to think, plan and implement rapidly
• Can be applied to other CPGs within the University Health Board

Benefits
 

For the Betsi Cadwaladr University Health Board:

• Delivery of a realistic and achievable operational plan for the CPG
• Establishment of a new way of working that encourages a bottom up led, top down supported approach
• Allows for better informed planning

For the Pharmacy and Medicines Management Clinical Programme Group

• Development of robust and achievable operational and strategic plans
• Delivery of CPG efficiency targets
• Delivery of CPG key performance indicators
• Ahead of plan development of 2015/16 operational plan
• Ahead of plan development of 3 year rolling strategic plan
• Development of integrated plans that span the entire system
• Ownership of the CPG plans and delivery schedules

For the wider NHS, this approach

• Is totally transferable to other NHS organisations
• Encourages long term service improvement
• Ensures achievable priority setting
• Supports higher success of achievement
• Encourages the sharing of best practice

Teva UK

• Delivery of a successful partnership working initiative with the NHS in Wales
• Adopting an innovative approach to provide solutions to address local challenges for the NHS
• Engaging external facilitators to encourage a creative way of thinking and doing

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References

[1] http://www.wales.nhs.uk/sitesplus/861/page/40836, website last accessed 9/10/15

Be Medicine Aware

Teva UK Limited and NHS East Riding of Yorkshire Partnership Project Case Study 

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This is a case study of how NHS East Riding of Yorkshire worked in a local partnership with the Teva Integrated Healthcare Manager and Teva UK Limited to address the issue of medicine wastage.

Project rationale

A report by the Department of Health estimates that unused medicines cost the NHS around £300 million every year, with an estimated £110 million worth of medicine returned to pharmacies, £90 million worth of unused prescriptions being stored in homes and £50 million worth of medicines disposed of by Care Homes.1

NHS East Riding of Yorkshire identified significant areas of medicines wastage in the local area, which if it was addressed successfully could save the NHS around £500,000 per annum.

The local PCT identified that the main population groups responsible for the over ordering of medicines are younger mothers and those over 60 years of age.

• It was suggested that these cohorts do not pay prescription charges and they often order their medication on an ongoing, monthly basis
• In some cases it was noted that elderly patients do not like to tell the GP they are not taking their medication and do not like to stop ordering it for fear of being ‘told-off’ by the doctor

Agreed objectives

The objectives of this Be Medicine Aware campaign was to:

1. Reduce the amount of repeat prescribing across NHS East Riding of Yorkshire
2. Make patients aware that using their medication correctly will make them feel better
3. Encourage patients to ask themselves “do I need this medication?" before they tick the box on their repeat prescription slip
4. Increase awareness that patients can talk to their local pharmacist for help and advice

Desired outcomes

• A monthly increase in Medicine Usage Reviews (MUR) completed on patients over the age of 60, young mothers and or pregnant women aged 18 or older in NHS East Riding of Yorkshire
• A reduction in overall repeat prescriptions dispensed to patients over the age of 60, young mothers and or pregnant women over the age of 18 in NHS East Riding of Yorkshire

Partnership with Teva UK Limited

In order to achieve these outcomes, NHS East Riding of Yorkshire worked in partnership with Teva UK Limited as they provided:

• Project management and communication skills
• Experience of delivering health awareness campaigns
• Expertise in working with creative agencies to develop the advertisements and posters
• A local integrated healthcare manager to co-ordinate the initiative and be a source of contact for all stakeholders involved

Both the NHS and Teva UK Limited abided by the relevant regulatory bodies and guidance, including the ABPI Code of Conduct.

Benefits of the partnership

This project demonstrated a successful partnership approach to address a significant public health issue facing the local health economy.

This partnership project provided a high profile campaign that strengthened public relations between the NHS, Teva UK Limited and local patients.