Prescribing context, benefits, dilemmas and challenges

Liz Plastow

Medicines Management Lead

NMC

Context of Strategic Change

Policy Initiatives – Darzi Review, PBC, WCC, MNC

Reforming NHS Patient Choice Plurality of Provision Patient Led Care Workforce Developments – modernisation Career Developments and changes

Future Service Provision

First Contact and Urgent Care Long Term Conditions Specialist and Restorative Services Public Health

Commissioning for Change

Getting the right mix of services to meet needs and preferences of patients

Seeking views of patients Understanding concepts cost-benefit,

productivity, opportunity costs, developing workforce!

Addressing health inequalities Familiarity with commissioning frameworks

and tools!

Services –future?-Patient Driven Longer GP opening times and when

needed? Community centred services –

Children’s Centres, WIC’s and LTC’s High St Diagnostics One Stop Shops New providers – social enterprise,

voluntary and independent sector!

Why Now?

2020 twice as many people >85 yrs 15 million with one or more LTC- Account for 50% Primary Care

Consultations, 75% inpatient days, high use urgent/emergency care

Desire – personalised services 15% H/Care budget and rising – 13.1

prescribed items per person 2003 up by 40% over previous decade

Extension of Prescribing Rights Timely Provides alternatives Improves access and choice Reduces travelling – patients and staff Selling point for organisations Must be seen – wider context –

conformance, reactions, health changes, life style changes

Benefit to Patients

Immediate and timely Reduction in number staff involved Improves continuity of care Empowers patients- concordance Skills workforce – confident ,

competent and capable

Accountability

Prescribing pts –LTC, multiple pathology/ morbidity, mental health?, and closer to home?

Acute care skills working outside hospitals Skill mix Clinical supervision Develop advanced competencies Providers in own right?

Ethical dilemmas

Patient led? Patient demands? Contractual obligations – plurality

provision Choice requires options Demonstrating value for money Risk assessment Clinical governance

Why continue?

Leading the way Enables flexible services and flexible

working Supports multi-disciplinary working Encourages shared learning Enables modernisation clinical

careers – MNC Career pathways

It’s a Celebration!

Well done! Where to now? As professional groups where to

now?

The future!

Performance Management Staff appraisal Risk assessment Clinical governance CONTINUING PROFESSIONAL

DEVELOPMENT