NHS Healthchecks Phase One Pharmacy Service Specification v7 1
PCT SERVICE SPECIFICATION (Community Pharmacy)
Name of Service: NHS Health Checks Phase One (Scarborough).
This service specification is for Phase One of NHS Health Checks in NHS North Yorkshire and York. It is a pilot and therefore this service specification should not be assumed to be that which would be rolled out across the whole of North Yorkshire.
Because this programme is a pilot, the detail of the processes described in this service specification will be reviewed on an ongoing basis. Any changes, if made, would be to ensure that the programme processes improve, and would be made in consultation with providers.
Up to three community pharmacists in the target wards will be encouraged to participate in Phase One. Where there are more community pharmacists interested in providing this service, accessibility (geographical, physical and opening times) will be taken into account.
It is hoped that providers help shape the programme so that it is effective and achieves its aims.
SERVICE PROVIDERCommunity Pharmacists in the target wards (Castle, Eastfield, Falsgrave Park, North Bay, Ramshill and Woodlands)
BACKGROUND
Vascular disease includes coronary heart disease, stroke, diabetes and kidney disease. It currently affects the lives of over 4 million people in England. It causes 36% of deaths (170,000 a year in England) and is responsible for a fifth of all hospital admissions. It is the largest single cause of long-term ill health and disability, impairing the quality of life for many people. The burden of these conditions falls disproportionately on people living in deprived circumstances and on particular ethnic groups, such as South Asians. Vascular disease accounts for the largest part of the health inequalities in our society.
In April 2008, DH published its plan for a systematic, integrated approach to assessing risk of vascular diseases for everyone between 40 and 74, followed by the offer of personalised advice and treatment and individually tailored management to help individuals manage their risk more effectively. It concludes that it is both clinically and cost effective way to enable more people to be identified at an earlier stage of vascular change, with a better chance of putting in place positive ways to reduce substantially the risk of premature death or disability
Local work has identified that CVD is the disease group which contributes the greatest to health inequalities in North Yorkshire & York PCT. This work has identified steps needing to be taken to help prevent CVD in these practices, including primary prevention. Targeted action like this will help the PCT achieve its aim to reduce health inequalities.
AIMS
The main aims of the programme are;
o To reduce the number of premature deaths from CVD related conditions across the region
o To reduce the incidence of related vascular conditions
o To reduce inequalities in incidence and premature death rates of CVD related conditions across the area
To offer appropriate lifestyle interventions and treatment as necessary
WHAT SHOULD THE SERVICE PROVIDE
NHS Health checks are made up of three elements;
Element One – Identification of Appropriate patients and Invitation for Screening
Elements Two - Carrying out the Health Check
Element Three - Follow Up and Long Term Management
Community pharmacists will be involved in delivering Element 2 of the healthcheck i.e the assessment , including communication of the findings to the patient and their GP practice and signposting services which offer interventions and advice to address identified risk factors.
Pharmacies providing this service are responsible for and should be able to demonstrate that they;
· Have the required competencies to perform assessments and, where appropriate, evidence of participation in a PCT approved educational event
· Have clear lines of responsibility and accountability for quality of clinical care, comprehensive programme of quality improvement activity, clear policies aimed at managing risk, procedures for identifying and managing poor performance
· Ensure that the patient has received, read and understood the patient information leaflet.
· Explain the purpose of the tests, when and how the results will be communicated and what happens next to the participants
· Carry out the required screening tests as detailed in the pathway in a face to face setting
· Assess, identify and record overall risk factors of individuals in an agreed format, using an agreed scoring tool (JBS2 or Heart UK calculator) on an agreed tenmplate.
· Provide and maintain any/all equipment to the appropriate standard. There will be an initial 6 month loan period for Point of Care blood testing (POCT) equipment. Following this, and the results of the evaluation, the pharmacy may be responsible for providing, maintaining and replacing all POCT equipment.
· Liaise with clinical biochemistry services and other local health professionals as necessary
· Ensure that full details of the assessment, findings and advice and information given is sent to the patient’s GP practice within 2 working days (ideally delivered ASAP) and a copy given to the patient.
· Clearly communicate information about risk factors for CVD to patients where appropriate
· Advise patients of potential pathways and interventions as appropriate
· Promote healthy lifestyle using the PCT’s Staying Healthy internet pages and Health Trainer Service as a resource
· Are proactive in reducing the inequalities in CVD risk identification and management and monitor uptake to ensure that health inequalities are reduced not increased
· Identify likely barriers to local participation and develop strategies to help overcome them.
· Liaise with other key stakeholders to ensure that concerns are discussed and managed in a timely fashion and that information on uptake/trends is shared
· Respect patient confidentiality and provide services which comply with disability legislation and all nationally and locally agreed guidelines
· Receive, store and transfer information in accordance with the data protection act and the NHS code of confidentiality
· Maintain full record of the NHS Health Check service including evidence of patient consent
PATHWAY
Element Two
Patients presenting for assessment should have evidence of invitation for a NHS Health Check and personal identification. Pharmacies may offer on the day assessment or choose to offer assessment by pre booked appointment only. Invitations should be validated to prevent patients obtaining more than one assessment.
Assessment
The assessment, which should be face to face, should include a record of:
· Age
· Gender
· Ethnicity
· Smoking habit/ status
· Family history of CVD including CHD and diabetes)
· Measurement of height, weight and BMI
· Blood Pressure – systolic and diastolic blood pressure measured on at least 2 occasions using the British Hypertension Society Guidelines and appropriately calibrated devices.
· HbA1C or Fasting Plasma Glucose tests for patients at high risk of diabetes (if BMI>30 OR BMI >27.5 from Indian, Pakistani, Bangledeshi, Other Asian and Chinese ethnic groups OR systolic BP >140mmHg OR diastolic BP > 90mmHg). Other individual factors including family history of diabetes should also be taken into account when deciding to screen for diabetes or not. Point of care testing (POCT) of random glucose or HbA1C may be used to provide a one stop service but should not be used to confirm the diagnosis of diabetes. Where blood glucose levels are high but not in the diagnostic range for diabetes, participants will be offered a HbA1C or an oral glucose tolerance test by their GP
· Random Total Cholesterol and HDL levels with HDL cholesterol ratio
· Blood tests for lipid and glucose profiles – providers should not insist on fasting levels if it is felt that this might compromise participation in the scheme
· Patients whose initial blood pressure is ≥ 140/90mmHg should be offered serum creatinine tests – this would ideally be collected at the first face to face appointment and sent for analysis. Where the facility to collect at the appointment is not available, the patient will be referred to their GP for further assessment
Patients may be asked to fill out a questionnaire detailing some of this information prior to attendance for the screening assessment.
The ten year risk of developing CVD should be calculated using the JBS2/ Heart UK methodology with adjustments for family history and ethnicity.
Patients will be classified into one of the following categories:
· High risk is defined as 20% or over risk of developing cardiovascular disease in the next ten years
· Medium risk is defined as 10% to < 20% risk of developing cardiovascular disease in the next ten years
· Low risk is defined as <10% risk of developing cardiovascular disease in the next ten years
The risk score of the individual patient will be communicated to the patient.
Brief personalised evidence based lifestyle advice (see NICE references below) should be given to all patients with lifestyle risk factors including: smoking cessation, increasing physical activity, healthy eating, weight management. This should be communicated using methods appropriate to the individual, including written information leaflets, verbal advice and internet resources including the PCT’s Staying Healthy internet pages. Patients may also be referred to the Health Trainer Service The type of advice given should be recorded.
Information from the assessment should be recorded on an agreed template and sent to the patient’s GP practice within 2 working days, with a copy given to the patient.
The service should ensure that patients understand the purpose and format of the assessments, how and when the results will be communicated and what happens next.
The pathway is summarised in Appendix 3
GOVERNANCE
The service should have protocols in place to ensure that , as a minimum, the standards in the following areas can be met;
Staff
Persons providing the service should ensure that they have:
· Basic knowledge of the cardiovascular disease
· Basic knowledge of the NHS health check programme
· Must be trained and certified to use the equipment specified
· Those involved in taking lipid measurements must be able to take finger prick blood samples and be able to understand the associated health and safety issues
· Follow the operating instructions of the device used and be aware of the consequences of improper use
· Be able to undertake the appropriate calibration and quality control processes
· Be able to interpret the results, understand the limitations of the results and be able to explain the results to patients
· Maintain comprehensive results
· All personnel involved in the process should understand the importance of professional conduct, the confidential nature of personal health information and the importance of accurate record keeping
· Keep a record of errors and demonstrate that action has been taken to avoid re occurrence
· Have up to date hepatitis B cover
· Know what procedure to follow in case of emergency or adverse event including needle stick injury and handling of clinical waste/spillages
At each stage of the process, a service co-ordinator, who has overall responsibility for overseeing the scheme, should be identified
Equipment
· Must be CE marked, fit for purpose and externally accredited or validated
· A device that has been validated to the British Hypertension Society standard must be used for taking blood pressure
· Blood pressure monitoring devices must be properly maintained, validated and regularly calibrated according to manufacturers’ instructions
· Lipid analyser used must be CE marked under the in vitro diagnostics medical devices directive
· Lancing devices used to obtain finger prick blood samples must be a single use disposable system or designed for multiple patient use
· All consumable must be stored in accordance with the manufacturer’s submission and batch numbers and expiry dates should be recorded.
Premises (responsibility of community pharmacist)
· Must be large enough to accommodate the equipment and have adequate access to facilities including running water or hand washing facilities and a computer terminal. The criteria for premises for Medicines Usage Reviews (MUR) must be met.
· Must have facilities for safe disposal of sharps (NB sharps boxes and collection will be provided by the PCT)
· Must comply with NHS infection control standards
· Must reflect a professional image and provide aural and visual privacy
Healthchecks should not be carried out in areas where food or drink is consumed
Blood monitoring should be carried out in an area designed for that purpose
REDUCING HEALTH INEQUALITIES
Pharmacies should be aware of the need to reduce health inequalities through this programme. They should be able to demonstrate actions they are taking to increase opportunities for accessing the service and to increase the number and types of format used to advertise the service.
Pharmacies should liaise with the other key stakeholders to maximise participation and develop opportunities to involve hard to reach patients and ensure that concerns are reported in a timely fashion
AUDIT
Pharmacies will be required to provide all the data set out in the performance monitoring section of this specification. In addition to that, there will be a requirement to take part in regular audit to ensure that the PCT is fulfilling its requirements including:
· Evidence that seldom seen/seldom heard patients, the vulnerable (e.g. patients with SMI, LD, homeless) have been included
PERFORMANCE MANAGEMENT
Purpose
The health checks programme is expected to improve the PCT’s performance in the following vital signs as recorded in annual monitoring;
· The all age all mortality rate per 100,00 population
· The CVD mortality rate amongst people under 75 years of age
· Implementation of the Stroke strategy
· Smoking prevalence in people aged 16 and over in routine an manual groups
· Healthy Life expectancy at age 65
· The proportion of people where health affects the amount/type of work they do
Requirement
The following data will be required from pharmacies:
· Number of patients who attended the pharmacy for their NHS Health check in last 3 months
· Percentage who attended the pharmacy for their NHS Health check in the last 3 months who have a ≥20% risk of developing CVD in the next ten years
· Percentage who attended the pharmacy for their NHS Health check in the last 3 months who were offered advice or information on (1) smoking, (2) physical activity, (3) weight management, (4) healthy food
· Percentage of patients who attend the pharmacy for their NHS check in the last 3 months whose results are conveyed to the GP within 2 working days
The clinical information proforma (Appendix 4) for manual returns. The completed form is to be sent to the patients GP and a copy sent to the PCT’s performance team with the patient name and address removed to comply with information governance legislation.
The preferred submission route is electronically via email to FAO John Watson. Template requests should be made to the same email address.
NATIONAL REQUIREMENTS TO BE FOLLOWED
· Putting Prevention First – NHS Health Check: Vascular Risk Assessment and Management Best Practice Guidance, Department of Health, April 2009
· National Service Frameworks for CHD, Diabetes and Renal Disease
· NICE Clinical Guidance CG73 - Early identification and management of chronic kidney disease in adults in primary and secondary care – Sept 2008
· NICE Public Health Guidance PH1002 - Four Commonly used methods to increase Physical Activity – March 2006
· NICE Clinical Guideline CG43 – Obesity – December 2006
· NICE Public Health Guidance PH01- Brief Interventions and Referrals for Smoking cessation in primary care and others settings –March 2006
· NICE Clinical Guideline 34 – management of hypertension in adults in primary care. Partial update – June 2006
· NICE Technology Appraisal 94 – Statins for the prevention of cardiovascular events – January 2006
· Handbook to Vascular Risk Assessment, Risk Reduction and Risk Management – UK National Screening Committee – 2008
· National Stroke Strategy – Department of Health
· Clinical Governance in Community Pharmacy – Guidelines for Good Practice for the NHS – Department of Health
FINANCE
A one off “sign up” payment payable upon completion of PCT accredited training (up to 2 people per pharmacy to complete the training to qualify) - £250 per pharmacy not per person. To claim this payment please submit an invoice to:
XX Bruce Willoughby
North Yorkshire & York PCT
5NV Payables 6675
Phoenix House
Topcliffe Lane
WAKEFIELD
WF3 1WE
VAT – please note this is outside the scope of VAT and should not be included in invoices.
Element 2: Assessment phase
Per assessment carried out at a community pharmacy - £23
(NB this figure includes the costs of consumables for POCT machines which must be purchased by the provider)
To claim this payment please submit an invoice, on a monthly basis, detailing the number of assessments carried out (which should agree with the number of performance report forms returned that month) to:
XX Bruce Willoughby
North Yorkshire & York PCT
5NV Payables 6675
Phoenix House
Topcliffe Lane
WAKEFIELD
WF3 1WE
VAT – please note this is an ‘exempt’ service for VAT purposes so VAT should not be applied to invoices.
SPECIFICATION DATE, REVIEW DATE, AND LEAD NAME/JOB TITLE
v7 10 June 2010
Review March 2011
Bruce Willoughby, Consultant in Public Health, NHS North Yorkshire and York
Appendix 1 – sign up sheet