Month: August 2023

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Preventing cardiovascular diseases

We adopted a systematic strategy to identify primary and secondary prevention of cardiovascular disease which resulted in enhanced lipid therapy, lifestyle advice and a 65% patient satisfaction rate.

Background

Lakeside Healthcare Group, a multi-site GP partnership in Cambridgeshire, Lincolnshire and Northamptonshire, secured funding to review more than 1,000 at-risk patients for primary and secondary prevention of cardiovascular disease (CVD). They asked NHS Midlands and Lancashire CSU (MLCSU) to identify high-risk patients, offer lifestyle advice, and undertake remote clinical reviews to optimise their lipid therapy using NICE-approved pathways.

Action

Our Medicines Management and Optimisation Team developed a standard operating procedure incorporating standardised review templates, structured clinical vocabulary, and treatment recommendations in line with the latest NICE pathways, guidance and evidence.

We used pathway searches to identify and risk-stratify patients – to determine the most appropriate intervention and care management based on their cardiovascular status, level of risk and priority. High-risk patients were prioritised and offered remote consultations with a pharmacist.

A patient-centred approach and shared decision-making principles resulted in patients being offered lifestyle advice, compliance advice, and/or a review of their lipid therapy. The team were keen to improve prevalence coding, and the accuracy of the information in practice registers whilst also ensuring to equip the primary care network team with the tools and processes required to continue identifying and reviewing at-risk patients.

Impact

1,311 patient reviews were completed from October 2021 to November 2022 – resulting in the optimisation of lipid therapy for 72 patients. 128 patients received lifestyle modification advice, and 15 were advised about their current lipid medications.

A patient satisfaction survey was offered to 137 patients, and 65% of respondents stated their experience with their lipid medication review was either good or very good.

Adopting a systematic strategy for identifying primary and secondary prevention CVD patients who require optimisation of lipid-modification therapy contributes significantly to reducing CVD cases. It improves population health, reduces health inequalities, and mitigates against escalating demand and costs leading to unsustainable pressures on the health and care system.

As a direct result of this project, patients were initiated on or had their lipid-modification therapy optimised as appropriate. A sustainable legacy was passed onto the local primary care network team to enable them to competently deliver lipid medication reviews going forward.

Feedback

The PCN Pharmacy team will implement the learning and continue developing the service to improve patient care. We hope to work with MLCSU on future projects.

Arvind Thandi, Head of Pharmacy and Dispensary Lakeside Healthcare, Lakeside Healthcare Group

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Blog: is Gen Z going to be the answer? 

As numerous 16 and 18 year olds in England receive their GCSE and A level outcomes, we have been contemplating whether the NHS features in the future plans of individuals from Generation Z as they step into the next stage of their education or enter the world of work. Within this blog, we delve into the Train element of the NHS Long Term Workforce Plan, by investigating the potential of Gen Z as the answer to our workforce challenges.

Since the release of the Plan, discussions surrounding recruitment strategies and the need to attract younger generations, particularly Gen Z, have been gaining attention. With an aging workforce, low unemployment rates, projected healthcare worker shortages, and skills gaps, it is crucial for the NHS, as the largest employer in the UK, to explore ways to appeal to the talent it urgently requires.

By 2025, nearly 40% of the working-age population will consist of individuals aged 18 to 24, whose expectations differ greatly from the previous baby boomer generation. Gen Z is the most ethnically diverse cohort, born into a technology-driven world, and highly concerned about issues like climate change, shifting finances, and the impact of Covid-19. They prioritise purpose, accountability, social progression, and seek a more balanced economic landscape. Health and wellbeing, with emphasis on mental health, and work-life balance are also important to them. In pursuit of this Gen Z expect to have high levels of flexibility, variety and opportunity for part-time work, secondments, sabbaticals portfolio roles and other similar opportunities.

Considering this profile, one might assume that careers in the NHS would be appealing to Gen Z. However, engagement efforts are falling short, and the employee value proposition (EVP) is not speaking to this generation. To bridge this gap, we must focus on strategies like strengthening our online presence, utilising digital promotion, and forging partnerships with local authorities, social housing, education, and the voluntary sector at a system or regional level. Understanding the desires and needs of this talent pool is crucial, with a shift towards emphasising equitable and varied opportunity, sustainability, climate change initiatives, flexible and agile work options, varied career paths, and comprehensive health, wellbeing, and financial inclusion support.

Merely capturing interest through an enhanced EVP and engaging platforms like TikTok is not enough. The NHS must ensure a streamlined, digitally enabled, and mobile-friendly application process that is efficient and offers interactive content during onboarding. Managers need to comprehend Gen Z’s motivations, work preferences, and expectations of success. Accessible on-the-job skills development opportunities should be maximised, avoiding unnecessary prerequisites for roles. An agile, creative, and collaborative approach to job design and delivery is vital to attract, train, and retain the next generation of NHS heroes. In essence, the NHS must embody its new EVP and live up to its promises.

NHS Midlands and Lancashire CSU (MLCSU) is actively embracing new ways of working to foster inclusivity and responsiveness as a key part of its culture. As part of this progressive mindset, we are evolving our recruitment approach to bolster our ability to attract and retain exceptional talent including these new entrants to that talent pool. Key outcomes will encompass the development of an evolving EVP that resonates with the changing needs and expectations of prospective employees. MLCSU will also integrate new technologies and automation into its recruitment processes, while expanding on traditional selection and assessment methods. The overarching aim is to create a more inclusive, efficient, and enjoyable candidate experience, and of course to attract some of those Gen Z heroes!

Contact us to see how MLCSU can help you.

A blog by Adam Burgess-Evans, Deputy Director of People at MLCSU.

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Improving the safety of patients prescribed clozapine

Our partnership with a local mental health trust resulted in advancements in addressing inadequate clozapine documentation, leading to improved patient safety, optimised medication processes, and quantifiable cost savings.

Background

NHS Midlands and Lancashire CSU’s Medicines Management and Optimisation Team collaborated with a local mental health trust to address the issue of inadequate documentation of clozapine, a high-risk medication, in primary care patient medication records. This posed significant risks to patient safety, including missed drug interactions, overlooked side effects, and compromised transfer of care. The team aimed to improve the quality and safety of care for patients prescribed clozapine.

Action

A comprehensive review of patient records was undertaken, and measures were implemented to address the issue. The team audited 220 patient records and added clozapine where it was absent. A safety protocol was developed and integrated into the prescribing systems of all local GP practices to alert clinicians about the potentially fatal complications of clozapine treatment.

The team collaborated closely with the mental health trust, information technology colleagues, clinical pharmacists, and prescribing system specialists to ensure accurate documentation and effective implementation of the safety protocol.

Impact

The project implementation had the following outcomes:

  • Enhanced patient safety: Initially, 36% of patients prescribed clozapine lacked proper documentation in their records. By including clozapine information for all 79 patients, the team achieved 100% visibility of clozapine prescriptions in primary care.
  • Correct medication positioning: All 220 patients had clozapine accurately positioned as a ‘hospital-only repeat’ medicine, effectively preventing unintended primary care prescribing.
  • Improved awareness and management: Integrating the clozapine safety protocol into the prescribing systems of 50 GP practices led to better awareness and management of clozapine-related side effects and drug interactions.
  • Enhanced collaboration: This implementation led to improved collaboration and communication between the team and the local mental health trust, resulting in the adoption of similar initiatives for other high-risk medications.
  • Reduced risks: The project significantly decreased risk associated with care transfer, inadvertent prescribing errors and missed side effects of clozapine treatment.
  • Quantifiable value: The team assessed the value of these safety improvements at £11,297 for the financial year, in terms of lowered risk of harm and prevention of hospital admissions.

The project was shortlisted for improving medicines safety category at the 2023 HSJ Patient Safety Awards.

Feedback

The prescribing system safety protocol is certainly noticeable and has alerted me to consider the potentially fatal side effects of clozapine treatment when I am reviewing my patients.

GP Partner

This collaborative initiative enhances the care provided to patients prescribed clozapine by upskilling primary care colleagues, bolstering key safety messages at the time of prescribing and ensuring patients in need are escalated to specialist mental health services in a timely fashion.

Associate Director of Pharmacy | Mental Health Trust

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Improving outcomes for vulnerable residents in Lancashire and South Cumbria

Our Business Intelligence team’s data-driven approach led to: improved care access, lowered acute service demand, and empowered patients, making a positive difference for vulnerable residents in Lancashire and South Cumbria.

Background

NHS Midlands and Lancashire CSU (MLCSU) was approached by Lancashire and South Cumbria Integrated Care Board to improve outcomes for the most vulnerable residents during the winter season. Sixty-eight per cent of the targeted cohort continued to experience unmet needs leading to inadequate support or referrals.

Action

To achieve the project’s goals, we used our established infrastructure, specialised skills, expertise, and vision to produce actionable insights. We focused on the prevalence of respiratory conditions in Central Lancashire by using health inequalities and population health management segmentation tools to create a target cohort. Responding to national direction, Core20PLUS5, the project team collaborated with service leads, analysed local data flows, and employed geographical views of data to benchmark across geographies.

The Winter Respiratory High-Risk project aimed to reduce the demand for acute services and admissions and identify unmet needs and address them. To identify wider determinants, the Business Intelligence team used Acorn Geo-segmentation tools which helped improve access, experience, and outcomes for the targeted cohort, and led to disease and medication reviews, immunisation offers and social prescribing.

Impact

MLCSU established a dedicated help desk and provided training support for staff, ensuring data quality through data warehouse processes, and linking primary and secondary care data. The team was able to capture additional patient activities, such as flu vaccinations, and update patient records with a long-term condition diagnosis, enabling referrals to support services.

The Winter Respiratory High-Risk Project identified that fifty-two per cent of the targeted cohort had multiple support needs, emphasising the importance of addressing unmet needs. We also shared best practices from other areas and applied lessons learned to refine the process, leading to an improved experience and better outcomes for the targeted cohort. The client was provided secure access to Information Governance compliant patient data, ensuring data protection and privacy. This initiative played an essential role in reducing the demand for secondary care and lowering morbidity rates, empowering patients to manage their health conditions more effectively.

Simultaneously, the average proficiency of individuals in managing their own health and well-being – measured through a Level 3 status – underwent a remarkable transformation. Starting from an initial low-end Level 2 status, which signifies individuals struggling to understand their role in healthcare, we successfully elevated their perception to an empowered Level 3 status. This designation signifies individuals who recognise their integral role in their care journey and possess the knowledge to proactively engage in self-care.

Feedback

“The MLCSU Business Intelligence Team were an integral part of our respiratory work. The team made time to work with us to fully understand the project requirements and desired outcomes. This allowed the team to make suggestions relating to the selection of appropriate cohort criteria, to ensure the project targeted those most vulnerable and most at risk. One project requirement was to enable members of the Primary Care Network to generate patient cohort lists – The BI Team were able to streamline this process by creating pre-set filters and guidance documents, ensuring buy-in from the Primary Care Network.”

Naomi Coldham,  NHS Lancashire & South Cumbria ​Integrated Care Board

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Inhaler prescribing errors: risks and patient safety

We improved patient safety and raised awareness across GPs, hospitals and community pharmacy of the risks of prescribing inhalers containing duplicate ingredients from the same drug group by identifying patients who were prescribed and using duplicate inhalers and highlighting the side effects this caused.

Background

Inhaler prescribing errors are frequently overlooked, leading to duplicate inhaler ingredients from the same drug group being prescribed and an increased risk of adverse effects for the patient. The NHS Midlands and Lancashire CSU’s Central Lancashire medicines team conducted an audit to determine the scale of inhaler prescribing errors and identify patient harm. The team aimed to inform primary care clinicians and investigate the reason for the prescribing error while sharing learning across all sectors of the integrated care system and preventing errors from occurring in the future.

Action

To assess the extent of inhaler prescribing errors, our medicines team created three EMIS searches to identify patients prescribed inhalers containing duplicate ingredients from the same drug group. For example, two long-acting beta agonists, two antimuscarinics or two inhaled corticosteroids. The team then completed an audit template in 47 GP practices, covering a total of 393,262 patients.

Patients identified with inhalers containing duplication from the same drug group were referred to their practice clinicians for a respiratory review to discuss inhaler use and stop the duplication. The audit excluded patients intentionally prescribed higher doses of inhaled corticosteroids for severe asthma or those requiring refill prescriptions.

Impact

The audit identified that 360 patients were prescribed inhalers with duplicate ingredients from the same drug class. Of these, 18% were actively using duplicate inhalers, with seven patients at high risk, experiencing side effects, requiring admission or referral. A third of patients had a respiratory review recorded, but the duplication was not identified or removed.

The audit also revealed that 64% of errors were due to GP prescribing systems, highlighting a need for improvement. Through this project, stopping inhalers with duplicate ingredients generated £22,789 in annual savings, reduced waste and carbon emissions.

The project raised awareness of the risks of duplicate inhaler prescribing across GP practices, hospitals and community pharmacy. Our medicines team delivered training sessions, issued prescribing newsletters, created a tool to reduce complexity of inhaler prescribing and dispensing, and completed patient case studies. The project made significant improvements to inhaler prescribing and reduced associated side effects across Central Lancashire, leading to substantial cost savings and improved patient care.

“The audit based on identifying duplicate inhalers was one of the best audits I have come across in a long while. It picked on a very common error that GPs make especially when issuing meds. We take inhalers very casually and usually don’t think much in issuing inhalers or restarting one. It was interesting to note how patients develop side effects from the combination use which all went away on stopping use. Good job, team. Well done. Has certainly changed my practice as a GP.“

Dr A. Ashfaq, GP

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Improving epilepsy services and reducing health inequalities

We brought together patients, experts and care system partners to identify areas of concern which contribute to premature avoidable death in people suffering with learning disabilities and autism who also live with epilepsy, and to highlight how integrated care needs to change to improve epilepsy services and reduce health inequalities.

Background

NHS Midlands and Lancashire CSU (MLCSU) were asked to work with 11 Integrated Care Boards (ICBs) in the Midlands to develop an improvement programme on epilepsy and reduce premature avoidable death. Community learning disability and specialist epilepsy services were already working together in some areas. However, at least 21 people with epilepsy were dying each week in the UK with nearly half of all epilepsy related deaths being potentially avoidable. Moreover, up to 50% of epilepsy deaths were due to Sudden Unexpected Death in Epilepsy (SUDEP), and in patients with learning disabilities and epilepsy (20-30% of the epilepsy population) the risk of sudden death was found to be more than three times higher. We were also aware of the challenges faced by commissioners and providers, including a lack of understanding of local needs, and a need for more strategic planning.

Action

We adopted a ‘whole-system’ approach and supported each integrated care system to benchmark epilepsy services across their system, including significant engagement with stakeholders across all epilepsy and learning disability services. We ensured that insight was grounded and informed by people with lived experience, that their voice is heard and needs met. This included examining an independent review into the premature death of Clive Treacey, an individual with a learning disability who suffered from complex epilepsy, and working closely with Clive’s sister.

An epilepsy advisory group was established to guide our work. We worked closely with Professor Rohit Shankar, SUDEP Action, Epilepsy Action, Epilepsy Nurses Association, International League Against Epilepsy and other national, regional and local experts who have developed the thinking on what is needed to improve outcomes.

We supported the use of a specialist tool to capture what good looks like for services and patients, creating understanding of the full context of services and establishing some minimum standards around epilepsy services and support.

Impact

The findings from this project have given each ICB a great foundation to build improvement plans and develop their local ‘capable communities’.

The patient and system outcomes we are expecting to see include:

*Impact on premature avoidable deaths for people with learning disabilities and autism

*Increased knowledge and awareness

*Drop in emergency department admissions

*Improved patient experience.

Phenomenal, system-wide impacts can be seen after just one year of the project, including:

*increased focus on improving epilepsy care embedded in system-wide improvement to tackle health inequalities

*bringing together of system partners to drive improvement

*shared understanding of the extent to which services are working well together to deliver good care

*clarity where gaps in provision or quality exist, and a springboard for new or enhanced services identified

*shared understanding of workforce capacity and capability, and where further investment is needed

*better use of system-wide resource to improve outcomes

*foundations in place to support the development of integrated epilepsy care and improved strategic commissioning.  

National experts and regional leads have given this project a great deal of attention and fully support the plans for improvement. Through this work, the MLCSU team now have a tried and tested blueprint for getting whole-system understanding and buy-in which can be used for similar projects in the future.

The project was shortlisted for Learning Disabilities Initiative of the Year at the 2023 HSJ Patient Safety Awards.

“This work has left us not only with quantifiable actions, made populations visible and given system ownership of the service issues faced in this critical area - but has created an advocacy for change and a social movement to improve the lives for whom we absolutely need to, and can, make a difference.”

Pardip Hundal, Assistant Director for Quality Improvement and Health Inequalities, NHS England