Integrated care system (Ics) pharmacy medicines optimisation and sustainability checklist for Nhs green plans

Abstract

Context The work was co-produced by the Chief Pharmaceutical Officer’s Clinical Fellow (CPhO) based at the GPhC 2021/22 and the University Hospitals Dorset Medicines Optimisation Pharmacist and Sustainability Lead for pharmacy who is also a member of Pharmacy Declares which is a diverse collaborative of climate conscious pharmacy professionals based in the UK. Pharmacy Declares vision is to rapidly galvanise pharmacy professionals and professional/regulatory bodies into action to tackle the climate & ecological crisis and protect lives. The climate & ecological crisis is a health emergency and its drivers and solutions are shared with other health and social care priorities Pharmacy Declares are calling for: Financial divestment from fossil fuels and reinvestment of funds into environmentally & socially beneficial arenas. Declarations of Climate Emergency‒honest recognition of the situation in which we find ourselves. Climate- Health Leadership & Education promoting an understanding of the climate and ecological crisis, our roles in contributing to it and simultaneously in its mitigation Specialist advice was sought from antimicrobial stewardship leads, primary care pharmacy teams, community pharmacy teams, clinical commissioning groups, secondary care pharmacy and anaesthetic leads. The target audience for this programme of work was integrated care system (ICS) pharmacy leadership and medicines optimisation teams as well as integrated care boards, net zero executive officer and integrated care partnerships. Issue/Challenge Climate change poses a major threat to our health as well as our planet. The environment is changing, that change is accelerating, and this has direct and immediate consequences for our patients, the public and the NHS. In October 2020, the NHS became the world’s first National Health Service to commit to reaching Net Zero. The ‘Delivering a Net Zero Health Service report sets out the NHS’s clear ambition and the Greener NHS programme is working with pharmacy staff across integrated care systems to ensure this most important of sectors is at the forefront of net zero healthcare. It builds on exemplar work already evident across the country and promotes sharing of best practice to reduce the environmental impact of healthcare delivery, whilst simultaneously making economic efficiencies and improving patient outcomes. Thanks to NHS people, partners, and suppliers, a Greener NHS is emerging. A year on from setting net zero targets, the NHS was on track to reduce its emissions equivalent to powering 1.1 million homes for a year. Together, we can achieve even more. To support the development of integrated care system (ICS/ICB/ICP) green plans we co-designed and developed a ICS pharmacy and medicines optimisation sustainability checklist to support ICS pharmacy leadership groups to develop multi year green initiatives for their local systems. We have received support from the Chief Pharmaceutical Officer’s office to develop the checklist and it is due to be presented to ICS leadership teams and chief pharmacists on the 7th Sept 2022. In collaboration with colleagues across the interface and representing diverse specialities, we developed a tableau of options for the delivery of sustainability within pharmacy green plans. Rather than being viewed as a compulsory check list of new targets to be achieved in year 1, we suggested that it will enable ICS teams to bring together the many ‘sustainability supporting work plans already in existence. We hope that it will showcase how teams can re-evaluate the potential of pharmacy services to reduce carbon emissions and hence, promote wider community health and acknowledge the latent power of multi-sector working. It is envisioned that over time Green Plans will be adapted according to local need and workforce capacity, as well as the growing proficiency within our profession to deliver planetary health Assessment of issue and analysis of its causes We identified that there was no single source of ICS pharmacy and medicines optimisation sustainability green plan guidance. Pharmacy teams were creating green plans in sector specific silos and there was a need to assimilate the workplans into one single ICS pharmacy green plan tableau of ideas. We collated the individual green plan ideas and linked them to relevant primary and secondary care pharmacy commissioning contractual frameworks, investment & impact fund, NHS contract, CQUINs and direct enhanced services. We linked many of the health benefits to the NHS Long Term Plan. Using contacts in higher education establishments we were able to determine the level of sustainability education and training for pharmacy undergraduate and post graduate students. We made recommendations to aid the development of pharmacy and medicines optimisation sustainability syllabuses to support undergraduate and post graduate pharmacy net zero and sustainability training. Through ICS pharmacy and medicines optimisation leadership webinars we engaged the senior leadership teams and invited a couple of the teams to comment on our initial proposal. We have received support from the Chief Pharmaceutical Officer’s office to develop the checklist/tableau and was presented to ICS Pharmacy Chief Pharmacists and Senior leaders. The document was very positively received with many of the stakeholders stating that it would support their work plans and conversations with the ICB in their ICS. Impact This national ‘do once’ approach to pharmacy and medicines optimisation sustainability green plans will improve productivity and efficiency for ICS pharmacy teams and may even accelerate the role out of such workplans. This was seen as positive benefit of our work and could be replicated for other priority areas across pharmacy ICS teams. ICSs will use the NHS Model Health System, Open prescribing, Prescqipp and EPACT 2 data to benchmark the delivery of pharmacy green plans at Trust and System level to provide insights on specific NHSE Net Zero initiatives. Health Benefits The climate emergency is also a health emergency and if left unabated it will disrupt care and affect patients and the public at every stage of our lives. Poor environmental health will contribute to major diseases, including cardiac problems, asthma and cancer, our efforts must be accelerated. Pharmacy system leaders were advised to incorporate climate adaptation into all service delivery models across all sectors of pharmacy to deliver sustainable pharmacy practice across the profession. Intervention The intervention has taken 9 months from inception to delivery of the Green Plan checklist to the Pharmacy and Medicines optimisation ICS leadership group. The work has also been shared with the NHSE Net Zero team to inform their work. We engaged with NHSE teams to ensure it complemented NHS Net Zero policies. This work has allowed us to roll out pharmacy and medicines optimisation sustainability green plans at scale across England through engagement with ICS chief pharmacists and leadership groups. To support spread and scale of this work the tableau of green plan ideas has also been shared with pharmacy colleagues in the devolved nations to inform their work. One Scottish colleague is working with the Scottish government developing a programme of work on medications and the environment and it is hoped our document will provide examples for her workstream. We have also shared this work with other NHSE Patient Safety and antimicrobial stewardship teams as sections of the checklist focused on medication safety, antimicrobial stewardship and admission avoidance. The document has been upload to the Future NHS Collaboration Platform to support teams developing their own local ICS green plans. ICS chief pharmacists stated that the document would aid their discussions with ICB Net Zero Chief Executive Officers. This work has contributed to my understanding of leadership through developing networks, engaging with stakeholders and NHSE leadership groups, collaborating across sectors and systems of the profession and engaging with senior leaders in each sector for optimal benefit of patients and the public. Involvement of stakeholders, such as patients, carers or family members: We engaged with multiple stakeholder groups during the development of the sustainability green plan checklist as is was a multisector cross cutting document we required stakeholder engagement from patient/medication safety groups, antimicrobial stewardship leads, undergraduate and postgraduate education, net zero, respiratory, anaesthetic and pharmacy medicines optimisation teams. Key Messages Development of collaborative multisector ICS pharmacy and medicines optimisation leadership sustainability green plan Multisector working to achieve unified pharmacy and medicines optimisation ICS sustainability goals Allow pockets of expertise to flourish but benefit the system as a whole Aligns with the Long Term Plan and Core20PLUS5 and complements existing NHSE Net Zero policies and NHS national contractual frameworks and enhanced services. Lessons learnt We have learnt that developing a national document is the first step in a very long process of stakeholder engagement, sharing with networks and engaging with the right audiences using the most influential advocates of your work. In this instance our target audience were ICS chief pharmacists. We had to wait for the right ICS webinar opportunity to share our work in the most efficient way, of the 42 ICS chief pharmacists we presented to 38 which was a successful delivery plan. We have also now shared our work on the NHS Futures platform and via social media where it was warmly received by a cross section of the pharmacy workforce. Measurement of improvement Measure improvement using data and metrics from the following ICS dashboards on an ongoing basis through ongoing engagement with ICS chief pharmacists and medicines optimisation teams. Data and Dashboards that teams will access to monitor implementation NHS Model System RxInfo EPACT NHSBSA Prescqipp Open Prescribing Greener NHS Dashboard Strategy for improvement The programme of work took 9 months from inception to fruition and was mainly co-delivered by the GPhC CPhO Clinical Fellow and the Medicines Optimisation Pharmacist Sustainability lead at University Hospitals Dorset . Engagement with specialist interest groups across all sectors of the profession was required to fine tune the content of the document. Feedback was requested during a national webinar with the ICS chief pharmacists group which we will be collating in due course.