PCIP update December 2021
On this page
Summary of achievements pre-covid
Community Treatment and Care (CTAC) Multidisciplinary Team (MDT) and Vaccination Transformation Programme (VTP)
A lot has been achieved in these areas, including the investment in establishing a phlebotomy service across Lanarkshire.
The MDT model was agreed in December 2019 including approval for the recruitment of 52wte community nurses to deliver CTAC/VTP services as part of PCIP. These nurses are currently redeployed to support the covid-19 and seasonal flu vaccination programme.
During the 2019/2020 seasonal flu programme we worked closely with GP practices to deliver vaccinations to certain cohorts. The learning from that flu programme was invaluable in informing the following year’s delivery model.
Urgent care
The urgent care work has been to develop the model for Advanced Nurse Practitioners (ANPs) to support urgent care in-hours and home visits. The tests of change for this model took place in 2019, with the scale and spread to all localities currently underway. As of March 2021 25 ANPs were in post – this was a mix of trained and trainee ANPs, with recruitment approved for a further six.
Pharmacotherapy
Before covid we had progressed successfully towards the year two staff provision, with all practices in Lanarkshire having access to a pharmacist resource.
Early successful development of a serial prescribing toolkit was ready to be rolled-out to practices.
Work prioritised during the response to covid-19
During the pandemic a number of members of staff were redeployed to other areas of the health service to directly support GPs in their response to covid-19. These included:
- Advanced Nurse Practitioners – moved to the covid-19 community pathway.
- Pharmacotherapy – this continued and worked alongside prescribing efficiency resource to provide an increased level of service during this time.
- PCIP community nursing staff moved to the covid-19 vaccination programme to support the delivery of the largest ever vaccination programme.
A number of PCIP pieces of work continued throughout the pandemic. These included:
- Reviewing project plans to reflect the joint letter from the Cabinet Secretary and British Medical Association, and the MoU2.
- Workstream structures were revised to make sure they could continue to progress. The changes included the digital workstream no longer being a standalone group, it is now aligned to each workstream and the CTAC and urgent care workstream being separated into two groups to reflect the different delivery timescales.
- The GP Community Link Worker (CLW) programme continued and the entire programme was established during the pandemic, with the recruitment of 17.6 wte CLWs who are now in post.
- Due to new guidance on the delivery of B12 injections, Airdrie and Hamilton localities have reviewed their patients receiving intramuscular vitamin B12 and reduced this where appropriate.
- Airdrie – 340 people to 151
- Hamilton – 806 people to 262
These reductions have released capacity in the treatment rooms and improved patient care by ensuring treatment is clinically indicated. The Pharmacy Team is rolling out processes and will provide further data which will identify those who require to continue with injections (following review) and those who can stop and start monitoring.
- The pharmacotherapy hub model test site was progressed by testing it in Airdrie, which has provided valuable learning to inform the model of the new hubs.
- The seasonal flu vaccination programme had the highest uptake ever seen in Lanarkshire with an 85% uptake in the 65 and over age group.
Moving forward – including the delivery of the GMS contract and Memorandum of Understanding (MoU) 2
Three areas of work are to be prioritised to be delivered by 1 April 2022. These are pharmacotherapy, VTP (travel health) and CTAC. We are working closely with the GB Sub-committee to deliver as much as possible in line with national timeframes.
Details are set out in the Memorandum of Understanding 2 and the Joint Statement to General Practices from Cabinet Secretary for Health and Social Care and the British Medical Association.
Workstream / project updates
Community Treatment and Care (CTAC)
Chronic disease monitoring
Progress has been made in agreeing operational definitions that have now been passed to the CTAC Operational Group to take forward and implement locally.
Treatment rooms
- Data monitoring and measurement plans have been developed to begin populating with information for reporting at respective treatment room meetings in North and South Lanarkshire. Testing of Vision Anywhere treatment room pilot is underway in South Lanarkshire.
- A local clinical protocol and standard operating procedure (SOP) have been developed for nursing staff administering B12 injections. The guidance has now been uploaded to the ‘NHSL Guidelines’ app.
- A letter has been issued to patients with information on self-care in acute and community sites with regards to ear syringing. North and South Lanarkshire treatment rooms have commenced a limited a number of appointments for evidence-based ear syringing.
Progressing the implementation of the CTAC work has been significantly impacted until recently, due to the redeployment of staff to support the covid-19 response. It is our plan to deliver CTAC by April 2022.
Vaccination Transformation Programme (VTP)
Seasonal flu
2020/21 programme
During the 2020/21 seasonal flu programme, vaccinations were delivered in large clinics to take into account covid-19 restrictions. The uptake of the vaccination was higher than ever before:
- 2 to 5 year-olds – 64%
- 65 and over – 85.1%
- Under 65s at-risk – 56.5%
The maternity component of VTP was progressed and implemented, which included midwives delivering both flu and pertussis vaccinations.
2021/22 programme
The 2021/22 seasonal flu programme is divided into two parts. One part delivered through the Primary Care Improvement Plan and the other through the mass vaccination programme.
Primary and secondary school pupils will receive their vaccinations from the School Immunisation Team and adults they will receive their vaccinations from the mass vaccination team. Where possible, those who are eligible for both the covid booster and flu vaccines will receive one appointment, so they don’t need to attend two appointments within a short period of time.
Children aged 6 months to 2 years at-risk and those aged 2 to 5 (not in school) will receive their flu vaccinations by locality teams, as part of the PCIP remit. Clinics for these age groups started on 13 September and are scheduled to run until early December 2021.
National and local data collection processes are being developed to ensure the uptake levels are monitored and reported regularly.
As the covid booster and flu vaccinations are being delivered jointly, there is an overarching communications plan to support this. A key message running through both programmes is reminding people not to contact their GP practice about vaccinations. A communications toolkit was issued to practices on 24 September with text and images to help support the key messages.
Travel vaccination service
While the planning for this service was temporarily paused due to the pandemic, the meetings are now up and running again. Currently, the team is considering appropriate options and working on developing operational processes.
The IT digital requirements are being explored by NHS Lanarkshire’s eHealth team, to find out what is achievable. The team is also linking with the national team to confirm what is being offered to help inform local requirements.
Scottish Government is progressing the ‘Fit for Travel’ and NHS inform website updates, as well as national training for staff through NHS Education for Scotland (NES).
There has been recognition that PGDs will be progressed nationally. We are anticipating receipt of these soon.
Pharmacotherapy
A number of areas of work have progressed in pharmacotherapy, including premises, IT and recruitment. The main achievements have been the agreement of the model and recruitment of 10 pharmacy support workers, 2 lead technicians and 11 pre-registration technicians. Other recruitment is also underway.
Over the past 12 to 18 months the pharmacotherapy service has continued for patients. This has included elements of level one, with a particular focus on acute prescription requests and Docman activities including IDLs and OP letters.
Work on the hubs is ongoing, with the identification of premises being the biggest barrier. Recruitment of pre-registration pharmacy technicians and the initial cohort of pharmacy support workers as started. There is a need to diversify the skill mix of staff and this will help in the delivery of level one pharmacotherapy. This skill mix is also mentioned in MoU2.
There remains ongoing concern in relation to the recruitment and retention challenges. The team is carefully considering how they can strike a balance between the ask of the contract and providing staff with a clinically satisfying role.
Serial prescribing
Serial prescribing is included in MoU2. There are a number of ways to use serial prescribing well in practices – especially if practice staff are involved and knowledgeable about the system.
So far, we are engaging with and working across 38 practices. A dashboard is being developed further and will be reported through the pharmacotherapy workstream. Serial prescribing is one part of many aspects of pharmacotherapy and we want to encourage practices to sign-up.
Click here to watch a video from a local practice manager on their involvement in serial prescribing.
The team is happy to share experiences and support practices with methods that suit them. For further information or for support to implement serial prescribing contact:
- Lynn Stewart, Improvement Manager Lynn.Stewart@lanarkshire.scot.nhs.uk
The national serial prescribing toolkit was launched on 28 September and practices should have received this directly from Healthcare Improvement Scotland (HIS). It can also be accessed at https://ihub.scot/improvement-programmes/scottish-patient-safety-programme-spsp/spsp-programmes-of-work/spsp-medicines-collaborative/pharmacotherapy/
Pharmacotherapy gap analysis audit tool
The scope of the audit and the subsequent data requirements were considered and agreed jointly between the Primary Care Improvement Team (PCIT) and the Pharmacotherapy Service’s Advance Clinical Services Pharmacist (PS-ACSP). The scope was defined as to identify and understand the gap between what is currently delivered by the PCIP pharmacotherapy service and level one pharmacotherapy as outlined in the GMS contract in all Lanarkshire practices across the following areas of activity:
- Acute prescription requests
- Reauthorisations
- Docman workflow
- Acute and reauthorisation requiring review
- Pharmaceutical queries
The findings from the audit and the next steps have been circulated to all practices, along with a short presentation summary which will support with sharing the report across practices teams and localities.
Additional professional services
Community Link Worker (CLW) programme
The entire CLW programme was established during the pandemic and is now up and running. This includes 17.6 wte CLWs engaging with 82 practices in varying capacity.
The service is now live in 57 practices – 28 in North Lanarkshire and 29 in South Lanarkshire.
The infographic shows initial feedback from practices. This includes:
“Glad to have them on board” “Great success and great service for patients in need”
The CLWs and co-ordinators continue to develop close working relationships with GP practices, as well as engaging with the practices who do not yet have this service and encourage them to take up the offer.
The CLW data dashboard is being developed and will include activity from the beginning of the service, this will be shared widely once it is ready. The team will also conduct a service review to ensure it is as robust as possible.
Financial Welfare Advisors (FWA) data monitoring and measurement returns are being developed and completed by providers. These will also be included in the data dashboard.
For more information, contact:
- Lynn Cunningham, Community Link Worker Co-ordinator (North Lanarkshire) Lynn.Cunningham@lanarkshire.scot.nhs.uk
- Carla Maxwell, Community Link Worker Co-ordinator (South Lanarkshire) Carla.maxwell@lanarkshire.scot.nhs.uk
Urgent care
ANP test of change
One piece of work that has continued is that of the support offered by the Advanced Nurse Practitioners (ANPs). During the height of the pandemic they worked in the Covid Community Pathway but they are back in general practice. Work has been ongoing to explore the ultimate aim of how they can be deployed across all areas of Lanarkshire.
As a step in that direction, since Monday 8 November two ANPs and one trainee ANP have been allocated to three practices in Cumbernauld. Also, from Monday 15 November two ANPs and one trainee ANP have been supporting five practices in East Kilbride. Further details will be provided in future updates.
This, and future provision, will be subject to the retention of both trainee and trained ANPs. The proposal would be to commence testing in areas where we have existing resource available.
Urgent care event
On 20 October 2021 an event was held to discuss urgent care in-hours. This built on the review session that was held in February which considered the post-pandemic provision and models of care.
The most recent event had a wide range of attendees including locality operational and medical management, Quality Cluster Leads, members of the GP Sub-Committee, Advanced Nurse Practitioners and Public Partnership Forum representation. The session ensured that local knowledge and expertise was captured and will inform our plans going forward.
Further events are planned and details will be circulated once these are confirmed.
Contact us
We know this was a detailed and lengthy update, but hope that you found it useful it providing a snapshot of the work that has progressed over the past 18 months.
We will be issuing regular updates, as and when appropriate.
For enquiries, please email LanGMS2018@lanarkshire.scot.nhs.uk
