"Business Development Proposal"
NHS DONCASTER FUR BUSINESS CASE Business development proposal template 1 December 2008 Business development proposal template (This template is to be used for all direct health care proposals) SECTION A To be completed by Development lead/Coordinator 1.Reference Number 2. Outcome of BDG Circle as appropriate Recommended Rejected Deferred Noted 3. Date 4. Reason for decision: Sections B – E must be completed by the Commissioning Guardian SECTION B To be completed by sponsor NB: All sections must be fully completed Failure to complete all section will result in the proposal being rejected 1. Name of Name: Kerry Munday Commissioning Guardian Signature: Designation: Assistant Director for PBC and Planned Care Tel No: 2. Name of Provide Pharmacist Support for Tickhill Surgery development Proposal and continuation of support for The Medical Centre and Phoenix Medical Practice 3. Development Year 2009/10 . 4. Name of sponsoring DonCare Interactive Commissioning Executive Board /Group (DICE) Name: Chris Simmonds 5. Name of project lead Signature: Designation: General Manager, The Medical Centre, Frances Street DICE Chair Tel No: 01302 811199 6. Date Submitted March 2009 Business development proposal template 2 December 2008 SECTION C To be completed by sponsor NB: All sections must be fully completed Failure to complete all section will result in the proposal being rejected 1. Is this resource required to achieve of one, or more, of the Yes PCT’s strategic objectives? Specify objective: SO3 For our patients - Commission high quality, evidence based accessible services closest to the patient’s home. 2. Is this resource required to deliver a Vital Sign/National No Target? Specify Vital Sign/National Target: Not Applicable 3. Is this target monitored by the Healthcare Commission? No Specify target: Not Applicable 4. Is this resource required to the deliver a Local Target/ National Yes Initiative or LAA or is it in the current Business Plan? Specify target and theme: PCT Business Plan 2008/09: Work in partnership with PBC to develop and change pathways of care to improve access, ensure value for money and relocate services closer to the patient c. Support PBC to improve access to services and improve patient pathways by giving a patient centred service. This will give patients the ability to discus their medications with a highly trained expert who will be able to inform them about their medication and advise on any alternatives in a friendly relaxed manner. The aims will be to educate and empower patients, reduce waste and ensure the DICE prescribing budget is used effectively. Business development proposal template 3 December 2008 SECTION C 5. World Class Commissioning Spotlight initiative/outcome or Yes competency? Specify initiative or competency World Class Commissioning Competencies: Competency 4a & 4c are addressed by this service as it provides Clinical Engagement with our patients Enhances our reputation as leader of clinical engagement 6. Is this resource required to deliver any target of the Yes Commissioning Prospectus? Specify target: Commissioning Prospectus 2008/09: 5 – Commissioning Intentions for 2008/09 Work in partnership with Practice Based Commissioners to develop and change pathways of care to improve access, ensure value for money and relocate services closer to the patient. 7. Is this resource critical to delivery a regulatory or legislative No requirement? e.g. Core Standard, NHS Litigation Authority, Auditor’s Local Evaluation, Information Governance, World Class Commissioning/NICE Guidance Specify regulatory or legislative requirement: Not Applicable In addition to the reasons outlined approve, why is this proposal required/ needed? E.g. a proposed new service or the result of a service review/health needs assessment? Doctors have a very limited time to put patients at ease, diagnose the problem and prescribe medication and patients by and large, do not ask questions about their medication. The ability for the patient to ask "our own" pharmacist about the efficacy of the treatment, side effects etc empowers and informs the patient and gives better assurance of compliance. Our pharmacist can also work with our clinicians on formulary development, clinical awareness etc. The pharmacist based at The Medical Centre is a member of our PBC board and works with them on budgetary control and service development. She sees over 400 patients each month and has built up a relationship with our patients that has increased her effectiveness both by improvement in patient care and reduction in our pharmacy costs. With Tickhill now joining DICE we want their patients to enjoy this level of quality service. Business development proposal template 4 December 2008 SECTION C SECTION D – BUSINESS CASE To be completed by sponsor NB: All sections must be fully completed Failure to complete all section will result in the proposal being rejected 1. SYNOPSIS (give an outline of the proposal) This business case is to request the use of DICE Freed Resources to fund a new pharmacist for DICE to be based at our Tickhill member practice. Furthermore, this case requests the use of our freed resources to continue the employment of our existing pharmacist supporting TMC and Phoenix. The pharmacists will be employed by The Medical Centre to work with DICE to ensure that best use is made of the pharmacy budget and that individual patients enjoy the benefit of discussing medication problems, thus ensuring patient compliance and value for money. The pharmacists will be full time employees of The Medical Centre, one based at TMC and one at Tickhill. This proposal is an extension of our successful pharmacist support model employed at The Medical Centre / Phoenix Medical Practice. Since employing our pharmacist we have demonstrated significant savings in relation to prescribing costs and provided additional capacity to identify and spread good practice in prescribing across both primary and secondary care. A particular success has been our pharmacist's involvement with secondary care to "harmonize" patients' medication. Employing the pharmacist at The Medical Centre has been self-funding producing "real budget savings far in excess of her costs by delivering greater efficiency savings than actual costs to the prescribing budget. Therefore we believe that this program is invaluable to the practices involved. Both pharmacists will be to be employed by The Medical Centre – one working there and the other based in Tickhill. The pharmacy support will be responsible for the following: Carrying out medication reviews for all necessary patients including care home patients, patients cared for at home, high risk patients and patients on large numbers of medication Provide interfacing for medicines reconciliation and patients discharged from hospital Monitor appropriateness of repeat prescriptions for the necessary patients Review and monitor medication prescriptions requiring repeat Business development proposal template 5 December 2008 authorisation Empower patients by giving them greater knowledge and awareness of any alternatives Have an input in disease management using their pharmacy knowledge to best effect. Recommend prescribing cost savings 2. Has an options appraisal been prepared and presented to the appropriate partnership board and is this the recommended option? If not, please provide reasons. DICE reviewed its options before employing its own pharmacist. Working with a community pharmacist or close links to a local pharmacy were also considered. 3. Explain how the proposal meets best practice in relation to evidence on service models, safety, clinical appropriateness, accessibility, responsiveness, efficiency, effectiveness, prevention and/or quality? This investment has brought additional quality assurance to our prescribing routines. Quality assurance comes from the routines set out in this proposal. In summary the pharmacy support program has already demonstrated: Developed regular practice based audit with feedback and education to patients to ensure appropriate use / compliance. Ensure policies and local guidelines are in line with recent NICE and NSF guidance Identify key areas for PCT/practice based audit implemented via the prescribing support network Monitor progress via well developed performance management tools e.g. PACT data Monitor practice performance monthly via the PCT Head of Medicines and Prescribing Support identifying and addressing any significant areas of concern Overall this proposal is designed to reduce risk in prescribing support and medicine management issues. We believe cost effectiveness has been demonstrated in since its introduction in DICE. DICE has consistently saved the biggest percentage against budget of any of the consortia. Our pharmacists will ensure we use best practice and have access to PPA detailed data to aid them in this work. They will also advise doctors on best use of pharmacy in DICE patient care, whilst adopting a patient centered Business development proposal template 6 December 2008 approach. They will be part of the Doncaster pharmacist "family" and attend meetings and training events organized by Doncaster's Head of Medicine Management. Training and development of all employees of The Medical Centre / DICE will receive on-going training and be encouraged to further their skills. 4. What are the measurable outcomes to be achieved? i.e. what are the outcomes for patients, the public and for staff. Outcome Key Performance Timescale Indicator Specify month number Provide additional Employ well qualified The TMC pharmacist capacity to identify and and innovative is already in post. spread good practice in pharmacists Tickhill will join us in prescribing across both April / May 2009. primary and secondary care Help achieve clinical Ensure patients Over 400 patient safety assurance by offered and receive interactions take place continued review of medication reviews each month at TMC patient medication that educate and already we would look across general practice empower them to provide similar in Tickhill by August Contribute to local We will work with 2009. implementation and Medical Advisor to achievement of “must achieve Doncaster Attend all medical do’s” and national wide objectives team meetings etc. guidelines Assist practices in The rationalisation of Increase in generic achieving targets such budgets is a key target percentage. Increase as an increase in in patient interactions. generic prescribing Decrease in waste / costs in 2009/10 Assist in the delivery of We will work with Throughout the year. Public Health issues public health on such as reducing healthcare initiatives prescribing of antibiotics NB:- These indicators will be included in the Business Plan, SLA’s or Contracts as appropriate by Performance Management or Contracting. Performance management of the proposal will be undertaken through the business planning process (Covalent) and a performance report against the outcomes will be produced for the Commissioning Executive Business development proposal template 7 December 2008 5. Please demonstrate how this proposal represents value for money. The pharmacy support program is anticipated to be self-funding by delivering greater efficiency savings than actual costs to the prescribing budget. Thus being the best use of the pharmacy budget ensures value for money. 6. Has a finance template (Appendix1) been completed and attached? Yes What is the full year cost of the development? The full year cost will be in the region of £124,000 to provide pharmacy cover for all members of DICE. 7. Will the development release resources/provide additional efficiency in other budget/service areas? If so, what is the estimated financial and service impact of the savings? This scheme already utilized by other DICE members demonstrated significant savings in relation to prescribing costs and provided additional capacity to identify and spread good practice in prescribing across both primary and secondary care. 8. In the table below outline a simple project plan to show the proposed steps (and their phasing) for the work required to move from receipt of initial approval to project completion. These will be included in the Strategic Business Plan as strategic sub- actions/milestones and performance managed monthly/quarterly. Your responses to these actions will be forwarded to the Commissioning Executive. Sub-action/Milestones Completion Month Specify month number Complete business plan March 2009. Advertise for post April 2009 Hold interviews April 2009 Appoint May / June 2009 Induction programme May / June 2009 Commence at Tickhill May / June 2009 Fully operational Aug 2009 Additional Comments Use this section to comment on whether there are sufficient capability, capacity and resources to consult upon and implement the plan, handle communications and provide strong leadership associated with the outline project plan The pharmacy structure is already embedded in the TMC and Phoenix practices. We will Business development proposal template 8 December 2008 use the present incumbent to train and develop the service for Tickhill liasing closely with the partners there. Taking account of the above actions, what is the minimum lead in time following approval to the operation going live? We would envisage a period of two months would be required to bring the service at Tickhill "on line". 9. Has a procurement methodology template (Appendix2) been completed and attached? If no, specify why. No. We will be "tendering" by advertisement for the new pharmacist. As the other pharmacist is in post we regard this as a continuation of the current service at TMC and Phoenix. 10. What procurement method is recommended? As detailed above, full advertisement for this post will be undertaken to fulfil the procurement requirements. 11. Are there any barriers to this proposal or does this represent a common view of the way forward? e.g. Is the proposal controversial? Are there any dependencies with other organisations (or within the organisation) that may present difficulties? Is there a risk of the project not being completed within the specified timeframe? We are unaware of any barriers or controversy regarding this proposed service. This is a continuation and improvement to the current service approved and funded through Freed Resources. The benefits have been seen in pharmacy saving in the PBC budget and patient feedback shows the service is of value. All members of DICE are fully supportive of this proposal and the PCT has approved funding from Freed Resources for this service in previous years. 12. Explain how you have engaged with clinicians, patients, and other stakeholders when preparing this proposal. Before establishing the service at TMC we had a working group of GPs nurses and managers examine the proposal – we also put it to our patient participation group who were also enthusiastic. Subsequently our patient group have revisited this area and they are very happy with the service our pharmacist provides. 13. Demonstrate how you have complied with Section 242 of NHS Act 2006 - Duty to Involve Patients. We have consulted with our patient group, explained the service and asked for comments in our newsletters and also included it in our PBC newsletter for patients (DICE Thrower). Business development proposal template 9 December 2008 14. What is the level of involvement is required from other stakeholders involved with this initiative? The pharmacists will have a high level of interactions with our GPs, nurses and support staff as well as our patients. 15. Have the following assessments been undertaken, received approval and are these attached? Health Needs N /A Equality Impact (Appendix 3) Yes Reference No. _____________ NB as legislation develops other assessments may be added. 16. Any additional comments? The service provided by our pharmacist at TMC / Phoenix has been a positive benefit to our patients and clinical staff producing an improved service for our patients and a rationalisation of our pharmacy costs. We want our new DICE member patients to enjoy the same benefits. SECTION E – Risk Assessment To be completed by sponsor Describe and assess the risk to the PCT if the business case proposal is rejected. Risk should be assessed using guidance in the PCT Risk Management Policy but consideration of the following factors should be included and the level assessed as No risk - 0 Low – 1 Minor-2 Medium -3 High - 4 Extreme -5 Area Level of risk Description of Mitigation Plans Risk Service/Business 0 Disruption Estate Loss 0 Reputation/Adverse 0 Publicity Incidents 1 Use of clinical Good training judgement and skills Complaints 1 As with any clinician Litigation 0 Failure to meet 1 As with any objectives service redesign Quality 0 Staffing and 0 Competence Business development proposal template 10 December 2008 Results/impacts of 0 inspections / audits Business development proposal template 11 December 2008 Section F - Evaluation ( For Business Development Group's use only) Average of Proposal name To be completed Scores No Areas Score Level 0 Score Level 1 Score Level Score Level 3 Score Level 4 Score Level 5 2 1 Supports to achievement of Does not Supports the Supports the Supports the Supports the Supports the the following: support achievement of achievement achievement of achievement of achievement • Strategic Objectives achievement of one of the of two of the three of the four of the of all of the • Vital Sign/National Target any of the specified specified specified specified specified • Local Target/National specified requirements requirements requirements requirements requirements Initiative/Business Plan requirements • Commissioning Prospectus • Regulatory/Legislative requirement 2 Impact if not implemented No impact Risk Risk Risk Risk Risk consequence consequence consequence consequence consequence score of 1 score of 2 score of 3 score of 4 score of 5 3 Target is monitored by the No Yes Healthcare Commission 4 Does the proposal Single tender, Tender Waived Limited Full Tender Full Tender Full Tender demonstrate value for not VfM / Single Tender Process or good Process or Process / money? assurance or Provider with Process to be but limited comprehensive Recent no VfM assurance carried out, benchmarking benchmarking/ Tender Info compensating or limited with some information Bidder Day info Use with evidence. benchmarking /adequate / used appropriate Does not information benchmarking VfM to be benchmarking demonstrate information proved information VfM 5 Improves outcome for patient No evidence of Ambiguous Unambiguous Evidence of Major evidence Significant improved evidence of evidence, but improved of improvement evidence of outcomes for improved not outcomes for outcomes for improved patient/negative outcomes for significant, of patient patients. outcomes for impact on other patient improved patient service areas outcomes for patients 12 Overall comments - not scored but taken into consideration 0 Business development proposal template 12 December 2008 Business development proposal template 13 December 2008