Report of the Launch Event Wednesday 27th April 2016

All Nations Centre Opening

Pharmacisits arrived and networked with all delegates at the All Nations centre before taking a seat.

Delegates were welcomed by Andrew Evans, Principal Pharmacist, . Mr Evans started providing background to why everyone has been invited and touching on the story of the origins of the Community of Practice (CoP).

He then introduced Paul Gimson, the lead for improvement in Primary care & Matt Wyatt, Improvement Advisor at 1000 Lives .

What’s a Community of Practice?

Matt Wyatt provided a plenary presentation on the concepts and methods that underpin the development of a community of practice. He described the origin of the concept, the defining features and how a CoP can do things that other types of group can’t.

Matt outlined the participatory and organic development of the relationships; highlighting the experiences that participants could expect. It has to be immersive, to understand it; you have to be surrounded by the experience.

The right focus for a Community of Practice?

Paul Gimson gave a presentation exploring what the focus of the CoP should be. He covered the primary care plan, discussed what the role of a “cluster pharmacist” is and asked delegates to consider their experiences across clusters, their integration, services and planning.

He asked what we need to do as a CoP to make these experiences better? He concluded the presentation with a closing remark that it’s up to the CoP to decide which, if not all, are the right focuses for this CoP. Mind mapping

Matt asked the participants in groups of 2-3 to ‘mind map’ the influences on the role of the “cluster pharmacist”. This issue caused fantastic discussion on the tables which is necessary for a CoP. The mind maps expanded to capture all thoughts and opinions around cluster pharmacy. There was a huge volume of feedback, some are displayed on the next few pages, the others are found in the appendix.

Mind Maps

What are cluster pharmacists dealing with?

The level of feedback from this session suggests that this topic could form the basis of a more detailed and dedicated session within a future meeting of the CoP. It was noted that several areas amongst the mind maps were repeated numerous times which may require further exploration of service and development needs. It was evident that sharing common experiences from pharmacists could be a powerful and integral component to shaping the future of the profession.

Some of the themes are below. The mind maps themselves still supply of a wealth of information –

 Development needs – CPD, role extension, training needs.  Recognition – identity, clinical expertise.  Communication – feedback, networking, isolation.  Support – admin tasks.  Time – Work life balance. Pressure to report drug switches, cost savings, activity spreadsheets.  Scope of practice – utility, current skill sets.  Quality of care – variation within a cluster.  Resources – IT

A pharmacist operating in unknown territory

Paul introduced Rob Liddington, a pharmacist formerly of the British Army discussed some of the challenges he has faced when trying to improve medicines optimisation in difficult circumstances with limited resource. These included snake bites, methanol poisoning and difficult decision making .His most poignant message to fellow pharmacists were to be inventive and adventurous.

Delights and Dilemma’s

Working on their tables, participants were asked to create two lists. These Wordles illustrate the feedback with the largest words appearing most often.

List 1: Things that annoyed you in your work, this week:

List 2: Things that annoy you in your work, permanently:

Participants were then asked to consider what made work meaningful for them, what aspect of their work, provided them personally with a sense of delight. The room then self-organised into complementary groups based on the themes that arose. The delights are in the wordle below.

The groups were then provided with a challenge:

1. To add up the total years experience on a table. 2. To list every initiative, programme or event they had come across in their professional career. 3. In their groups to then write a list to capture work the CoP could do in the future. They were encouraged to discuss some of the issues and problems that have arisen throughout the day.

The result:

1. The total experience of the 75 attendees in the room was 1234 years. 2. The list of events are below, a total of 68 different pieces of work.

List of programmes, initiatives and policies 111 Mid staffs 1000 Lives Minor Ailments scheme Agenda for change MMIS AWMSG 2003 MUR Blacklist MURs 2004 Clusters NHS direct Common Ailments 2013 NICE (late 90's) CPD NWIS Community pharmacy contract 2005 Pathlinks Degree course (up 3 to 4) 1997 PGDs Devolution 2001 Pharmacist mandatory CPD 2207/8 Different health ministers Polypharmacy List of programmes, initiatives and policies DMEs 3010 POM's to Ps DMR Post grad diplomas Electronic prescriptions Pre reg exams 1992 Emails Prescribing data Enhanced services Prudent Healthcare 2014/2015 Facility Pharmacists QoF Fallow year 2001 Registered / Checking technicians Fund holding 90's Responsible Pharmacist GMS 2004 contract Robotic dispensing GP contract 2008 RPS / GPHC HA to Trusts to UHBS 2010 NHS reorganisation RPSGB to GPHC 2010/11 Healthcare inspectorate Wales Schools of pharmacy 2010 Improving Health 2014 Setting the direction Independant / Supplementary Prescribers Shipman Internet - patient googling Smoking cessation / banned indoors Just in case boxes Spoonful of sugar Kings Fund Supplementary Independant prescribing 2004 LHB reorganisations 2009 & others Together for Health 2000's LHG to LHB 2000 / 2001 Trusted to care, Berwick report MECC TTC 2002 Medicines act WCCG 2012 Medicines Reconciliation WES - hosted computers

3. The work we could do in the future was sorted by themes which are:  Improving Relationships  Training and Development  Sharing Best Practice  Measurement  Finance  Governance

At the risk of being lists of tables, the idea is so that the whole CoP has a record of what was recorded. They are included to create discussion at future events. Duplication has been removed or combined.

Improving relationships Advice forum - in between meetings - share resource for problem solving Communication Decrease the isolation Directory of COP Educate colleagues i.e. GP Education of healthcare team Education of patients Education required for GP's to explain purpose of role - clarify different pharmacist roles Improving relationships Email list Embedded in practice Encourage GP attendance (funding / locum cover) Engagement Engagement with GPs and rest of team Expectations and clarification of the role (Pharmacists, GPs, practice, HB and WG) Feedback from surgery's - how getting along Forum Good to have more practice managers involved GP expectations integration into GP team Greater influence in primary care Integration - community pharmacy its role integrating into the cluster world Minor ailment training Multidisciplinary working Networking PR ( improving relationships) Professional networking - blogs, email, electronic forum Promote pharmacists resource i.e. What we can do for patient Promotion of role Public awareness - patient opinion, patient education Public Health / health promotion - empowering patients Publication of role Regular contact Relationship with team Support Sustaining role of cluster practice pharmacists Time for COP to shine while GP community decline Understanding of others about the role USP of a cluster pharmacist Visibility in practice

Training / Development Medication review - tools available to help ? Cluster tech's Adopt additional skills? - phlebotomy, foot assessments, monitoring conditions Advocacy / mental capacity e.g. In care homes (Shine) Chronic disease management Clinical element and teaching - monitoring i.e. Bloods etc, introduction, clinically identity areas go Clinicaltowards systems (?) training (master classes) Consultation skills Education - skills - what and how? Standardised? Education and training - patient assessment, consultation skills, deprescribing, TA relevant, Expertcardiology, speakers resp, - T2DM 1 hour [Relevant clinical session to primary added care] to COP Getting the most of a cluster pharmacist Importance of IP qualification Induction checklist / plan for cluster pharmacist (based on experience of pharmacist) Interpreting bloods (in context of CDM) Interpreting test results Training / Development IT training IT/ colleague roles Optional training Peer review / Mentoring / Hot review / Clinical Supervision Professional development - maintenance / building competency Protective time Research / Evaluation Specific cluster pharmacist tasks, applicable across all surgeries. Training (specific) Training needs, support needs and resources of pharmacists Training on GPs and how they operate - funding, QoF, GMS contract. Training package Undergraduate - incorporate into course. Pre reg - split between primary and secondary care

Sharing best practice Benefits of cluster pharmacists to practice & patient England - 3 year postgrad qualification (facility + iPek (sic?) is this better Glossary of best practice examples Inhaler technique (AW note - Powys project) Learning from good model of practice Polypharmacy / de prescribing Prescribing Process Quick wins - care homes, polypharmacy, enteral nutrition, asthmatics (inhalers), gaining confidence, relationships with GPs/ DN's. Reorganisation - delivering value Share and evaluate best practice - GP one. Sharing good idea / practice Sharing ideas across cluster practices Sharing of skills / expertise / learning / case studies Sustaining GP Practices

Measurement ? Increase number of pharmacists per surgery rather than cluster Impact of pharmacists on improving patient care Improve DNA rates Increase number of pharmacists i.e. One per surgery Meaningful data Repeat dispensing Showing 'value', outcome measures - quality, quantity time saved, financial save Waste / batch prescribing

Finance Batch prescribing - savings vs safety Business cases writing Finance Financial return to practices / LHB - value to struggling partnerships and LHB Funding / Business cases MUR funding - Clusters instead for COP Potential threats to general practice business from community pharmacy e.g. Dispensing, flu, drums, asthma checks etc - these sayings will not attract new GP partners

Governance Antibiotic governance Centralised uniform evaluation Clear direction to be set by - Cluster ? LHB? WAG? Patients? GPs? Clinical coding (contribution to QoF / LES) RGD ( Service evaluation - Pincer study) - KPI, outcomes , IT support

Evaluation

This programme of work is being evaluated by (supported by a grant from the Health Foundation). Alison Bullock introduced the research team and the evaluative element of the programme. She outlined what the evaluation would entail and the contributions of those involved.

Three things will happen to support the production of a final evaluation report in 2017:

• Observation of the CoP meetings • Focus group discussion and individual interviews • Your reports about your QI practice (submitted on a short structured online form)

• Short structured online reports about your QI practice.

Purpose

To learn about how a Community of Practice might help you use your quality improvement skills (Bronze IQT training) for better service outcomes.

Does a CoP support the habits of an improver and develop technical, soft and learning skills? Closing Keynote

The closing keynote was presented by Dr. Richard Lewis, the National Professional Lead for Primary Care in Wales.

He shared his early reflections of being in post.

He recognised the formidable challenges facing GPs, and primary care in Wales and across the UK. He was pleased to have encountered unexpected levels of enthusiasm, examples of innovation and novel ways of trying to overcome what are difficult times for health services.

He advocated that primary care can offer the means of a solution to the challenges currently facing health systems the world over and that the National Primary Care Plan for Wales is an unequivocal commitment to put primary care front and centre.

He promoted that new approaches have to be found – if we are to maintain sustainable health and social care services.

He covered the significant evidence of initiatives involving the valuable use of health professionals in practice and in the community across all specialities and more through cluster working in Wales.

There is evidence emerging on their impact from all these areas on increasing capacity and helping to manage workload.

He put questions to the group and there was light discussion over what problems are being faced and the way forward within a CoP.

Richard closed the keynote with a message to the CoP ‘we can predict clusters should make waves of change…once they are having a measurable impact, I think clusters too have the potential to change everything.’

Forming the Community of Practice

Margaret Allan, Director of WCPPE closed the first Community of Practice for Cluster Pharmacists. Margaret recapped on the day’s events and reiterated that the CoP is what the group wants out of it, and that it can only truly form if we keep the momentum going. She thanked everyone for their time and commitment, contributing to the mind maps, dilemmas and discussions. She hoped that others felt the sense of purpose created in the room and that this was an opportunity for ongoing networking and communication for the pharmacists in the community.

On behalf of 1000 Lives Wales, Paul Gimson and Matt Wyatt quickly thanked everyone for their attendance and reminded them of the upcoming meetings, overleaf.

Next Time

Tuesday 12th July 2016 Thursday 13th October 2016 Wednesday 25th January 2017

For further information contact:

Paul Gimson Public Health Wales Mail: Innovations House, Llanharan CF72 9RP Email: [email protected] Phone: 01443 233233

APPENDIX

Attendee list

First name Last name Job title Organisation Margaret Allan Director-WCPPE Cardiff University Mark Allen Clinical Pharmacist Cardiff & Vale UHB Policy and planning Company Chemists K Louise Allen manager, Wales Association Wales Centre for North Wales Regional Pharmacy Professional Victoria Allum Coordinator Education Pharmacist prescribing Abertawe Bro Claire Arthur advisor Morgannwg UHB Practice Support Brecon Medical Group Thomas Banning Pharmacist Practice Carl Barrett Cluster Pharmacist Cwm Taf UHB Practice Based Pharmacist - Rachel Beckett Monmouthshire South Aneurin Bevan UHB Practice Manager - Bridgend North Network Abertawe Bro Ian Bevan Lead Morgannwg UHB Sarah Bevan Cluster pharmacist Hywel Dda UHB General Practice (The Health Centre Ann Brown Practice Manager Abercynon) Alison Bullock Professor Cardiff University Prescribing Adviser Taf Sarah Bush Ely Cluster Cwm Taf UHB Senior Primary Care Mike Curson Pharmacist Aneurin Bevan UHB Abertawe Bro Manjinder Dahel Prescribing advisor Morgannwg UHB Frailty and Chronic Conditions Cluster Lowri Davies Pharmacist Hywel Dda UHB Ian Dodd Practice Manager Cwm Taf UHB Allan Donnithorne Cluster Pharmacist Cardiff & Vale UHB Practice Based Clinical Rowena Duffield Pharmacist Aneurin Bevan UHB Abertawe Bro Bethan Edwards Cluster Pharmacist Morgannwg UHB Consultant in Pharmaceutical Public Sian Evans Health Public Health Wales Head of Pharmacy Community Pharmacy Samantha Fisher Affairs, Lloyds Pharmacy Wales Programme Manager for 1000 Lives Improvement Paul Gimson Primary Care Service First name Last name Job title Organisation Anthony Hall Practice pharmacist Aneurin Bevan UHB Practice Based Clinical Pharmacist Caerphilly East Neighbourhood Care Lloyd Hambridge Network Aneurin Bevan UHB Healthcare Partnerships Paul Harris Manager Boots UK Taff Ely cluster Daniel Hay pharmacist Cwm Taf UHB Jamie Hayes Dirctor Cardiff and Vale Practice Based Pharmacist- Monmouthshire North Lucy Higgins NCN Aneurin Bevan UHB Practice-Based Clinical Pharmacist, Newport Claire Hill North NCN Aneurin Bevan UHB Charlotte Hill GP cluster Pharmacist Cwm Taf UHB Wales Centre for head of programme Pharmacy Professional Kath Hodgson delivery Education Principal Pharmacist in Gareth Holyfield Public Health Public Health Wales Caroline James pharmacist Cwm Taf UHB Kirsty James Receptionist Cwm Taf UHB GP , DSMP for IP Tracey James pharmacist at Newport Aneurin Bevan UHB neightbour care network Hayley James pharmacist Aneurin Bevan UHB Kate Jenkins Cluster Pharmacist Cardiff & Vale UHB

Marian Jones Cluster Pharmacist Cardiff & Vale UHB Viv Kent Practice Manager Aneurin Bevan UHB Prescribing Advisor Non Lewis Advanced Pharmacist Cwm Taf UHB Abertawe Bro Christina Lewis GP Cluster Pharmacist Morgannwg UHB Robert Liddington Pharmacist Specialist Care quality commission Abertawe Bro Sarah Long cluster pharmacist Morgannwg UHB Community Pharmacy Paul Mayberry Lead Aneurin Bevan UHB Haydn Mayo Community Director Cardiff & Vale UHB Ruth Mitchell Pharmacist Boots

Practice Business Moira Moore Manager Ashgrove Surgery Sarah Moore Practice manager Parc Canol group practice practice based Melissa Morgan pharmacist Aneurin Bevan UHB First name Last name Job title Organisation

Gethin Morgan Cluster Pharmacist Cardiff & Vale UHB Abertawe Bro Kirsty Morris Prescribing advisor Morgannwg UHB Advanced Practice Abertawe Bro Vanessa Morton Pharmacist Morgannwg UHB Cluster Pharmacists - Abertawe Bro Rachel Murphy West Network Bridgend Morgannwg UHB Emma Nurse Cluster Pharmacist Hywel Dda UHB Practice based clinical Carl Peacock pharmacist Aneurin Bevan UHB

Lorna Phillips Respiratory Pharmacist Cwm Taf UHB Lia Popa Pharmacist Betsi Cadwaladr UHB practice based Lisa Pottenger pharmacist Aneurin Bevan UHB Wales Centre for Pharmacy Professional Carolyn Poulter Regional Co-ordinator Education Nerys Rees Practice Nurse Cwm Taf UHB Lisa Riley Pharmacist Aneurin Bevan UHB Wales Centre for Head of Programme Pharmacy Professional Debra Roberts Development Education Research Centre Elaine Russ Manager Cardiff University Has Shah GP Cwm Taf UHB Kate Spittle Practice Pharmacist Cwm Taf UHB Senior Primary Care Anne Sprackling Pharmacist Aneurin Bevan UHB Pharmacist Prescribing Abertawe Bro Neil Sugden Adviser Morgannwg UHB Practice business Jayne Taylor-Lloyd manager Cwm Taf UHB Elly Thomas Practice Pharmacist Ashgrove Surgery Helen Thomas Pharmacist Davies Chemist Ltd Senior Primary Care Jane Thomas Pharmacist Aneurin Bevan UHB Primary Care Abertawe Bro Avril Tucker Antimicrobial Pharmacist Morgannwg UHB Primary Care/Practice GP practices in Cwm Taf Christine Vining Pharmacist and Cwm Taf UHB Wales Centre for Pharmacy Professional Sheree Vyas pharmacist Education Jonathan Walker Locality Pharmacist Betsi Cadwaladr UHB Service Improvement and 1000 Lives Improvement Andrew Ware Development Manager Service Katie Webb Researcher Cardiff University James Wermig practice pharmacist Aneurin Bevan UHB First name Last name Job title Organisation

Helen Wigley Cluster Pharmacist Cardiff & Vale UHB Don Wilkes Practice Pharmacist Argyle Medical Group Rory Wilkinson Locality Lead Pharmacist Betsi Cadwaladr UHB Prescribing Support Anna Williams Pharmacist Hywel Dda UHB locum practice Nerys Williams pharmacist Parc Canol surgery Aman Tawe Partnership Michael Williams Practice Pharmacist Medical Practice Ivana Wong cluster pharmacist Cardiff & Vale UHB Pharmacist Team Leader Bev Woods - Primary Care Cwm Taf UHB

Mind Maps

01/05/2016

09:30 Registration & Refreshments 10:00 How did we get here? Andrew Evans 10:20 What’s a Community of Practice Matt Wyatt Pharmacists 11:00 The Right Focus For a COP Paul Gimson 12:00 A Pharmacist in Unknown Territory Rob Liddington in Practice 12:30 Lunch & Networking All Wales Community of Practice 13:30 Delights and Dilemmas Matt & Paul 14:30 Evaluation Alison Bullock 14:45 Closing Keynote Richard Lewis 15:00 Forming the Community of Practice Margaret Allan 15:30 Close

Andrew Evans Matt Wyatt HOW DID WE GET HERE? WHAT IS A COP?

Mechanistic Organic Answer Context Best Practice Good Practice Rational Holistic Risk Averse Risk Wise Apologising … Deductive Political Structure Network Targets Outcomes Projects Experiments • Improvement Facts Ideas Unilateral Together End Points Connections Advisor at Public Instructed Advocated Planned Responded Health Wales Taught Learned Delivered Achieved To With Supervised Accountable Manufactured Grown Consultation Participation • Why am I here? Process People Universal Individual Standardised Tailored Similarity Diversity Supply Equip • Complex Need Designed Evolved Information Communication Organised Understood • Creating Space Teams Groups Intelligence Wisdom Inform Discuss • Apologising Regulated Appreciated Negotiated Mediated Probable Possible Show Guide Invent Innovate Leadership Relationship

1 01/05/2016

TQM BPE CIC PDSA L6σ & PBMA …

End The Process Fallacy

Processes are defined by a very highly Step 2 specified, predetermined end point and they are very, very useful. Step 1 Things that are not processes: • Retrospective Coherence Start • Lists drawn into shapes

It must be your fault ...

Extravert v Introvert Sensing v Intuition Thinking v Feeling Judgement v Perception

Integrated Modernisation Pathway Seamless Linkage Facility Leadershippers on tour ... Proactive Context Pyramid Optimal Resource Framework Stable Client Model • Culture Inclusive Downsizing Market Special Polynomial Network • Vision Focused Consensus Vision Strategic Engagement Transformation • Values Instinctive Fallback Solution Virtual Empowerment Mechanism • Strategies Mutual Appreciative Flow • Objectives Elemental Scoping Principal Established Cartesian Exercise • Missions Participative Tertiary Approach Innovative Learning Forum • Champions Organic Stakeholder Cascade Evolutionary Leadership Cycle • Frontlines Narrative Pooling Inquiry • Processes (again) Robust Re-engineering Tree Collaborative Centred Challenge Eclectic Regional Partnership

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1 www.inc.com13 4

Altogether in practice … Communities of Practice ...

1991: Institute for Research “Your trained in a on Learning in Palo Alto, California - Etienne Wenger silo, employed in and Jean Lave coined the term Community of Practice a silo and then The term was first used in someone says, their study of apprenticeship and has since been applied to now all go and government, education, social service providers, and various work together … professional organizations. it’ll be fine!” A lot has happened since!

The basics … Fluffy bunnies …

A community of practice is a “… it is recognised that network of people who share a specific area of knowledge some of the most creative and are willing to work and and sustainable work learn together over a period comes from facilitating of time to develop and share passionate and that knowledge committed practitioners • a shared domain of interest to share experiences and • a membership who meet to knowledge, in order to share their experience bring about change in • and a common practice their own practice.”

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Over the last 10 years ... • Care Planning • Unified Assessment • Chronic Conditions • Passing the Baton • Discharge Nurses • Intermediate Care • Challenging Behaviour • Falls Collaborative • Complex Care Forum • PMLD • Pharmacists in Practice

Practice in Practice …

• It’s a living thing not a machine, it lives & dies! • Groundwork, a few rules & a sense of direction • Fine tuning the rhythm & wisdom of the crowd • Enthusiasts, the six hour rule & a tipping point • Participative, fun and intellectually stimulating

A shift in perspective ...

How to create the conditions that enable people to feel good, have space to think, get together, take a risk, do a couple of experiments and nurture their intrinsic motivations ... all at the same time?

24 The Fundamental Attribution Errorwww.thesun.co.uk

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Leveraging the Diversity ...

Crowd Error = Average Error – Diversity Unconditional Positive Regard static.panoramio.com25

Paul Gimson THE RIGHT FOCUS

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Cluster Pharmacists... Current roles within the pharmacy team • Practice Based Pharmacist • Primary Care Pharmacist • Prescribing Advisor • Community Pharmacist • Intermediate Care Pharmacist • Hospital Pharmacist • Prescribing Pharmacist • etc

Follow the money... Primary Care Plan

• A primary care service made up of a wide range of professionals working as a coordinated and integrated team of GPs, nurses, pharmacists, midwives, health visitors, dentists, optometrists, physiotherapists, podiatrists, healthcare support workers, social workers and others. • Will become the mainstay of the NHS: tackling the root causes of ill health, preventing people from being admitted to hospital unnecessarily, helping those who have been admitted to get home quickly with the right support; motivating and supporting people with chronic conditions and long-term illnesses to manage their health at home. • The new primary care service for Wales will help to reshape the NHS, developing and increasing the primary care workforce to provide the majority of care close to people’s homes, accelerating the transfer of services from the hospital to the community and improving the way people can access services.

Primary Care Plan Primary Care Plan

• A primary care service made up of a wide range of professionals PRINCIPLES working as a coordinated and integrated team of GPs, nurses, “No GP should pharmacists, midwives, health visitors, dentists, optometrists, UNDERPINNING THE PLAN routinely be physiotherapists, podiatrists, healthcare support workers, social undertaking any workers and others. • Prevention • Will become the mainstay of the NHS: tackling the root causes of activity which could, • Co-ordinated care ill health, preventing people from being admitted to hospital just as appropriately unnecessarily, helping those who have been admitted to get home • Co-Production quickly with the right support; motivating and supporting people be, undertaken by an with chronic conditions and long-term illnesses to manage their • Planning services at a health at home. community level of advanced nurse, a • The new primary care service for Wales will help to reshape the 25,000-100,000 people clinical pharmacist or NHS, developing and increasing the primary care workforce to • Primary Care Clusters provide the majority of care close to people’s homes, accelerating an advanced the transfer of services from the hospital to the community and • Prudent healthcare. practioner paramedic” improving the way people can access services.

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So what...?

...is your experience? ...do we need to do? • Of working ACROSS the • To improve working cluster? ACROSS the cluster? • Of INTEGRATION with • To INTEGRATE the role of the wider primary care cluster pharmacist with the rest of the primary team? care team • Of the provision of • To deliver CLINICAL CLINICAL PHARMACY PHARMACY SERVICES SERVICES based on the identified • Of PLANNING services on NEEDS of your local a population level population

Pick a subject you think is important

Rob Liddington UNKNOWN TERRITORY

mind-mapping.co.uk

Lunch & Networking Matt & Paul RECONVENE @ 13:30 DELIGHTS AND DILEMMAS

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Dilemmas ... Delights ...

www.despair.com Discovering any Create list with dates, of all the potential assets policies, strategies, projects Exapting assets to a reorganisations and big ideas new greater utility Adapting assets with that you’ve been involved in continuous feedback

(or subjected to) throughout Optimising assets by your career, that have effected moving them around how you practice. Milking the assets you’ve already got

Stretch participants to explore opportunities and innovate in unpredictable environments

Some Participants will

Conceptual feel more comfortable Participative method, in exploration others in creative facilitation and analysis: the model is a immersive exercises synthesis to leverage

the collective diversity

Time scale is fractal over a session, a day and the life of the programme Time Real World Real

Learning sessions begin and end by reflecting on Expert led case study, the participants own measurable precedent experience of life back and working tools

in the real world Conceptual

Stretch participants to analyse problems and embed evidence in predictable environments

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Evaluation

Alison Bullock Helping GP practice-based pharmacists to EVALUATION implement their improvement skills: Assessing the value of a community of practice model

Working in collaboration with Purpose Margaret Allan Andrew Evans Matt Wyatt Paul Gimson To learn about how a Community of Practice might help you use your quality improvement skills (Bronze IQT training) for better service outcomes.

Does a CoP support the habits of an improver and develop technical, soft and learning skills?

Guinea pigs………….. Our approach 1.Develop an ‘official’ theory (logic model) to describe the conditions or context (C) under which the mechanisms (M) operate to produce desired outcomes (O).

2.Undertake a CoP case study, observing meetings, interviewing participants

3.Present a ‘real’ theory which describes the features required for optimising the contribution of a CoP and implementation of QI skills.

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What will happen?

• You participate in CoP meetings which we observe • Focus group discussion and individual interviews • Short structured online reports about your QI practice.

This project has been reviewed and approved by a research ethics committee at Cardiff University.

Thank you for listening

[email protected]

02920 875403

www.cardiff.ac.uk/curemede

Corporate slide master With guidelines for corporate presentations Pharmacists in Practice 27 April 2016 Richard Lewis All Nations Centre, Cardiff KEYNOTE Dr. Richard Lewis National Professional Lead for Primary Care in Wales NHS Wales/Welsh Government

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The Primary Care Plan 1978

• Primary Care Front and Centre – Planning care locally – Improving access and quality – Equitable access – A skilled local workforce – Strong leadership.

Alma Ata 1978 Alma Mata Declaration 1978

• Government Commitment • Clusters • Public Health Initiatives (PHW & Legislation) • Community Referral • Personal Responsibility • Integrated Whole System Approach/Planned & Unscheduled Care, OOH, Social Care • Multidisciplinary Primary Health Care Teams

Real Challenges Real Needs OECD Report

• An ageing population

• High levels of chronic disease • Health inequalities

• Lifestyle choices

• and other

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Primary and Community Care Teams Re-Inventing the Primary Healthcare Team • Clinical pharmacists • Improving access to Community Pharmacy • Improving access to optometry • Improving access to audiology • Improving access to dentistry • Extended practice nurse role • Advanced & specialist nurse practitioners • Physiotherapists • Paramedic practitioners • Occupational therapists • Physicians Associates

Let’s Journey Together

Margaret Allan FORMING THE COP

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