Homecare Medicines: Reducing
the risks
Professor Ray Fitzpatrick
Clinical Director of Pharmacy Royal Wolverhampton NHS
Trust
Co Chair Standards and Handbook Workstream of the
National Homecare Strategy Board
Background
Homecare is a Rapidly growing market
value circa £1.5bn
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200,000 patients receiving medicines
via the homecare route
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2011 Department of Health
commissioned a review of homecare
services. Review led by Mark Hackett
CEO University Hospital Southampton
NHS Foundation Trust.
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Report published November 2011
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Key Findings in Hackett Report
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NHS has used homecare services for patients since 1995. However, in the
last four years there has been a rapid development of services without the
necessary controls to ensure common standards of best practice.
Examples of good practice but wide variation across NHS
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Key Recommendations:Collaborative procurement processes to be developed
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National Standards to be developed
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NHS internal homecare governance processes to be strengthened with the
Chief Pharmacist at the centre working alongside the Chief Medical and
Nursing Officers of the Trust
Patients to be engaged in development and commissioning of homecare
services
Implementation
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April 2012 Strategy board established to take forward the key
recommendations in Hackett report.
Board established several work streams
Patient Charter – clear specific charter to enable patients to understand
their homecare services and how they can influence them
Homecare Standards and Handbook – Royal Pharmaceutical Society
approved standards with aligned documentation in a Handbook
Governance – a guide to good governance for acute trusts using
homecare services
Systems – initial recommendations to the NHS on short term system
solutions and an output based specification for a new Homecare system
solution
Procurement – recommendations associated with improving the
procurement models for use within the NHS and improved transparency
of SLAs through a shared management system
Homecare Standards and handbook: reducing
the Risks with Homecare medicines
http://www.rpharms.com/unsecure-supportresources/professional-standards-for-homecareservices.asp
Patients’ charter
 Homecare Service Information for
Patients & Carers
 Registration and consent form
 Patient satisfaction questionnaire
 Medicine Pathway
 Individual Care Plan
 Suitability and Needs Assessment for
individual patients
 Clinical Records
 Clinical Service Protocols and Reports
 Non-clinical Home visits Protocols and
Reports
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Domain 1
The Patient
Experience
Domain 2
Implementation
and Delivery of
Safe and
Effective
Homecare
Services.
2.1 Contractual framework required for a Homecare
Service
 Homecare Services Aims and Rationale
 Homecare Service Specification
 Tender of Request for Proposal and Adjudication
Criteria
 Service Level Summary or Service Level Agreement
 Technical agreement
 KPI’s
 2.2 Operational Guidance for Running a
Homecare Service
 Prescriptions
 Temperature controlled storage
 Custom made medicines and imported medicines
 Key holding guidance
 Adverse weather guidance
 Homecare Service Review Meeting Agenda
 Transferring Patients between Homecare Providers
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Domain 3
Governance of
Homecare
Services.
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Homecare Strategy & Policy
Patient Confidentiality, Data Protection and
Information Sharing
Recommendations from the IT workgroup
Managing Complaints
Patient Safety & ADR Reporting
Quality Assurance and Risk Management
Audit of compliance with the RPS Professional
Standard
Clinical Trials
Workforce Planning

Job Descriptions
Regulation and External Accreditation
Domain 3 will be of particular interest to chief pharmacists seeking to establish or
review their governance arrangements for homecare
Reducing the Risks: A Chief Pharmacists Perspective
Standard 8.1
The Chief Pharmacist or
equivalent ensures that the
organisation maintains a
clear vision for homecare
services, optimal use of
homecare medicines and
sharing best practices across
homecare organisations. .
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Why do I
need a
handbook?
I maintain robust governance on medicines dispensed in
house, so homecare medicines should be no different
As majority of medicines delivered through homecare are
PbR excluded commissioners will require compliance with
RPS Standard
Developing a Homecare Strategy
What homecare do
we do already?
SWOT analysis
Where am
I now
What are my gaps
to comply with
RPS standards
What do I need to
do to fill the gaps
My Strategy
Strategy - Review Current Homecare
Therapy areas
Current Therapies
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Stable HIV patients currently
provided through homecare.
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Rheumatology patients
receive biologics through
Pharma schemes managed
by the clinic
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Paediatrics, gastroenterology
and renal
Issues
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Homecare not suitable for
every patient.
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Not managed by NHS.
Acquisition of Cannock
hospital will more than
double number of patients
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Need to understand the
rationale. Are there better
alternatives for the patient?
Strategy - Review Governance
Arrangements
Strengths
 All prescriptions processed
through pharmacy (clinical
screening, ordering and
invoicing).
 Good financial
governance.
 Good patient level
information on homecare
usage and expenditure
 A member of my
procurement team has a
specific homecare role.
Weaknesses
 Homecare has developed
in a relatively unplanned
way apart from HIV.
 No homecare pharmacist
or team
 SLA’s not monitored
closely.
 No monitoring of KPIs
 No audit of homecare
services and providers.
 No forward planning of
which medicines
delivered via homecare.
My Homecare Strategy
1. Revise medicines policy to cover medicines delivered via
homecare. Example homecare policy in handbook.
2. Establish a homecare team resourced from gain sharing
agreement with commissioners. Example JD’s for
Homecare Pharmacist and Technician in handbook.
3. Review appropriateness of current homecare therapies
and identify alternative models if necessary and what
additional homecare services local patients and
commissioners would like to have
4. Establish robust SLA’s with homecare providers (see
handbook), monitor KPIs (internal and providers)
5. Team to develop robust risk management arrangements for
homecare medicines particularly in the light of recent
Summary
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First Hackett report identified homecare market has grown
rapidly in recent years with wide variation in NHS ability to
manage these.
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Patient safety alert issued in April 2014 highlights the risks of
missed doses with homecare medicines
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To reduce risks with the delivery of medicines via homecare
services a number of work-streams established under national
homecare strategy board.
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RPS Homecare standards published in September 2013
provide a framework for us to work to.
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The Homecare Handbook published earlier this month contains
guidance on how to meet these Standards.
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IT workstream still to be completed and handbook needs to be
updated regularly
To reduce risks associated with homecare
medicines, we need to take control!