NHS Structure and Policy Flashcards
How is the department of health funded?
Public funding - Chancellor of the Exchequer
Roughly how much of tax money is used for healthcare?
£1 per every £5
Who determines health and social care policy?
Secretary of State for Health
Who is responsible for policy and delivery in health and social care?
Department of Health
What are the overseeing commissioning groups?
Public Health England
NHS England
Regional Teams
Who can provide community pharmacies with funding?
NHS England
Local Authorities
Clinical Commissioning Groups
Who negotiates contracts between community pharmacies and NHS England?
Pharmaceutical Services Negotiating Committee
How are essential and advanced services funded?
NHS England
How are enhanced services funded?
NHS England local area teams
Where do social care providers receive funding from?
Local Authorities
Who receives funding from CCGs specifically?
Commissioning Support Units and Acute Care
Mental Health Trusts
Who commissions Specialised Clinical Services?
NHS England
How much of the NHS budget is controlled by NHS England?
40%
What are the aims of NHS England?
Set our priorities and strategies of NHS
Commissioner for primary care in England
Planning and buying of specialist services
Negotiating partner for PSNC
What are the 5 NHS England Regional Teams?
London Midlands and East North South East South West
What are the aims of the NHS England Regional Teams?
Plans for improving healthcare in their area
Healthcare commissioning and delivery in their area
Working with CGs, LAs, and health and wellbeing boards
What are CCGs made of?
GP practices
What are the minimum requirements for the governing body of CCGs?
One nurse
One hospital doctor
Two lay persons
What commissions are controlled by CCGs?
Planned hospital care
Emergency care
Out of hours care
Prescribing budgets
How many CCGs are there in England?
195
What do Commissioning Support Units do?
IT, business and management support
Accounting services
Information analysis
What is the purpose of Clinical Senates?
Team of healthcare specialists
Share clinical knowledge to inform service commissioning and design
How many clinical senates are there in England?
12
What are Local Professional Networks?
Provide clinical input in local commissioning decisions
One for pharmacy, dentistry and optometry in each locality
Pharmaceutical Needs Assessments
What are Local Pharmaceutical Committees?
Consult on matters affecting local pharmacy contractors
Help plan, negotiate and discuss services with commissioners
Advice to contractors and those wanting to know more about pharmacy
How many Local Pharmaceutical Committees are there in England?
80
What is the purpose of the Care Quality Commission?
Regulate health and adult social care services
Ensure care from hospitals, dentists, ambulances, care homes and home care agencies meets government standard
What is the NHS improvement regulatory body?
Oversee foundation trusts, NHS trusts and independent providers of NHS-funded care
What is the purpose of NHS Improvement?
Support providers to give safe, high quality and compassionate care in a financially sustainable way
Support providers to meet areas covered in five year forward view
What is the purpose of Healthwatch England?
Gather and represent public views on English health and social care services
What are vanguards?
Group of people leading new developments or ideas
Form care models to transform service delivery
How many vanguards are there in England?
50
What are the 5 different Vanguard sites?
Integrated Primary and Acute Care Systems Multispeciality Community Providers Enhanced Health in Care Homes Urgent and Emergency Vanguards Acute Care Collaborations
What are the two major health policies?
Equity and Excellence: Liberating the NHS
Healthy Lives, Healthy People
What are the 5 key priorities of the Equity and Excellence policy?
Patients come first Improving healthcare outcomes More autonomous and accountable system Improving public health Reform long-term social care
What would be the impacts of the equity and excellence policy on pharmacy?
Integration of pharmacists - MDTs, health and wellbeing boards, role in medicines optimisation
Payment by performance, incentive for high quality, efficient service
What are the key improvements for the NHS five year forward view?
Increase the number of GP pharmacists
GP practices to work with community nurses and clinical pharmacy teams
GPs to work closer with community pharmacies to make full use of skills
What is the NHS mandate?
Objectives and requirements for NHS England
Updated yearly
What are the objectives in the NHS mandate?
Improve health outcomes and reduce inequalities
Create safest, highest quality healthcare services
Balance budget to improve efficiency and productivity
Prevention of illness and support to lead healthier lives
Maintain and improve performance against core standards
Improve out-of-hospital care
Support research, innovation and growth
What is included in the RPS report on future care models?
Role of pharmacist in chronic conditions/preventable illness
Improve underutilisation
Improve out of hours and urgent care through pharmacies
Increase public awareness of pharmacy
What are the NHS England aims for community pharmacy?
Develop team for personalised care
Stronger role in integrated out of hospital services
Bigger role in health advice and improving overall health
Improve patient experience to optimise medicines use
What is the Murray Review?
Review clinical services offered by pharmacies
What are the future views for pharmacists?
Work in primary care teams
Increased care home/A&E involvement
Read-write access to Summary Care Records
What is determined by NHS legislation?
Products prescribable under NHS
Patient charges for drugs dispensed under NHS and grounds for exemption
What is the quality payment scheme?
Payments to community pharmacy contractors meeting certain criteria
What are the four gateway criteria for quality payments?
Provision of at least one advanced service
NHS UK entry up to date
Staff can send and receive NHS mail
Can link to NHS digital systems
What are the extra domains in quality payment criteria?
How many have to be met?
Patient safety Public Health Digital/Urgent care Clinical effectiveness Workforce
One or more
What is the Pharmacy Integration Fund?
Support development of clinical pharmacy practice in a wider range of primary care settings
More integrated and effective NHS primary care pathway
What are the aims of the pharmacy integration fund?
Make better use of community pharmacy, pharmacists and technicians
Improve patient access
Relieve pressure on GPs and A&E
Contribute to delivering a 7-day service
What is the basis of approval for community pharmacy contracts?
Who undertakes this?
Pharmaceutical Needs Assessment done by LA health and wellbeing board
Which services are nationally agreed and commissioned by NHS England?
Essential and advanced services
What are commissioned by LAs, CCGs and NHS England local offices?
Locally commissioned services
What are the roles of health and wellbeing boards, local pharmaceutical networks and NHSE local offices in enhanced services?
Pharmaceutical needs assessment done by boards and networks
NHSE local offices commission
What are the seven essential services?
Dispensing Repeat dispensing Disposal of unwanted medicines Public health - 6 campaigns a year Signposting Self care support Clinical governance - HCP accountable for quality of services
How are the patient/public involved in clinical governance?
Notify of services provided
Patient satisfaction questionnaires
Monitor medicines owed/put of stock
Establish complaints system
What are other terms of service for clinical governance?
Clinical audits Risk management programme Staff training and management Whistle blowing policy Premise standards Data protection
What are the six advanced services?
MURs NMS Urgent Medicine Supply Advanced Service Flu vaccine Appliance Use Review Stoma Application Customisation
What is the aim of medicines use reviews and when are they offered?
Improve patient’s knowledge, concordance and use of prescribed medicines
After dispensing prescription for previous 3 months
What are the MUR target groups?
If taking high risk medications If recently discharged and medication is changed Respiratory diseases At risk of or diagnosed with CVD On multiple medicines
What are the aims of the new medicines service?
Improve adherence Increase engagement with condition and medicines to support them in decision making Reduce wastage Reduce hospital admissions from ADRs Increase ADR reporting
Give some examples of conditions targeted by NMS
Asthma/COPD
T2DM
Antiplatelet/anticoagulant therapy
Hypertension
What were the positives identified of the NMS?
Increased adherence by ~10%
Saved money
Patients were positive and supportive of service
What is the Urgent Medicine Supply Advanced Service?
Patients calling 111 with urgent requirement for repeat medicines referred directly to community pharmacy instead of GP
Who is offered the flu vaccine service?
Patients in high risk groups
What are the pre-requisites for locally commissioned services?
Suitable premises
Trained and qualified staff
Appropriate equipment
Aligned with national guidelines and local needs
What are the six enhanced services?
Anticoagulant monitoring Minor ailments scheme PGD service Needle and syringe exchange service Care home service Home delivery
What are the three locally commissioned services?
Vascular risk assessments
Weight management schemes
Sexual health
What is remuneration?
Payment for NHS services, determined by Department of Health
What is reimbursement?
Arrangements for repayment of costs of medicines dispensed against NHS prescriptions, determined by Department of Health
Where are the reimbursement amounts found?
Branded products - Manufacturer’s NHS list price
Generic products - Drug tariff price
How do drug tariff prices work?
Price for each product is fixed regardless of how much individual community pharmacy paid
Updated monthly
Where is the profit made on import/export of medicines currently?
Export medicines as import medicines are not much cheaper due to exchange rate
What is the negative of exporting medicines for profit?
Shortage of medicines in UK
Why is there a discount deduction scale for reimbursements?
Medicines cost less than list price through wholesaler discounts, bulk buying and parallel importing
DoH estimates difference
How frequent is reimbursement for dispensed medicines?
Monthly
What is the downside of NHS cost control mechanisms?
Attempting to purchase cheaper medicines
Attempt to increase level of discount beyond NHS scale
Minimise stock to reduce waste - problems with availability
What are the costs involved in running a community pharmacy?
Staff Training Rent and bills Deliveries Stock loss, incorrect claims Equipment
How do community pharmacies make their profits?
Number of dispensed prescriptions Payment for services Accurate remuneration and reimbursement Cost containment Quality payments
What problems arise from stock shortages?
Decreased patient satisfaction Patient confusion from swaps Increased workload Inconvenience to patient Reduced compliance
How do hospital pharmacies receive income?
National tariff reflecting national average prices for hospital procedures
Achievement of ‘commissioning for quality and innovation’ indicators
Non-profit
How are costs controlled in hospital pharmacies?
Efficient and rational use of medicines
Encourage patients to use own drugs
Home care services
