JOINT WORKING

 

Joint Working

We have a long history of working in partnership with others. Indeed, some of our greatest achievements have come about through collaborative effort.

The Department of Health (DH) defines joint working between the NHS and the pharmaceutical industry as situations where, for the benefit of patients, one or more pharmaceutical companies and the NHS pool skills, experience and/or resources for the joint development and implementation of patient-centred projects and share a commitment to successful delivery. Our ability to continue with our long-standing collaborative efforts pivots on the DH’s joint working mandate and enables us to discover and invent new ways, every day, to help the world be well.

We're currently working with the NHS in numerous ways, across various disciplines and disease areas. Whether it's cost reductions, improved quality of patient care or access to the latest research in a specialist area, we do what we can to help.


Our Joint Working Partnerships​​

Executive Summary

This is the executive summary of the joint working agreement between Merck Sharp and Dohme Limited (MSD) and the South London Health Innovation Network. This agreement lasts from April 2015 to October 2015.

Project Title:

The improvement of integration care pathways for the arrangement of unscheduled care in hypoglycaemia and hyperglycaemia (South London Health Innovation Network Hypo Pathway Project).

Aims and objectives:

In October 2012, LAS launched a new pathway in which GPs are informed within 24-48hrs (with patient consent) where an ambulance crew has treated a hypoglycaemic episode on scene (no hospital conveyance). LAS identified a need to evaluate implementation of this pathway and it was agreed that the Health Innovation Network would provide the capacity and expertise to support this evaluation. It was decided that, using the results of the evaluation, HIN and LAS would then work with service users and providers across the 12 South London CCGs to improve the pathway and in this way deliver enhanced patient outcomes.

The objective of the project is to maximise the benefits of the hypo/hyperglycaemic pathway and ensure that patients receive integrated and tailored care to reduce the risk of these events occurring, many of which are avoidable and increase referral rates to 100%.

Benefits to the Patient:

Through the enhanced knowledge and confidence of LAS staff attending to patients, the recording of information in a standardised way and the subsequent follow up by designated HCPs, patients will have access to a better, more cohesive standard of care and it is anticipated will have better outcomes as a result.

Benefits to the Partner Organisations:

HIN - This project directly helps the South London Health Innovation Network to attain their goal of delivering cross boundary working within their membership to improve health outcomes for South London residents.

LAS – This project helps LAS by working to reduce the number of avoidable hypoglycaemic episodes and by providing the reassurance that patients will receive optimal follow up care after ambulance staff have delivered treatment on scene.

Benefits to MSD:

  • Engagement in this structured Joint Working Project supports MSD’s patient centric approach. MSD’s reputation as a trusted and valued partner will be enhanced.
  • MSD will have an established working relationship with the South London Health Innovation Network. • This project raises awareness of Hypoglycaemia amongst clinicians, which is in line with our current diabetes franchise strategy.

Project Title:

NHS Southwest Long Acting Reversible Contraception (LARC) Implementation Project

Description:

NHS South West, MSD and Bayer HealthCare are working in partnership to achieve region-wide implementation of National Institute for Health and Clinical Excellence (NICE) LARC Guidance, October 2005. This collaborative project aims to impact on region-wide teenage pregnancy rates, unintended pregnancy rates and abortion rates.

Expected benefit to patients:

Better access to the full range of contraceptive options and increased support to areas of highest need to help reduce health inequalities.

Completion date:

March 2012

Project Title:

Primary Care Diabetes Facilitator Project

Description:

The parties involved are working together to increase management of diabetes in Primary Care, to reduce unplanned hospital admissions, to improve early identification of patients at high risk of developing diabetes, to ensure prescription of diabetes medicines in line with NICE recommendations, to improve compliance and frequency of medical reviews and to improve the cost effectiveness of current services within the NHS.

Expected benefit to patients:

Better management of diabetes in Primary Care, fewer unplanned hospital admissions, early identification and subsequent advice on making a positive lifestyle choice and an overall benefit from the improvements to the cost-effectiveness of NHS services.

Completion date:

End of 2012

Project Title:

NHS Nottingham City and Industry Maximising Resources and Outcomes in Diabetes (NIMROD)

Description:

NIMROD will seek to understand why the rates for diabetes-related hospital admissions in Nottingham City are higher than national average and then take steps to reduce the number of avoidable hospital admissions for people with diabetes and diabetes-related illness.

Expected benefit to patients:

Aside from benefits gained from increased quality and efficiency, patients are expected to benefit from a reduction in avoidable hospital admissions in Nottingham and from the programme's objective to ensure that all patients with diabetes in Nottingham City are treated in line with current best national practice i.e.NICE and local clinical guidelines.

Completion date:

End of 2012

Executive Summary

This is the executive summary of the joint working agreement between Merck, Sharp and Dohme Limited (MSD) and London Sexual Health Programme (NHS England, London) and Bayer HealthCare.

Project Title:

Improving Choices in Contraception through Training

Aims and Objectives

This partnership is designed to support NHS London in the implementation of NICE LARC Guidelines (NICE CG30, published in 2005) with peripatetic trainers delivering training and education to Healthcare Professionals in their practices in London.

Benefits to the Patient

Improved access to LARC, in particular, intrauterine system (“IUS”), intrauterine device (“IUD”) and subdermal implant (“SDI”).

Enable patients to make a more informed decision when choosing contraception appropriate to their lifestyle.

Reduction in unintended pregnancies in women of all age groups and termination of pregnancy (TOP) rates.

Benefits to London Sexual Health Programme (NHS England, London)

Reduced variation in Long Acting Reversible Contraception (“LARC”) uptake across NHS London by focusing on areas of low uptake and limited access to LARC.

Upskilling, training and delivery of LARC training to healthcare professionals in London to the nationally recognised standards set by the Faculty of Sexual and Reproductive Healthcare (“FSRH”) and the Royal College of Nurses (“RCN”).

Increase the number of fitters of three LARC methods equally (IUS, IUD, SDI), from both doctors and nurses across boroughs within NHS London. Fitters will also be trained on how to remove the LARC.

Reduction in unintended pregnancies in women of all age groups and termination of pregnancy (TOP) rates.

Benefits to MSD

Increased uptake of each of the three LARC methods (IUS, IUD and SDI) by the implementation of the NICE Guideline on Long Acting Reversible Contraception (CG30) within general practice and sexual and reproductive health services.

Both MSD and Bayer manufacture a LARC method and therefore increasing LARC uptake will benefit all Parties of the Joint Project Group.

Actively demonstrate the added value that MSD can bring to patients and the NHS through collaborative working which utilises MSD's skills, experience and resources.

Completion Date

March 2015

Project Title:

Transforming Community Services in Diabetes - Developing Skills and Competencies in Primary and Community Care

Description:

This programme has been designed to develop the skills of staff in primary and community care. It will utilise skills and expertise from within the pharmaceutical industry combined with the Care Trust Plus's knowledge of the community in Blackburn to deliver improved services on a local basis.

Expected benefit to patients:

By up-skilling and training Healthcare Professionals (HCPs), healthcare will be improved in the Blackburn area which will ultimately reduce hospital admissions, re-admissions and referrals.

Completion date:

End of June 2012

Date of Preparation: 2011 | 6-10 GEN/90062-09a

Project Title:

Adult Diabetes Service Project

Description:

The contributors to this project are working together to redesign the provision of diabetes primary care to provide a service that is not only accessible, fair, equitable and personalised. These improvements will be implemented in the hope of reducing inequalities and making the best use of available resources.

Expected benefit to patients:

Greater access to diabetes care in Central Lancashire, in a way that allows greater choice of care to suit individual needs and circumstances.

Completion date:

End of 2012

Project Title:

Department of Health (DoH) supported Pathfinder Project on Public and Patient Engagement (PPE). Branded locally as 'myNHS myVoice'.

Description:

This project aims to deliver a feasibility study that will enable Clinical Commissioning Groups (CCGs) to better understand their population and work with the local population to develop future services.

Expected benefit to patients:

With the aim to recruit 5,000 people to myNHS myVoice (the Leodis Patient Panel), patients are expected to benefit from being given the choice to engage on subject in which they had a personal interest or involvement, as well as an increased awareness of the potential for future, service shaping, involvement. Patients will have greater influence on pathway redesign as well as commissioning and will help to develop a service in which they are involved in a way that suits them.

Completion date:

30 th April 2012

Project Title:

Pulmonary Advancement Network for Newark and Sherwood Health (PANNASH)

Description:

This project aims to enhance primary care and treatment received at home for sufferers of Chronic Obstructive Pulmonary Disease (COPD). The project will also aim to improve the abilities of Newark and Sherwood CCG Healthcare providers.

Expected benefit to patients:

Reduction in emergency hospital admissions and better health for people suffering from COPD

Completion date:

July 2012

Executive Summary

This is the executive summary of the joint working agreement between Merck, Sharp and Dohme Limited (MSD) and South East Coast Ambulance Service, Surrey Downs CCG & North West Surrey CCG.

Project Title:

Reducing Repeat Ambulance calls for Diabetic Hypoglycaemia – The Surrey Hypo Pathway project.

Aims and Objectives

The aim of the project is to improve the care of patients living with diabetes (type 1 and type 2) by reducing avoidable episodes of severe hypoglycaemia, through increasing disease review and more effective aftercare following a hypoglycaemic event.

Improved identification, recording and reporting of non-conveyed and conveyed patients suffering hypoglycaemic episodes by the ambulance service will result in better diabetes related health outcomes.

The project involves developing robust clinical management pathways between South East Coast Ambulance Service (SECAmb) and both primary care and community diabetes providers.

Benefits to the patient

Improved communication between healthcare professionals and timely patient follow up will ensure that patients at risk of further hypoglycaemic events are followed up and managed more appropriately.

A follow-up review will promote better health outcomes and reduce subsequent 999 ambulance call outs.

Benefits to South East Coast Ambulance Service, Surrey Downs CCG & North West Surrey CCG

The project will develop the knowledge and skills of ambulance staff to improve their understanding and recognition of diabetic hypoglycaemia through face to face training and eLearning resources.

Develop and implement a defined pathway for the reporting and subsequent management of patients who have suffered an episode of hypoglycaemia which has resulted in an ambulance call out.

Benefits to MSD

Improved reputation as a collaborative partner to the NHS and provider of healthcare solutions and resources.

Identification of patients at risk of hypoglycaemia who may benefit from alternative oral anti-hyperglycaemic agents including DPP-4 inhibitors as part of a diabetes management review to prevent a subsequent hypoglycaemic event.

Ability to take and share the learnings from this project to other Health Care Organisations to support the integration of diabetes pathways across all relevant stakeholder groups.

Completion date of contractual obligations

Date of Preparation: January 2016 | DIAB-1136206-0001

Project Title:

Long Term Conditions Early Intervention Programme

Organisations involved

Heywood, Middleton and Rochdale Clinical Commissioning Group (HMR CCG), MSD, University of Manchester and Verily Life Sciences LLC.

Summary

The joint working project supports a NHS England Test Bed, aimed at improving the care of long-term conditions (LTCs) in HMR CGG through the combination of interventions. Three LTC patient cohorts (diagnosed and at future risk) with diabetes, COPD and heart failure will initially be targeted. The project offers a package of interventions that targets both primary care healthcare practitioners (HCPs) and patients with MSD’s clinical change management programme, analytical tools and remote monitoring / coaching service. The aim is to improve the management of patients with LTCs, reduce hospital admissions and improve NHS resource utilisation through the combination of interventions in the Test Bed.

Background

Almost two thirds of the Greater Manchester population live in some of the most deprived areas in England. Over 20% of the population have two or more LTCs with a significant proportion living with functionally limiting disease. Deaths from circulatory disease are almost double the average in England. NHS Heywood, Middleton and Rochdale Clinical Commissioning Group (HMR CCG) spend 17 % of their budget on 2% of their catchment population. A significant budget spend is related to supporting patient care across three LTCs; diabetes (DM), heart failure (HF), and chronic obstructive pulmonary disease (COPD). A typical HMR patient with complex LTCs has an average of nine admissions to NHS hospitals over a 12 month period. Therefore, focusing on the management of patients with these LTCs in primary care may improve patient care, reduce unplanned hospital admissions and reduce expenditure.

Heywood, Middleton and Rochdale Clinical Commissioning Group (HMR CCG) successfully led a submission to the NHS England Test Bed programme looking to pioneer and evaluate the ‘use of novel combinations’ of interconnected innovations such as wearable monitors, data analysis and ways of working which will improve patient outcomes at the same or lower cost, when compared to business as usual. This Test Bed is in the first wave of programmes announced by the NHS following a competitive application process and independent external review.

Project Approach

HMR General Practices will have the opportunity to participate in patient and healthcare practitioner (HCP) focused services. HCPs can join a clinical change management programme (Evidence into Practice) as well as access clinical audit and population management software (MSDi) that will be used to identify LTC patients who might not be managed to NICE standards of care, highlighting them for earlier clinical review and management, including referral to a remote monitoring and health coaching service (Closercare).

These services have not been offered as a combination in primary care in England. Data analysis will be performed, compliant with the Data Protection Act and NHS guidelines, to better evaluate the needs and risks in three cohorts of LTC patients (diagnosed, undiagnosed and at future risk) to support HCPs, community and public health teams to improve care, outcomes and expenditure. The Test Bed will evaluate if the package of interventions is acceptable and effective for adoption across the NHS.

Project Objectives

The objective is to evaluate whether the package of interventions can impact on unplanned hospital admissions (UHA) at 12 months for patients with COPD, HF, and Diabetes mellitus in HMR CCG.

The evaluation will also show whether the package of interventions has an impact on patient outcomes and health service use, is cost-effective and adequate for future adoption and diffusion across the NHS.

Benefits

Patient: Improved management of patients with LTCs to reduce unplanned hospital admissions.

NHS: Better use of primary healthcare resources, reduced utilisation of unplanned hospital care by patients with LTCs.

MSD: Evaluation of the package of services implemented with the Test Bed. Experience and recognition as a partner in the delivery of healthcare within the NHS.

Funding

Each party is responsible for funding its own participation in this programme.

Date of Preparation: May 2017 | NOND-1219829-0000

Project Title:

Diabetes Primary Care Change Programme as part of Fylde Coast Diabetes Community Integrated Service

Description:

The Fylde Coast Diabetes Community Integrated Service (DCIS) will be a community-based diabetes care model that brings together a range of professionals to provide the best standard of diabetes care for the Fylde Coast population. This model of diabetes care will aim to provide high-quality accessible care to improve outcomes for people with diabetes. It supports collaborative working across the health economy to ensure seamless, integrated care and is built on a foundation of proactive care planning and shared understanding.

The Diabetes Primary Care Change Programme is integral to ensuring effective implementation of the DCIS and update local clinical practice through:

  • Supporting local practices to reflect on diabetes care management and develop local diabetes care management protocols through facilitated sessions
  • Building a foundation of shared understanding and approaches to diabetes care management and thus support the implementation of the DCIS
  • Proactive care planning and empowered patients supported through effective use of technology and change management
  • Creating a conduit for diabetes clinical development requirements linked to the professional education element of the DCIS

Benefit to patient

People with diabetes feel better supported to manage their condition by having a greater understanding of their condition and the treatment options available to them which supports self-management leading to a better quality of life, closing the gaps between increased length of life and reduced quality of life.

Benefit to NHS

Services delivered closer to home, contributing to the achievement of other specific project objectives. People delivering diabetes care are able to provide the best support and care possible for people with diabetes which will lead to a reduction in waiting times to see the right person, leading to a more proactive service approach. In the long-term a proactive approach will support a reduction in diabetes related complications; improved adherence to care plans through self-management, in turn allowing clinicians to provide more, “hands-on,” support for people with complex needs.

Benefit to MSD

Supporting Fylde & Wyre CCG & other NHS stakeholders so that the appropriate patients with T2DM can achieve improved outcomes through a more accessible service with appropriate support. Being able to demonstrate that MSD is a trusted partner in optimising and enhancing diabetes care through deployment of resources and skills to support and facilitate higher quality care for all appropriate patients. Shared skill, expertise and resources applied to further enhance patient outcomes and service performance. The expected collaboration may benefit MSD indirectly from changes in clinical behaviour as National Diabetes guidelines (NG28) are implemented locally.

Completion date:

expected April 2018

Date of Preparation: May 2017 | DIAB-1222300-0000

Project Title

Provision of core diabetes training for care staff and healthcare professionals within care homes across Buckinghamshire

Organisations involved

A collaborative Joint Working project between Aylesbury Vale CCG, Chiltern CCG and MSD

Summary

Aylesbury Vale CCG and Chiltern CCG will work with MSD to deliver a series of structured educational study days for care home staff across 2017 and 2018. We aim to increase the knowledge, confidence and skills of care home staff to better manage their diabetic populations, while improving health outcomes, and experience of healthcare for this population.

Background

The Buckinghamshire wide Care Homes Programme Board has a remit to improve patient care and reduce avoidable admissions from care homes. The Board have identified issues that exist in working towards these goals.

Monitoring and medication:

  • Lack of appropriate monitoring of type 2 diabetes residents on medication leading to risk of hypoglycaemia (hypo).
  • Insufficient training in use of blood glucose meters in both residential and nursing homes.
  • Lack of knowledge in being able to identify, manage and prevent hypos.
  • No appropriate provision of glucose available to manage a hypo.
  • High incidence of medication errors identified in relation to storage and administration of insulin.

Communication:

  • Inconsistency in reporting of patient indicators such as weight change, food intake and incidents of hypos
  • The appropriate use of care plans reflecting needs of residents relating to diabetes management

Knowledge and skills:

  • Wide variation, awareness and understanding of HealthCare Professionals (HCPs) regarding appropriate diabetes management for patients in a care home setting – especially in relation to understanding individual blood glucose targets etc.
  • No provision of a formal learning programme for care home staff in relation to caring for residents with Type 2 diabetes.
  • Safety issues specifically with insulin storage, administration and insulin delivery such as the safe management of needles etc.
  • Poor awareness of nutritional issues relating to diabetes such as malnutrition, unplanned weight loss and management of hypos.

Access:

  • Difficulty in accessing services for care home residents- e.g. annual review/ foot check/retinopathy screening.

Project Approach

The aim of this service is to provide appropriate, clear, consistent training provision in line with the agreed Buckinghamshire competency standards to care staff and healthcare professionals working in care homes with residents with diabetes. Training will be provided by Aylesbury Vale CCG and Chiltern CCG and delivered by their staff (Gill Dunn, Diabetes Specialist Nurse and Jacqui Kent, Care Home Pharmacist). The training will be rolled out through a number of study days held across 2017, where a network of care home diabetes champions will be set up to ensure sustainable improvements to the quality of care delivered to residents living with diabetes. Each Care Home will be asked to get involved through:

  • The Care Home staff will appoint a Diabetes champion at each care home (Nursing & Residential)
  • Provision of confidence mapping survey to be completed pre training event
  • Attendance for appropriate staff at training event
  • Completion of confidence mapping survey post training event

The desired outcome being improved levels of knowledge for staff and improved standards of care for patients with diabetes residing within care homes leading to a reduction in non-elective admissions pertaining to diabetes care.

Project Objectives

Key objectives to deliver the aim are to:

  • Provide structured education proposals for care staff and healthcare professionals in line with the local guidance (Aylesbury Vale CCG and Chiltern CCG areas)
  • Maximise the effectiveness and quality of care provided for the diabetic population
  • Promote Care Quality Commission advice and guidance regarding diabetes care within care homes
  • Promote patient centred care for patients with diabetes residing within care homes
  • Promote residents taking responsibility for the management of their condition with the support of care home staff
  • Encourage care staff and healthcare professionals to share knowledge and learning regarding diabetes care within care homes.

Benefits

Patients and residents of care homes will receive better, more effective care from staff and HCPs who will be more confident in managing the diabetic population residing within care homes across Buckinghamshire.

The NHS will benefit from; an upskilled workforce more competent and confident in managing their patients and residents living with T2D in Care Homes across Buckinghamshire. Reduced utilisation of healthcare resources as more effective care would be provided by Care Home staff. Reduction in non-elective admissions and hypo’s requiring admission from care homes.

This project aims to drive effective implementation of national guidelines (NICE NG28) at a Care Home level. If the provisions as set out in the NICE guidance NG28 are followed, this may result that newer type 2 diabetes products may be prescribed, which may indirectly benefit MSD and other manufacturers.

Funding

The contribution from MSD will total a Transfer of Value amount equalling £15,690.

The contribution from Aylesbury Vale CCG and Chiltern CCG will amount to a combined total of £12,026.

Date of Preparation: October 2017 | DIAB-1233904-0000

Project Title

Surrey IBD Pathway Project - Flare to Earlier Care

Organisations involved

MSD UK, Surrey and Sussex Hospitals NHS Trust, The Kent, Surrey and Sussex Academic Health Science Network

Summary

IBD represents a chronic disease patient population that spans the full range of severity and complexity of management. Late diagnosis and delayed management of an acute flare results in increased mucosal damage. For the patient, this means greater morbidity, increased chance of hospitalisation, greater need for complex interventions or requiring surgery. This is combined with a socio-economic impact on loss of quality of life, reduced economic productivity and a poorer experience. Conversely, better access to IBD services allowing early and appropriate intervention will improve outcomes for the individual patient as well as reduce NHS and social costs.

This patient-centred redesign of the IBD patient pathway service at East Surrey Hospital should significantly alter the care delivery model for patients by matching their needs with the right interventions; through integrating all stakeholders, employing non-face to face technologies (including the “Patient Knows Best” clinician/patient interface), and by optimising the use of steroids and immunosuppression with thiopurines, anti TNF Alpha’s and other biologics. The joint working agreement will run from September 2017 to September 2018.

Background

In the past, a patient with a flare of IBD at East Surrey Hospital could be stuck behind a 12-month queue for an outpatient follow up. This queue is strongly influenced by lower remunerations for follow appointments compared to a newly referred patient - which distorts pathways towards payment at the cost of necessity. The mechanisms to bypass this queue and gain access to specialist services is often poorly supported, inconsistent/variable therefore destined not to alter the service at an appropriate scale. The important consequence for the health service and patient include: driving up appointments with overstretched primary care, unscheduled emergency outpatient appointments, increased emergency department visits and increased admissions to hospital. In summary the late intervention (delayed flare to care) is associated with poorer and more costly outcomes.

Project Approach

The aim is to identify and enrol into the project a patient cohort of a minimum of 100 IBD patients within Surrey and Sussex Hospitals Trust (and possibly other participating Trusts across Surrey). The project will employ the digitally- enabled patient/clinician interface, ‘Patient Knows Best’. This patient cohort will be identified and managed through the project by a clinical fellow. The complete timelines for the evaluation and re-design will be 12 months with baseline set at 0 months, and interim impact measures at 3 and 6 months. If the project shows positive outcomes at 12 months, it will then be reviewed for possible ongoing development.

Project Objectives

To show an improvement in Patient Activation Measures (PAM) and in Patient-Reported Outcome Measures (PROM) scores, to show therapeutic optimization of IBD therapies and to demonstrate an improvement in NHS resource utilisation

Benefits

To patients: It is expected that patients will have earlier, appropriate intervention which will match their need with the appropriate clinician.

To NHS: The flexibility of the service should be shown to divert pressure away from immunosuppressive monitoring and away from busy consultant clinics. We expect to see a reduction in visits to GP, out-patient appointments and hospital admissions due to flares of disease.

To MSD: It is expected that due to quicker interventions, patients who flare will be moved up the treatment pathway and may be prescribed biologics, therefore there is potential to see an increase in overall anti-TNF prescribing; which may then benefit MSD as one of many manufacturers in this space. A further benefit is being able to demonstrate that MSD are trusted partners in optimising and enhancing IBD care through deployment of resources to support and facilitate higher quality care for all appropriate patients.

Funding

MSD and the NHS are supporting this project with resources approximately equivalent to £40,000 each, over the course of the 12 month project.

Date of Preparation: September 2017 | GAST-1231307-0001

Project Title

London Joint Working Group on Substance Use and + Hepatitis C & MSD HCV Pharmacy Testing Project

Organisations involved

MSD UK, London Joint Working Group on Substance Use and Hepatitis C (LJWG), Chelsea and Westminster Hospital, South Thames (HepNet) ODN, North Central London ODN, 4 x CCGs (Lambeth, Southwark, Hammersmith & Fulham and Haringey), Kings College Hospital BBV Testing Laboratory, Lambeth, Southwark, Lewisham Local Pharmaceutical Committee, Middlesex Local Pharmacy Committee , SLaM Pharmacy Needle Exchanges, Public Health England Colindale, Public Health England Health Protection, Lorraine Hewitt House Drug and Alcohol Service Lambeth, Turning Point, Kensington Chelsea & Westminster Local Pharmaceutical Committee, Central and North West London NHS London Trust, Cepheid UK, Invitech (Orasure)

Summary

Aims:
1) To determine if the model of treating drug user networks could potentially be applied to the London population and reduce transmission as indicated by research in Scotland.
2) To impact the transmission of hepatitis C and reinfection by identifying infection hot spots and potential treatment networks to facilitate access to diagnosis and ensure transition into treatment for this vulnerable mobile population

Methodology

The results will be measured and a report of the results shared with ODN’s (Operational Delivery Networks), commissioners and other interested stakeholders both locally and nationally. The following will be measured and assessed:
1) No. of patients tested and counselled;
2) Pharmacist engagement;
3) No. and % of positive diagnoses;
4) % of patients referred into care;
5) Length of time to both referral and treatment;
6) 50% of positive patients referred into treatment within 14. of days;
7) Patient experience;
8) Hitting milestones and ultimate deadline

Timing

1) Kick-off meetings x 2 (20/06/17);
2) Pharmacists training meetings (end of August 2017);
3) Interim project results (end of Sep 2017);
4) Data assessed and shared (PHE Registrar) by 15/10/17;
5) Project Review Meeting x 2 (end of Oct 2017);
6) Project outcomes and results communicated (end of Nov 2017)

Outcomes Expected

1) Increased engagement of both patients and pharmacists;
2) Increase in referrals, diagnosis and treatment;
3) Improved patient outcomes;
4) Positive patient experience;
5) Increased engagement between all stakeholders;
6) CCGs to fund service longer term

Background

75% of needle exchanges are in pharmacies rather than within drug and alcohol treatment services. This is therefore an environment where current drug users are likely to attend and can be offered hepatitis C testing. Currently there is little or no hepatitis C testing undertaken at this first and regular point of contact. The project will also provide onward referral to assessment and treatment for PWIDs (People who inject drugs) and especially people currently using drugs have found services difficult to access.

Project Approach

This is a Proof of Concept project that will support MSD, NHS, Patients and supporting partners in the development of their strategy moving forward with regard to the sustainability of community based services. If successful, there is also the opportunity to upscale the project by recruiting additional pharmacies to deliver the testing service outside of the pilot pharmacies. The evidence from this project could be used to present to other CCGs to obtain longer term financial commitment to fund the service. The project also intends to lead to an increase in engagement of patients and an increase of referrals. This in turn should lead to more diagnoses and an increase in treatment by identifying more patients requiring treatment.

Project Objectives

Patients:
1) To deliver point of contact testing in community pharmacies that offer needle exchange;
2) To support active case finding in the identified pilot pharmacies

NHS:
1) Identify pathways and barriers in each pilot from testing in the needle exchange, to accessing assessment and treatment through the Operational Deliver Network (ODN) Multi-Disciplinary Team (MDT);
2) Provide information to the CCGs and Public Health regarding the services they will be required to fund. To also provide a health economic guide for CCG’s local population

MSD:
1) Partner with the ODNs in different London boroughs to identify novel pathways for both identification of the viral burden and developing strategies to best target resources,
2) Determine if the model of treating drug user networks could be applied to the wider London population and reduce transmission as indicated by research in Scotland

Benefits

Patients:
1) Provision of quick and easy access to testing and a clear pathway into assessment and treatment in specialist care;
2) Increased engagement in testing service,
3) Improved outcomes -higher percentage of patients successfully completing treatment and clearing their HCV virus. Reduce onward transmission of virus in high prevalence population. Patients are more aware of risk factors for transmission and so are able to reduce their risk of acquiring HCV.

NHS and Public Health:
1) Provide information to the CCG’s and public health regarding the services they will be required to fund for longer term sustainability;
2) Identify pathways and barriers in each pilot from testing in the needle exchange, to accessing assessment and treatment through the ODN Multi-Disciplinary Team (MDT);
3) The findings will inform ODN’s, CCG’s and PH in London and nationally regarding the services they would be required to fund and supporting infrastructure required if they were to repeat this template for effective case finding and onward referral and treatment.

Date of Preparation: August 17 | INFC-1222844-0004

Project Title

SMASH Care Community Diabetes Project

Organisations involved

SMASH Care Community and MSD

Summary

SMASH Care Community will work with MSD to improve the quality of their Diabetes service by understanding the community’s needs better, working with the community to meet care needs earlier and by looking at new and innovative ways to help them address the challenges set out by the burden of diabetes and to standardise the approach across the practices involved.

Background

South Cheshire and Vale Royal CCG is implementing the Care Community concept as a way of working in the future. Being part of a care community means, working with neighbouring GP practices and the wider community to make the most of the resources within the town or Care Community. It means continually improving the quality of service by understanding the community’s needs better, working with the community to meet care needs earlier by using community rather than professional help and by using improvement techniques to make services as efficient and effective as possible. Across SMASH Practices, there is a variation in the percentage of people with diabetes receiving the 8 care processes and achieving the NICE NG28 3 treatment targets

Project Approach

The programme will be undertaken with the member practices in three stages across a 12 month period:
1. Review of current practice – MSD will run an analysis of practice informatics data and confidence mapping to create a baseline position and understanding of the practice’s approach to diabetes care
2. Review and implement guidelines through facilitated clinical change management – MSD will facilitate the change management programme, practices will be supported to create a local diabetes management protocol to improve patient care with Clinical support from the CCG
3. Measure progress and share learnings – the progress made following implementation of the local protocol will be measured and changes will be made to practice; the protocol will be agreed and shared with the wider team.

After 12 months MSD will re-run the analysis of practice informatics data and confidence mapping to allow analysis and comparison to the baseline data set.

Project Objectives

Standardise and harmonise ways of working by implementing NICE NG28
More cost-effective care: Cost effective prescribing, fewer admissions with diabetes complications, reduction in referrals to diabetes services
Greater patient access: extended hours clinic.
Workforce transformation and stability

Benefits

Benefit to Patient - Patients feel better supported to manage their condition by having a greater understanding of their condition and the treatment options available to them which supports self-management leading to improved management and a better quality of life.

Benefit to NHS - People delivering diabetes care are able to provide the best support and care possible for people with diabetes by implementing NG28 which will lead to improved patient management and a reduction in the cost burden of managing diabetes. This will support an improved quality of care; a reduction in diabetes related complications and improved self-management.

Benefit to MSD - Supporting SMASH Care Community to improve outcomes for diabetic patients will demonstrate MSD as a trusted partner through deployment of skills and resources to support and facilitate higher quality care for all appropriate patients. The collaboration may benefit MSD indirectly from changes in clinical behaviour as National Diabetes guidelines (NG28) is implemented locally.

Funding

This project involves a pooling of skills and resources between the NHS and MSD over 12 months
NHS contribution: £11,030; MSD Contribution: £12,840; Total £23,870

Date of Preparation: September 2017 | DIAB-1229523-0006

Project Title

Wessex Skin Mapping Project

Project Leads:

Renee Perry & Liz Williams; Project Manager Skin Pathway: Richard Haddon

Organisations involved

Wessex Cancer Alliance (WCA) & MSD

Summary

MSD and the WCA will support a joint working project that will enable Wessex to improve cancer outcomes and funding decisions. MSD and the WCA will work jointly to map the current skin pathway in Wessex, complete a gap analysis, and create a recommended skin pathway.

Background

The areas of focus for the newly formed cancer alliances, including the WCA, are defined as the following: prevention, earlier and faster diagnosis, improving patient experience, address living with and beyond cancer, invest in modern services and transform commissioning and accountability.

The WCA covers a geography that falls under 2 STP’s (Sustainability & Transformation Plans); Isle of Wight & Hampshire (IOW & Hants) & Dorset. The WCA has been given a local mandate by both STP’s to be the mechanism in which cancer outcomes for patients in Wessex are improved. To this end the Cancer Alliance will be expected to feed back to the STP’s best practice and value for money.

Project Approach

Skin Pathway Mapping: To provide a project manager that will facilitate mapping of local skin pathways to complete a gap analysis and create a recommended skin pathway for Wessex which can inform improvement plans which may lead to local areas being able to reduce variation and reduce the strain on the existing systems as the number of skin cancer patients has increased in recent years. The recommended skin pathway should facilitate Wessex in achieving national cancer metrics.

By completing a gap analysis and creating a recommended pathway, the WCA aims to streamline the flow of patients through the system and enable the system to effectively route patients from referral to treatment and finally to receiving a recovery package. If the recommended pathway is successful and can demonstrate improvements to patient outcomes and/or patient experience, the WCA would advocate that the pathway be taken up by NHS England to review for its use nationally.

Project Objectives

Skin Pathway Mapping: To map the current skin pathway in Wessex, complete a gap analysis, and create a recommended skin pathway which can lead to decreased variation, preparing Wessex to meet NHS targets such as the 28 day definitive diagnosis, and improving the ability of Wessex to cope with the system pressure based on the increasing number of patients. The output would be a best practice recommended skin pathway from the point of a patient visiting the GP with suspect skin legions to the point at which the patient has received a recovery program after treatment of skin cancer. The skin pathway document would include recommendations to commissioners to inform their priorities and contracts with service providers.

Benefits

Patients:
Patient experience and outcomes would improve in Wessex based on a standardised skin pathway that reduces wait times and ensures patients receive equitable care in Wessex.

NHS
Recommended Skin Pathway is provided to NHS stakeholders and local improvements are made to decrease variation and increase pathway efficiency in Wessex.

NHS & MSD
If successful, the Recommended Skin Pathway will be shared with national NHS stakeholders as best practice to be adopted in other areas of the country, which raises the profile of both the WCA and MSD.

MSD
Enhanced reputation of MSD and the wish to work with MSD further, MSD gains a better understanding of customer and patient needs.

Funding

Skin Pathway Mapping: The resource required to complete the skin pathway mapping is a time commitment of two days per week from a MSD project manager with strong project management skills, facilitation skills, and light data abilities to compare patient outcome data and health economics in different areas within Wessex. It is not expected that the project manager have medical expertise, as the responsibility of the project manager will be focused on facilitation of the knowledge and expertise from the medical providers in Wessex.

The WCA will commit an equal time commitment of two days per week divided amongst stakeholders, including one day per week from the WCA project manager and approximately one day per week split between clinical stakeholders, such as nurses and oncology consultants. The project will last for 12 months.

Date of Preparation: 8th May 2017 | ONCO-1212540-0002

Project Title

Increasing the detection and diagnosis of blood borne viruses within the General Practice Population in BCUHB

Organisations involved

MSD, BCUHB, Welsh Government and Public Health Wales

Summary

The aim of the project is to increase testing, detection (using risk factors identified by the NHS) and diagnosis of blood borne viruses (Hepatitis C, B and HIV) within the General Practice population, supported by MSD and ultimately provide infected individuals with access to specialist advice and treatment to reduce the risk of transmission within the population, provided by the GP practices.

Background

In Wales, studies suggest that 0.5% of the general population (approximately 14,700 people) have been infected with hepatitis C (HCV) and an estimated 12,000 people have chronic hepatitis C giving a prevalence of 0.4% of the population. About three-quarters of these individuals are unaware that they are infected. Injecting drug use is the probable cause of the majority of reported hepatitis C infections through the sharing of blood-contaminated needles and other equipment and at least nine out of ten people will have acquired their infection in this way. It is estimated that in Wales in a year, between 3 and 9 in every 100 injecting drug users will become infected with hepatitis C (Public Health Wales 2015).

Hepatitis C is one of the leading causes of liver cirrhosis in the UK and increases the risk of liver cancer and the need for liver transplantation. The Liver Delivery Plan for Wales aims to improve services on a national scale that will address the increasing incidence of chronic liver disease within the population. The three main public health risks are identified as the rising incidence of obesity, alcohol consumption and increased risk of blood borne virus within the population.

The population of North Wales is estimated at 700,000. The prevalence of HCV is estimated by Public Health as 0.4%. This would suggest that approximately 3,000 patients in North Wales have become infected with HCV but are unaware of their diagnosis.

Hepatitis B (HBV) is a viral infection that is spread through the blood and other bodily fluids (semen, saliva and vaginal fluids) of an infected person. HBV causes inflammation of the liver (hepatitis) and may also cause long-term damage. HBV is less common in the UK than other parts of the world but certain groups are at increased risk. This includes people originally from high risk countries, people who inject drugs and people who have unprotected sex with multiple sexual partners.

The service development pilot will involve the screening of the practice population, from a sample of North Wales primary care practices for evidence of abnormal liver function and then assessment of any risk factors for BBV.

This joint working has arisen through a request to industry from Dr Brendan Healy (Consultant Microbiologist Public Health Wales) with support from the Innovation team at Welsh Government.

MSD Healthcare Services, a department within MSD responded to this enquiry and through our solutions that were offered, Dr Healy has matched us to BCUHB.

The joint working project aims to equip BCUHB to identify in a clear and timely manner patients with blood borne viruses (BBV); Hep B, C and HIV.

The project will involve up to 20 practices/surgeries across the West locality of BCUHB to enable the parties to manage capacity and ensure referrals can be dealt with appropriately.

Project Approach

To interrogate GP computer systems to identify patient with risk factors for HEP C / HIV, invite them for testing and place them on the correct clinical and non-clinical pathway.

Project Objectives

The objective of the project is to improve diagnosis rates of patients with Hep C, B and HIV. This will reduce the long-term cost burden to NHS Wales, improve patient’s health and once detected potentially result in more patients gaining access to treatment for their Hepatitis C.

Benefits

The benefits of the project would be to improve diagnosis rates of patients with Hep C, B and HIV.

This will reduce the long-term cost burden to NHS Wales, improve patient’s health and delivery.

This will provide greater opportunity for patients to access treatment for Hep C, which will ultimately also potentially benefit MSD as a manufacturer.

Funding

Approximately equal contributions will be provided from both the NHS and MSD in line with current joint working protocols. The estimated contribution will be £50,000 a year from each organisation over 2 years.

Date of Preparation: August 2017 | INFC-1227879-0000

Project Title

Avoiding Medication-Related Problems for Patients Living with HIV and Co-Morbidities In Brighton & Hove

Organisations involved

MSD UK, Brighton and Sussex University Hospitals NHS Trust, Brighton and Hove CCG

Summary

A proof-of-concept approach to integrate all stakeholders in the management of patients living with HIV and Co-morbidities in Brighton & Hove, with a view to increasing GP’s knowledge and confidence when prescribing, ultimately resulting in fewer medication related problems for this patient cohort.

Methodology

The project will be in 3 phases, with the final phase lasting 12 months. The schedule proposed is:

Phase 1 – July-mid August 2017

  • Pharmacy creates a questionnaire for GPs to set the base line for confidence mapping
  • Questionnaire is disseminated and feedback collated by pharmacy
  • Feedback from the survey is shared and discussed with steering committee

Phase 2 - September 2017-August 2018
Steering group meet to review feedback, agree solutions and set qualitative measurements for the next 12 months

Phase 3 - September 2018
Measurements collated, written up and communicated

Background

People living with HIV (PLWH) who are stable on cART are typically followed up every 6 months by their HIV outpatient clinician, who is responsible for prescribing and managing their cART and any other directly HIV-related medicines (eg co-trimoxazole for Pneumocystis jiroveci [PCP] prophylaxis). Their General Practitioner (GP) is usually responsible for the ongoing management of all their other medicines, including those recommended or initiated by non-HIV secondary care specialties (eg cardiology). In addition, certain specialist treatments (eg for Hepatitis C or for cancers) are managed by other secondary or tertiary care teams. The resulting lack of a unified dispensing record increases the likelihood of potentially inappropriate drug to drug interactions and can result in harmful interactions or interacting medicines remaining undetected. Older PLWH, with their increased likelihood of having multi-morbidity and multiple prescribers involved, are therefore particularly at risk of problematic polypharmacy.

The Brighton & Hove Lead Commissioner for Sexual Health and HIV has for many years worked with local GPs and BSUH NHS Trust to promote strong engagement between primary and secondary care, and to support HIV educational initiatives for GPs, and many local GPs already contact the HIV Pharmacy Team to check for potential DDIs when co-prescribing for PLWH. Despite this, important DDIs and other medicines-related problems continue to occur, which have resulted in PLWH suffering significant additional morbidities.

Project Approach

In line with published evidence, Brighton HIV pharmacy team are concerned about the number of medication related problems that HIV patients are suffering. As the HIV patient cohort becomes older they are more likely to be on a wider variety of medicines and there is a feeling locally that the HIV patient cohort would benefit from a more integrated approach defined as a primary and secondary care patient pathway. To that end MSD are looking to work with the HIV pharmacy community, HIV consultants and GP’s to create a solution that would reduce the number of medicine-related problems associated with prescriptions for non HIV medications for the stable HIV patient who is more likely to access their GP than the specialised HIV service.

Project Objectives

  1. Increase GP confidence in prescribing for HIV patients with other co-morbidities
  2. Reduce medication-related problems and drug-to-drug interactions
  3. Assess the impact of the solution in the GP community and on patients, with a view to this being shared as a best practice example of integrated-working

Benefits

To patients:

  • Potential for patients needing to have antiretroviral changed to one with less drug-to-drug interactions
  • Number of medication-related problems is reduced

To NHS:

  • GP’s more confident to treat patients with HIV and co-morbidities
  • Potential cost saving if GP’s do not have to refer to hospital, or emergency admissions to A&E are reduced

To MSD:

  • Enhanced reputation of MSD as a valued partner to the NHS and the wish to work with MSD further

Funding

MSD’s contribution will cover partial (1.5 days per week) of a Pharmacist’s time, part-funds to provide a solution in phase 2 of the project, a Health Economist’s time to sit on the steering committee and help to measure the impact of the intervention (3 days in total) and a Medical Governance team member, supporting the co-creation of the solution (3 days in total).

NHS contribution will be 3.5 days per week of the pharmacist’s time to manage the project and implement the solution, once decided by the steering committee. In addition, there will be part-funding of the solution agreed upon for phase 2 and clinical oversight and guidance from an NHS consultant, a GP and a Consultant Pharmacist.

Date of Preparation: October 2017 | INFC-1236107-0000

Project Title

Reducing Unwanted Pregnancies Programme within Drug and Alcohol Services in Wales

Organisations involved

MSD, Kaleidoscope Project and Public Health Wales

Summary

The aim of the project is to establish a nurse led programme to reduce the level of unwanted pregnancies in Wales through working with drug and alcohol services across Aneurin Bevan University Health Board (ABUHB) and Cwm Taf University Health Board (CTUHB).

Background

Unwanted pregnancy rates and levels of termination in Wales still present a public health issue despite continued increase in the use of contraception. It therefore remains a high public health priority to address these issues.

One of the core areas of focus is vulnerable women. This covers a number of areas, one of which is those women accessing the drug and alcohol services across Wales. There is a large variation in the level of service provision across the Health Boards in Wales with ABUHB leading the way.

There are currently approximately 4000 women accessing these services. Approximately one third of which would be of child- bearing age. These women might have a chaotic lifestyle and therefore may not access contraception services via their GP or Integrated Sexual Health services. There is therefore a possible opportunity to provide these women with contraception services and sexual health / lifestyle advice if there was a dedicated healthcare professional within the service able to provide it.

One third of ‘Looked after Children’ in Wales are born to a mother with an addiction and this number is increasing. The overall estimated cost of this to Social Services in Wales is well over £117 million a year.

Project Approach

To establish a nurse led service to reduce the level of unwanted pregnancies in Wales. PHW and Kaleidoscope's contribution to the project shall be in the form of time contributed by their employees. MSD’s contribution to the project shall be limited to providing the time and expertise of its own staff as well as funding the nursing services provided by Kaleidoscope via PHW.

Project Objectives

To work in collaboration to achieve the following key outcomes:

  • Address the gaps and variations within the contraceptive service across Aneurin Bevan and Cwm Taf University Health Boards.
  • The number of patients receiving a LARC to increase over the 6 month period of the project over baseline in the specific areas of highest priority identified by Kaleidoscope (50% of time spent in ABUHB, 50% of time spent in CTUHB).
  • Reduce unwanted pregnancies in vulnerable women in the drugs and alcohol service in South East Wales, this will be assessed by using the Neo 360 database following completion of the project.

Benefits

The benefits of this project have to be mutually beneficial to all parties;

  • The Patient – Reducing unwanted pregnancies and the potential psychological impact associated with these or with terminations.
  • PHW– Reducing unwanted pregnancies, reduction in terminations and associated social care costs within Aneurin Bevan and Cwm Taf UHBs.
  • Kaleidoscope – Provide a service to an unmet need in the drug and alcohol service and reducing unwanted pregnancies in this patient group will indirectly reduce the burden on the Kaleidoscope service.
  • MSD - Increased numbers of patients potentially identified for LARC fitting may result in a potential opportunity for an increased uptake of LARCs overall. As a manufacturer of a LARC, MSD will potentially indirectly benefit from this programme.

Funding

Approximately equal contributions will be provided from both MSD as one party and then the Kaleidoscope Project and Public Health Wales together, in line with current joint working protocols. The estimated contribution will be £61,500 over 6 months split between the organisations.

Date of Preparation: 5th December 2017 | WOMN-1241343-0001

Project Title

Merton GP surgeries Primary Care Change Programme for Diabetes with Colliers Wood surgery, Mitcham Family Practice and Mitcham Medical Centre

Organisations involved

Colliers Wood surgery, Mitcham Family Practice, Mitcham Medical Centre and MSD

Summary

Merton GP surgeries will work with MSD to improve the quality of their diabetes service by understanding the local population needs better, working with the individual practices to meet the practice training needs in order to address the challenges set out by the burden of diabetes and to standardise the approach across the practices involved. The program will run over a 12 month duration and the expected outcome will include improved diabetes care for patients as a result of increased confidence for the surgeries in treatment of diabetes.

Background

For diabetes in Merton more needs to be done locally on: helping people and families to achieve and maintain a healthy weight; early identification of those at risk and having disease; ensuring access to appropriate services to support people with diabetes to control their blood sugar levels and reduce potential complications; reducing GP Practice variations and better achievement of the care processes.
(Merton JSNA summary document 2015)

There are 3 GP practices in the Borough of Merton who wish to sign up to Evidence Into Practice in order to support their ongoing management of their diabetic population, implementing and optimising NICE NG28 and local diabetes management guidelines.

Project Approach

The program aims to offer a structured approach to the management of diabetes and works with the NHS to ensure that people with diabetes receive optimal care through effective implementation of national and/or local policy and guidelines.

  1. Review of current practice – MSD will run an analysis of practice informatics data and confidence mapping to create a baseline position and understanding of the practice’s approach to diabetes care
  2. Review and implement guidelines through facilitated clinical change management in the form of clinical workshops run by a clinical specialist (MSD will facilitate the change management programme).
  3. Measure progress and share learnings – the progress made following implementation of the Clinical workshops will be measured and changes will be made to practice; the protocol will be agreed and shared with the wider team.

After 12 months MSD will re-run the analysis of practice informatics data and confidence mapping to allow analysis and comparison to the baseline data set.

Project Objectives

Improved patient outcomes

Improved confidence in management of diabetes within the surgeries taking part

Standardise and harmonise ways of working by implementing NICE NG28

More cost-effective care: Cost effective prescribing, fewer admissions with diabetes complications, reduction in referrals to diabetes services

Workforce transformation and stability

Benefits

Benefit to Patient - Improved standard of care received by adults with type 2 diabetes through increasing the number receiving all 9 care process on an annual basis, increased number of adults with type 2 diabetes achieving all 3 treatment targets. Patients may feel better supported to manage their condition by having a greater understanding of their condition and the treatment options available to them (enabled by the NHS teams improved knowledge, skills and confidence) which supports self-management.

Benefit to NHS - People delivering diabetes care are able to provide the best support and care possible for people with diabetes by implementing NG28 which will lead to improved patient management and a reduction in the cost burden of managing diabetes . This will support an improved quality of care; a reduction in diabetes related complications and improved self- management.

Benefit to MSD - Supporting Merton GP practices to improve outcomes for diabetic patients will demonstrate MSD as a trusted partner through deployment of skills and resources to support and facilitate higher quality care for all appropriate patients. The collaboration may benefit MSD indirectly from changes in clinical behaviour as National Diabetes guidelines (NG28) are implemented locally.

Funding

This project involves a pooling of skills and resources between the NHS and MSD over 12 months.

NHS contribution: £17,700; MSD Contribution: £16,800; Total £34,500

Date of Preparation: December 2017 | DIAB-1241154-0000

Project Title

East Merton GP surgeries Evidence into Practice with Wide Way Surgery, Tamworth House Medical Centre, Cricket Green Medical Practice, Figges Marsh Surgery, Ravensbury Park Medical Centre, The Rowens Surgery and Streatham Commons Group Practice

Organisations involved

Wide Way Surgery, Tamworth House Medical Centre, Cricket Green Medical Practice, Figges Marsh Surgery, Ravensbury Park Medical Centre, The Rowens Surgery and Streatham Commons Group Practice

Summary

The East Merton GP surgeries mentioned above will work with MSD to improve the quality of their diabetes service by understanding the local population needs better, working with the individual practices to meet the practice training needs in order to address the challenges set out by the burden of diabetes and to standardise the approach across the practices involved. The program will run over a 12 month duration and the expected outcome will include improved diabetes care for patients as a result of increased confidence for the surgeries in treatment of diabetes.

Background

For diabetes in Merton more needs to be done locally on: helping people and families to achieve and maintain a healthy weight; early identification of those at risk and having disease; ensuring access to appropriate services to support people with diabetes to control their blood sugar levels and reduce potential complications; reducing GP Practice variations and better achievement of the care processes.1

There are 7 GP practices in the Borough of Merton who wish to sign up to Evidence Into Practice in order to support their ongoing management of their diabetic population, implementing and optimising NICE NG28 and local diabetes management guidelines.

Project Approach

The program aims to offer a structured approach to the management of diabetes and works with the NHS to ensure that people with diabetes receive optimal care through effective implementation of national and/or local policy and guidelines.

  1. Review of current practice – MSD will run an analysis of practice informatics data and confidence mapping to create a baseline position and understanding of the practice’s approach to diabetes care.
  2. Review and implement guidelines through facilitated clinical change management in the form of clinical workshops run by a clinical specialist (MSD will facilitate the change management programme).
  3. Measure progress and share learnings – the progress made following implementation of the clinical workshops will be measured and changes will be made to practice; the protocol will be agreed and shared with the wider team.

After 12 months MSD will re-run the analysis of practice informatics data and confidence mapping to allow analysis and comparison to the baseline data set.

Project Objectives

Improved patient outcomes

Improved confidence in management of diabetes within the surgeries taking part

Standardise and harmonise ways of working by implementing NICE NG28

More cost-effective care: Cost effective prescribing, fewer admissions with diabetes complications, reduction in referrals to diabetes services

Workforce transformation and stability

Benefits

Benefit to Patient - Improved standard of care received by adults with type 2 diabetes through increasing the number receiving all 9 care processes on an annual basis, increased number of adults with type 2 diabetes achieving all 3 treatment targets. Patients may feel better supported to manage their condition by having a greater understanding of their condition and the treatment options available to them (enabled by the NHS teams improved knowledge, skills and confidence) which supports self-management.

Benefit to NHS - People delivering diabetes care are able to provide the best support and care possible for people with diabetes by implementing NG28 which will lead to improved patient management and a reduction in the cost burden of managing diabetes. This will support an improved quality of care; a reduction in diabetes related complications and improved self- management.

Benefit to MSD - Supporting Merton GP practices to improve outcomes for diabetic patients will demonstrate MSD as a trusted partner through deployment of skills and resources to support and facilitate higher quality care for all appropriate patients. Following NG28 should be sufficient to demonstrate the benefit to MSD; as this may result in the increased use of anti-diabetic medicines in line with guidelines.

Funding

This project involves a pooling of skills and resources between the NHS and MSD over 12 months from Feb 2018 to Feb 2019.

NHS contribution: £29,575; MSD Contribution: £26,950; Total £56,525

References

  1. Merton JSNA summary document 2015

Date of Preparation: January 2018 | DIAB-1245516-0001

Project Title

Wessex Academic Health Science Network (AHSN) Diabetes STP Project

Organisations involved

Wessex AHSN, MSD & 4 GP practices from SE Hampshire CCG

Summary

The aim of the project is to work with the AHSN on improving population health in Type I and Type II diabetes by deploying EVIDENCE into PRACTICE™ (a 12-month facilitated, clinical change management programme provided by MSD) across 4 surgeries within the SE Hampshire CCG. The programme aims to offer a structured approach to the management of people with diabetes and works with the NHS to ensure that people with diabetes receive improved care through effective implementation of national and/or local policy and guidelines.

Background

In 2001, the Department of Health set out nine care processes that people with diabetes should receive each year to detect the early signs of complications1. Additionally, the National Institute for Health and Care Excellence (NICE) has set 3 treatment standards for blood glucose, blood pressure and cholesterol which, when achieved, reduce the risk of a person with diabetes developing complications2.

Wessex AHSN, working with the ABPI and EMIG, invited industry to partner with Hampshire & IoW STP at the beginning of 2017. MSD was successful and are now working in partnership on a project to cover the following areas:

  1. Population base Health
    1. Focus on optimising outcomes for people with diabetes or at risk of diabetes
    2. Use data to identify, segment and highlight risk across population cohorts to tailor service to specific segments
    3. Explore action learning to drive early adoption and scaling of changes to population health management and pathways
  2. Behaviour Change
    1. Support patient self-management (including compliance) and workforce’s ability to promote higher levels of self-management
    2. Focus on people with diabetes
    3. Explore opportunities to combine pharmaceutical and med-tech innovations to support higher levels of compliance and self-management and reduce pressure on workforce

The aims of structured education and patient self-management programmes is to improve outcomes through addressing an individual’s health beliefs, optimising metabolic control, addressing cardiovascular risk factors (helping to reduce the risk of complications), facilitating behaviour change (such as increased physical activity), improving quality of life and reducing depression. An effective programme will also enhance the relationship between the person with diabetes and their healthcare professionals, thereby providing the basis of true partnership in diabetes management.2

Within the STP, Fareham & Gosport and South East Hants CCGs show significant variation in the percentage of people with diabetes receiving the 9 care processes, structured education programmes and achieving the 3 NICE treatment targets.

  Percentage of people receiving all 9 care processes3 Percentage of newly diagnosed people with Type 2 or other diabetes recorded as having 'attended' a structured education program3 Percentage of people achieving all 3 treatment targets3
England National/Wales National (delete as appropriate) 39.6% 5.9% 41.3%
Fareham & Gosport CCG 26.6% 9.0% 38.5%
South East Hants CCG 37.2% 4.2% 40.2%
  • Across Fareham & Gosport and South East Hants CCGs fewer patients with type 2 diabetes are receiving all 9 care process compared to the national average3
  • Across Fareham & Gosport and South East Hants CCGs fewer patients with type 2 diabetes are achieving all 3 risk factor targets compared to the national average3
  • Across South East Hants CCG fewer patients with type 2 diabetes have attended a structured education programme for diabetes compared to the national average3

Project Approach

Use the EIP software to interrogate GP systems and identify patients in 3 cohorts to intervene and establish surrogate markers of improved outcomes.

  • Type 2 diabetic patients who have been diagnosed in the last 5-7 years
  • All type 1 diabetic patients
  • Type 2 diabetic patients over >5

Run confidence mapping exercises with each practice to ensure the information and training through clinical review sessions are tailored to individual need and so achieve the best outcomes. The practices, facilitated by MSD, work with local NHS appointed specialists from secondary care to ensure that the clinical sessions provide direction based on both national & local area guidelines.

Project Objectives

  1. To provide a structured approach to the management of diabetes based on the latest evidence based practice
  2. To improve patient outcomes in the 3 areas stated above and the nine quality measures
  3. To ensure that people with diabetes in the target cohorts receive optimal & consistent care

Benefits

Benefits to patient
People with diabetes feel better supported to manage their condition by knowing the treatment options available to them, which can enhance self-management leading to a better quality of life.

Benefits to NHS
Healthcare professionals delivering diabetes care are able to provide the best support possible for people with this condition by implementing NG28, which may lead to improved patient management, reduction in the cost burden of managing type 2 diabetes and a reduction in diabetes related complications.

Benefits to MSD
Through the deployment of skills and resources to support and facilitate higher quality care by supporting Wessex Academic Health Science Network team to improve outcomes for diabetic patients will demonstrate MSD as a trusted partner to the NHS.

Funding

Approximately equal contributions from NHS organisations and MSD.

Over a 12-month period:

MSD would contribute approx. £28,965

NHS would contribute £30,180

TOTAL £59,145

References

  1. Department of Health. National Service Framework for Diabetes: Standards (2001).
  2. NICE (2015) Type 2 diabetes in adults: management.
  3. NHS Digital, National Diabetes Audit Report 2014-2016.

Date of Preparation: February 2018 | DIAB-1231162-0007

Project Title

Redbridge EiP Cluster (3)

Organisations involved

Mathukia Surgery
VM Surgery
Castleton Road Health Centre
MSD

Summary

The Redbridge cluster will work with MSD to improve the quality of their Diabetes service by understanding the local population needs better, working with the three GP practices to meet the practice training needs to address the challenges set out by the burden of diabetes and to standardise the approach across the practices involved.

Background

In Redbridge Diabetes, Coronary Heart disease, hypertension, COPD, Heart failure and asthma are the top five long term conditions. They are treatable but impact on health if poorly controlled.
Diabetes prevalence is higher in Redbridge than in London and England whereas the prevalence for the other four conditions is similar to London prevalence. The burden of disease is likely to increase in primary care. Generally, the practices in localities are managing their long term conditions effectively for some of the clinical indicators. However, diabetes control (% of patients with HbA1c<59mmol/mol) is slightly worse in Redbridge (62.8%) than the national average (66.5%).
Numbers of prescriptions for treatment drugs have increased between 2007 and 2013 by 18% for asthma/COPD, 30% for hypertension and heart failure and CHD, and 42% for diabetes, however the costs of prescribing have decreased for hypertension, heart failure and CHD due to an increase in the prescribing of low cost drugs1.

Project Approach

The programme will be undertaken with all the practices in three stages across a 12 month period:

  1. Review of current practice – MSD will run an analysis of practice informatics data and confidence mapping to create a baseline position and understanding of the practice’s approach to diabetes care
  2. Review and implement guidelines through facilitated clinical change management – MSD will facilitate the change management programme, practices will be supported in meeting their training needs with Clinical support from local Diabetes experts
  3. Measure progress and share learnings – the progress made following implementation of the Clinical workshops will be measured and changes will be made to practice; the protocol will be agreed and shared with the wider team.

After 12 months MSD will re-run the analysis of practice informatics data and confidence mapping to allow analysis and comparison to the baseline data set.

Project Objectives

Standardise and harmonise ways of working by implementing NICE NG28

More cost-effective care: Cost effective prescribing, fewer admissions with diabetes complications, reduction in referrals to diabetes services

Workforce transformation and stability

Benefits

Benefit to Patient - Improved standard of care received by adults with type 2 diabetes through increasing the number receiving all 9 care processes on an annual basis, increased number of adults with type 2 diabetes achieving all 3 treatment targets. Patients may feel better supported to manage their condition by having a greater understanding of their condition and the treatment options available to them (enabled by the NHS teams improved knowledge, skills and confidence) which supports self-management

Benefit to NHS - People delivering diabetes care are able to provide the best support and care possible for people with diabetes by implementing NG28 which will lead to improved patient management and a reduction in the cost burden of managing diabetes. This will support an improved quality of care; a reduction in diabetes related complications and improved self- management.

Benefit to MSD - Supporting the three practices to improve outcomes for diabetic patients will demonstrate MSD as a trusted partner through deployment of skills and resources to support and facilitate higher quality care for all appropriate patients. The collaboration may benefit MSD indirectly from changes in clinical behaviour as National Diabetes guidelines (NG28) is implemented

Funding

This project involves a pooling of skills and resources between the NHS and MSD over 12 months.

NHS contribution: £6,300; MSD Contribution: £10,735; Total: £17,035

References

  1. Redbridge Joint Strategic Needs Assessment Executive Summary, 2015-2016 https://www.redbridge.gov.uk/media/2189/jsna-executive-summary.pdf (Accessed: October 2017).

Date of Preparation: December 2017 | DIAB-1241136-0000

Project Title

Newcastle GP Services Evidence into Practice Diabetes Project

Organisations involved

Newcastle GP Services and MSD

Summary

Newcastle GP Services will work with MSD to improve the quality of their Diabetes service by understanding the community’s needs better, working with the community to meet care needs earlier and by looking at new and innovative ways to help them address the challenges set out by the burden of diabetes and to standardise the approach across the practices involved.

Background

Newcastle GP Services is supporting local General Practice in the city of Newcastle upon Tyne to provide coordinated, high quality clinical care, in our communities, which is safe, offers a positive patient experience and improves patient outcomes.
Across Newcastle GP Services Practices, there is a variation in the percentage of people with diabetes receiving the 8 care processes and achieving the NICE 3 treatment targets:

Project Approach

The programme will be undertaken with 4 GP practices in three stages across a 12 month period:

  1. Review of current practice – MSD will run an analysis of practice informatics data and confidence mapping to create a baseline position and understanding of the practice’s approach to diabetes care
  2. Review and implement guidelines through facilitated clinical change management – MSD will facilitate the change management programme, practices will be supported to create a local diabetes management protocol to improve patient care with Clinical support from the CCG
  3. Measure progress and share learnings – the progress made following implementation of the local protocol will be measured and changes will be made to practice; the protocol will be agreed and shared with the wider team.

After 12 months MSD will re-run the analysis of practice informatics data and confidence mapping to allow analysis and comparison to the baseline data set.

Project Objectives

Standardise and harmonise ways of working by implementing NICE NG28

More cost-effective care: Cost effective prescribing, fewer admissions with diabetes complications, reduction in referrals to diabetes services

Workforce transformation and stability

Benefits

Benefit to Patient- Patients feel better supported to manage their condition by having a greater understanding of their condition and the treatment options available to them which supports self-management leading to improved management and a better quality of life.

Benefit to NHS - People delivering diabetes care are able to provide the best support and care possible for people with diabetes by implementing NG28 which will lead to improved patient management and a reduction in the cost burden of managing diabetes . This will support an improved quality of care; a reduction in diabetes related complications and improved self-management.

Benefit to MSD - Supporting Newcastle GP Services to improve outcomes for diabetic patients will demonstrate MSD as a trusted partner through deployment of skills and resources to support and facilitate higher quality care for all appropriate patients. The collaboration may benefit MSD indirectly from changes in clinical behaviour as National Diabetes guidelines (NG28) is implemented locally.

Funding

This project involves a pooling of skills and resources between the NHS and MSD over 12 months
NHS contribution: £10,090; MSD Contribution: £14,555; Total £24,655

Date of Preparation: November 2017 | DIAB-1236655-0002

Project Title

Evidence Into Practice across Warrington CCG

Organisations involved

MSD UK Ltd and Warrington CCG

Summary

Warrington CCG and MSD are collaborating together to deliver a programme of change management in Diabetes care across the 28 practices. This is done via practice performance review, confidence mapping of the HealthCare Professionals in Diabetes and reflective practice to implement changes in line with NICE guidance. The project will run for 12 months with data gathering at start, mid-project and completion. The project aims to start January 2018 and complete January 2019

Background

  • Warrington CCG is undergoing a redesign in diabetes services. Part of its core vision to deliver ‘Excellence for Warrington’ is in Helping people to live longer, healthier lives, supported by sustainable services, wrapped around individuals—not buildings or organisations

Diabetes is increasing in prevalence and is becoming increasing complicated. As a result it is important that primary care practices are confident in delivering the reviews and care associated. There is variation in delivery of care across the IntraHealth Wigan sites and this project will aim to reduce that variation

Project Approach

MSD will conduct practice performance reviews across all sites and confidence mapping to ascertain the skill levels of those delivering care. This will then be reflected back to the practice team and then tailored clinical sessions to address any gaps will be developed. The changes implemented will be tracked and monitored at 6 months and then 12 months via Evidence into Practice (EiP)

Project Objectives

Benefit to Patient - People with diabetes feel better supported to manage their condition by having a greater understanding of their condition and the treatment options available to them which supports self-management leading to a better quality of life, closing the gaps between increased length of life and reduced quality of life.

Benefit to NHS - Services delivered closer to home, contributing to Warrington CCG aims. People delivering diabetes care in Primary Care are able to provide the best support and care possible for people with diabetes. In the long-term a proactive approach will support a reduction in diabetes related complications; improved adherence to care plans through self-management and reduced complications and hospital admissions

Benefit to MSD - Being able to demonstrate that MSD is a trusted partner in optimising and enhancing diabetes care through deployment of resources and skills to support and facilitate higher quality care for all appropriate patients. Shared skill, expertise and resources applied to further enhance patient outcomes and service performance. The expected collaboration may benefit MSD indirectly from changes in clinical behaviour as National Diabetes guidelines (NG28) are implemented locally.

Funding

Total Value of NHS Contribution

Total Value of MSD Contribution (including PM)

Total Project

£87,980.00

£71,990.00

£159,970.00

Date of Preparation: December 2018 | GB-NON-00263

Project Title

NHS Buckinghamshire Diabetes Change Management Programme

Organisations involved

Aylesbury Vale CCG, Chiltern CCG and MSD

Summary

Aylesbury Vale CCG, Chiltern CCG will work with MSD to improve the quality of their diabetes service by looking at new and innovative ways to help address the population health challenges set out by the burden of diabetes and people at risk of developing diabetes and to standardise the approach across all of the practices involved.

Background

Buckinghamshire is a 1st wave Accountable Care Systems (ACS) being created around the country to deliver improvements to local health and social care. The goal is to expand and redesign out-of-hospital care, providing more care closer to home to reduce length of stay in hospital, and simplifying/streamlining care for people with long term conditions such as diabetes.

Moving the care of the diabetic population out of hospital and repatriating them to primary care will mean that there is a need to support primary care in education to improve their skills, knowledge and confidence in managing their diabetic populations. Across all GP Practices involved there is significant variation in the percentage of people with diabetes receiving the 8 care processes and achieving the NICE 3 treatment targets.

Project Approach

The programme will be undertaken with the member practices of the Aylesbury Central Locality in 4 stages across a 12 month period:

  1. Review of current practice – MSD will run an analysis of practice informatics data and confidence mapping to create a baseline position and understanding of the practice’s approach to diabetes care.
  2. Review and implement guidelines through facilitated clinical change management – MSD will facilitate the change management programme, practices will be supported to create a local diabetes management protocol to improve patient care with clinical support from the CCG.
  3. Measure progress and share learnings – the progress made following implementation of the local protocol will be measured and changes will be made to practice; the protocol will be agreed and shared with the wider team.
  4. After 12 months MSD will re-run the analysis of practice informatics data and confidence mapping to allow analysis and comparison to the baseline data set.

Project Objectives

Standardise and harmonise ways of working by implementing NICE NG28.

More cost-effective care: Cost effective prescribing, fewer admissions with diabetes complications, reduction in referrals to diabetes services

Greater patient access: extended hours clinics; working at scale.

Workforce transformation and stability

Benefits

Benefit to Patient
Patients feel better supported to manage their diabetes by having a greater understanding of their condition and the treatment options available to them which supports self-care leading to improved management and a better quality of life.

Benefit to NHS
People delivering diabetes care are able to provide the best support and care possible for people with diabetes by implementing NG28 which will lead to improved patient management and a reduction in the cost burden of managing diabetes. This will support an improved quality of care; a reduction in diabetes related complications and improved self- care.

Benefit to MSD
Supporting Aylesbury Vale CCG, Chiltern CCG to improve outcomes for diabetic patients will demonstrate MSD as a trusted partner through deployment of skills and resources to support and facilitate higher quality care for all appropriate patients. The collaboration may benefit MSD indirectly from changes in clinical behaviour as National Diabetes guidelines (NG28) is implemented locally.

Funding

This project involves a pooling of skills and resources between the NHS and MSD.

Total Value of MSD Contribution £23,170.08

Total Value of NHS Contribution £24,431.25

Total Project £47,601.33

Date of Preparation: January 2018 | DIAB-1243562-0004

Project Title

Derbyshire pharmacy testing initiative for hepatitis C and HIV.

Organisations involved

MSD UK, Derbyshire LPC and Derbyshire County Council Public Health.

Summary

Aims: To determine if testing for hepatitis C and HIV in pharmacies delivering needle exchange and/or supervised consumption services can reduce the impact of on-wards transmission of hepatitis C and HIV and reduce the reinfection. This will be done by identifying infection hot spots and potential treatment networks to facilitate access to diagnosis and ensure transition into treatment for this vulnerable mobile population.

Methodology:
The results will be measured by the pharmacists and a report of the results shared with ODN’s, public health, LPC, commissioners and other interested stakeholders both locally and nationally.
The following will be measured and assessed: 1.) Pharmacist engagement and total number of tests undertaken; 2). No. of patients tested and counselled; 3.) No. and % of positive diagnoses; 4). % of patients referred into care; 5.) % of positive patients successfully following treatment pathway

Timing:
1.) Kick-off meeting (15/01/18); 2.) Pharmacists training meetings (Jan 2018); 3.) Pharmacy testing of hepatitis C and HIV (Feb – July 2018); 4.) Interim project results (July 2018); 5.) Data assessed and shared (PHE Registrar) by Sept 2018; 6.) Monthly project Review Meetings; 7.) Project outcomes and results communicated (November 2018)

Outcomes Expected:
1.) Increased engagement of both patients and pharmacists; 2.) Increase in referrals, diagnosis and treatment; 3.) Improved patient outcomes and reduce reinfection rate; 4.) Positive patient experience; 5.) Increased engagement between all stakeholders; 6.) CCGs to fund service longer term

Background

75% of needle exchanges are in pharmacies rather than within drug and alcohol treatment services. This is therefore an environment where current drug users are likely to attend and can be offered hepatitis C and HIV testing. Currently there is little or no hepatitis C or HIV testing undertaken at this first and regular point of contact. The project will also provide onward referral to assessment and treatment for patients who inject drugs (PWIDs) and especially people currently using drugs have found services difficult to access.

Project Approach

This is a Proof of Concept project that will support Derbyshire Public Health in the development of their strategy moving forward with regard to the sustainability of community based services. If successful, there is also the opportunity to recruit additional pharmacies to deliver the testing service outside of the pilot pharmacies subject to funding being made available via NHS or Public health. The evidence from this project will be shared to support other CCGs to obtain longer term financial commitment to fund the service. The project also intends to lead to an increase in engagement of patients and an increase of referrals. This in turn should lead to more diagnoses and an increase in treatment by identifying more patients requiring treatment.

Project Objectives

Patients: 1.) Provision of quick and easy access to testing and a clear pathway into assessment and treatment in specialist care. 2.) Increased engagement in testing service. 3.) Improved outcomes.

NHS / LPC / Public Health: 1.) Provide information to the CCG’s and public health regarding the services they will be required to fund for longer term sustainability. 2.) Optimise the patient pathway to reduce the barriers of testing in the needle exchange and accessing assessment and treatment through the Operational Deliver Network (ODN) Multi-Disciplinary Team (MDT) Secondary care. 3.) The findings will inform ODN’s regionally and nationally, providing a template for effective case finding and onward referral and treatment.

MSD: 1.) Partner with the ODNs / secondary care regionally to identify novel pathways for both identification of the viral burden and developing strategies to best target resources. 2.) Determine if the model of treating drug user networks could be applied to the wider Derbyshire population and reduce transmission as indicated by research in Scotland.

Benefits

Patients: 1.) To receive point of contact testing in community pharmacies that offer needle exchange/ supervised consumption. 2.) For a positive screening test to have referral into appropriate treatment pathway.

NHS / LPC / Public Health: 1.) Provide information to the CCG’s and public health regarding the services they will be required to fund for longer term sustainability. 2.) Optimise the patient pathway to reduce the barriers of testing in the needle exchange and accessing assessment and treatment through the Operational Deliver Network (ODN) Multi-Disciplinary Team (MDT) Secondary care. 3.) The findings will inform ODN’s regionally and nationally, providing a template for effective case finding and onward referral and treatment.

MSD: 1.) MSD is currently a supplier of NHSE approved HCV and HIV medications and patients may have access to these treatments, however there will be no preferential arrangement in place over other available treatments. 2.) The project will provide a seat at the table for population health initiatives in HCV and allow MSD to strengthen relationships with PHE, NHSE, ODNs, the local authorities involved as well as patient group stakeholders. 3.) From a policy perspective, it will provide an evidence based proof of concept to support our thinking around the sustainability of HCV / HIV services.

Funding

Derbyshire LPC and Public Health are supporting the training of pharmacists, the delivery of the testing service and data capture including final write up for publication at a cost of £15,000. MSD are funding £10,643.95 which includes testing kits, screening analysis, clinical waste management and project management support.

Date of Preparation: December 2017 | INFC-1240642-0000

Project Title

Evidence Into Practice Across General Practices in Cardiff South West Cluster

Organisations involved

Cardiff and Vale University Health Board and MSD

Summary

Cardiff South West GP Cluster will work with MSD to improve the quality of their diabetes service by understanding the community’s needs better, working with the community to meet care needs earlier and by looking at new and innovative ways to help them address the challenges set out by the burden of diabetes and to standardise the approach across the practices involved.

Background

Cardiff South West GP Cluster is supporting local General Practice within Cardiff and Vale University Health Board to provide coordinated, high quality clinical care, in the community, which is safe, offers a positive patient experience and improves patient outcomes.
Across Wales and Cardiff and Vale UHB, there is a variation in the percentage of people with diabetes receiving the 8 care processes and achieving the NICE 3 treatment targets:

Project Approach

The programme will be undertaken with 11 GP practices in three stages across a 12 month period:

  1. Review of current practice – MSD will run an analysis of practice informatics data and confidence mapping to create a baseline position and understanding of the practice’s approach to diabetes care.
  2. Review and implement guidelines through facilitated clinical change management – MSD will facilitate the change management programme, practices will be supported to create a local diabetes management protocol to improve patient care with clinical support from the health board.
  3. Measure progress and share learnings – the progress made following implementation of the local protocol will be measured and changes will be made to practice; the protocol will be agreed and shared with the wider team.

After 12 months MSD will re-run the analysis of practice informatics data and confidence mapping to allow analysis and comparison to the baseline data set.

Project Objectives

  • Standardise and harmonise ways of working by implementing NICE NG28
  • More cost-effective care: Cost effective prescribing, fewer admissions with diabetes complications, reduction in referrals to diabetes services.
  • Greater patient access based on need.
  • Workforce transformation and stability.

Benefits

Benefit to Patient - Patients feel better supported to manage their condition by having a greater understanding of their condition and the treatment options available to them which supports self-management leading to improved management and a better quality of life.

Benefit to NHS - People delivering diabetes care are able to provide the best support and care possible for people with diabetes by implementing NG28 which will lead to improved patient management and a reduction in the cost burden of managing diabetes. This will support an improved quality of care; a reduction in diabetes related complications and improved self-management.

Benefit to MSD - Supporting Cardiff South West GP Cluster to improve outcomes for diabetic patients will demonstrate MSD as a trusted partner through deployment of skills and resources to support and facilitate higher quality care for all appropriate patients. The collaboration may benefit MSD indirectly from changes in clinical behaviour as National Diabetes guidelines (NG28) is implemented locally.

Funding

This project involves a pooling of skills and resources between the NHS and MSD over 12 months
NHS contribution: £32,106; MSD Contribution: £33,320; Total £65,426

Date of Preparation: December 2017 | DIAB-1242657-0002

Project Title

London Joint Working Group (LJWG) for Substance Use and Hepatitis C & MSD: Phase 2 - RNA Hepatitis C Testing in Community Pharmacy

Organisations involved

MSD, LJWG, ODNs (North Central London, West London & South Thames), CCGs (Lambeth, Southwark, Haringey, Hammersmith & Fulham), Community Pharmacy (Lambeth, Southwark, Haringey, Kensington & Chelsea, Westminster, Hammersmith & Fulham), Local Pharmacy Committee Chair (1. Kensington, Chelsea & Westminster, 2. Middlesex LPC, 3. Lambeth, Southwark & Lewisham), Public Health England, Cepheid

Summary

  1. To identify patients with Hepatitis C, to increase the engagement of these patients (people who inject drugs) and to increase referrals into the ODNs. This should lead to more patients in this cohort being diagnosed with chronic HCV and, consequently, increase the numbers being treated and cured.
  2. The evidence base can potentially be used to present to CCGs to obtain longer term financial commitment to fund this service.
  3. Point of care Hepatitis C testing commissioned by the LJWG with Cepheid RNA testing in 8 pharmacies (4 London Boroughs) selected on the basis of high needle exchange. The project supports MSD, NHS, patients and supporting partners in the development of their future strategy with regard to the sustainability of community based services.

Timing: 6 month project (April 2018 – September 2018)

Background

75% of needle exchanges are in pharmacies rather than within drug and alcohol treatment services. This is therefore an environment where PWIDs (people who inject drugs) are likely to attend and can be offered hepatitis C testing. Currently there is little or no hepatitis C testing undertaken at this first and regular point of care. The project will also provide onward referral for assessment and treatment for PWIDs, especially those who have found HCV services difficult to access.
Following on from Phase 1 that used oral swab antibody testing, Phase 2 will reduce one step in the patient pathway by using Cepheid RNA testing to directly diagnose active HCV. The results from Phase 1 and Phase 2 can be compared to see if the type of test offered makes a difference to the engagement of this cohort.

Project Approach

This project that will support MSD, NHS, patients and other partners in the development of their strategy moving forward with regard to the sustainability of community based services. There are 8 pharmacies, across 4 London Boroughs, taking part in this project. Each pharmacy will have 50 tests and contingency management vouchers; these will be used to encourage the client to return for their test result. There is a clear referral pathway from community pharmacy into their respective local ODN. There will be a combination of classroom and one-to-one training to ensure the pharmacists are competent to deliver the test and complete the onward referral.

Project Objectives

Overall Project Objective
To improve access to HCV diagnostics for PWID patients in the community pharmacies with needle exchanges. Secondly, to evaluate linkages to care. Finally, to have an impact on on-wards transmission, reinfection, and to identify hotspots.

Patients: 1.)To deliver point of care testing for hepatitis C RNA using 8 x GeneXpert IV:2 and 400 Xpert HCV Finger Stick tests (Cepheid) in community pharmacies that offer needle exchange; 2) To support active case finding in the identified pilot pharmacies

NHS: 1.) Identify pathways and barriers with testing in each pilot needle exchange pharmacy, to accessing assessment and treatment through the Operational Deliver Network (ODN) Multi-Disciplinary Team (MDT); 2.) Provide information to the CCGs and Public Health regarding the services they will be required to fund. Also to provide a health economic guide for a CCG’s local population.

Benefits

Patients: 1) Provision of quick and easy access to testing and a clear pathway into assessment and treatment in specialist care; 2) Increased engagement in testing service; 3) Improved outcomes for patients and the NHS.

NHS and Public Health: 1) Provide information to the CCGs and Public Health regarding the services they may be required to fund for longer term sustainability; 2) The findings will inform ODNs in London and nationally providing a template for effective case finding and onward referral and treatment.

MSD: 1.) The project will provide MSD with the opportunity to participate in population health initiatives in HCV, with the aim to demonstrate MSD as a credible partner with PHE, NHSE, London ODNs, local authorities and patient groups 2.) From an elimination strategy perspective, it will provide an evidence based proof of concept to support our thinking around the sustainability of HCV services.

Funding

LJWG partner contribution £39,530, MSD contribution £38,000. The MSD funding for this JW project is unrelated and separate to the NHSE HCV tender.

The contingency management vouchers will be delivered by LJWG and signed for by the lead pharmacist in each pharmacy to acknowledge receipt of these. There will be 50 issued per pharmacy to correspond with the number of tests being carried out. The voucher will be given to the client (patient) only when they come back to receive the result of their RNA Test and this will be captured on the Client Questionnaire, form completion is mandatory. 400 contingency vouchers totalling £2,000 will be purchased by the LJWG, using MSD funding as part of this Joint Working project.

Date of Preparation: April 2018 | INFC-1253846-0002

Project Title

SAS‐HYPO‐FIFE

Organisations involved

Scottish Ambulance Service (SAS) and MSD

Summary

The Scottish Ambulance Service (SAS) are working with NHS Fife Diabetes Service with the support of SCI‐Diabetes and MSD to better manage hypoglycaemia in their diabetic patients with particular emphasis on what happens to patients who experience a hypoglycaemic event that results in an ambulance call‐out. The aim of the project is to improve patient care, increase capacity and upskill attending paramedics.

Background

Patients with diabetes can have their health affected in a number of ways and one of the most serious is when they experience a hypoglycaemic event. These events can be devastating and have a lasting and negative effect on the patient’s physical and mental health.

In addition to the impact of these hypoglycaemic events on patients, the impact on the health economy can be substantial.

Project Objectives

The project objectives are as follows ‐

  • Through an online questionnaire understand any knowledge gaps in diabetes management amongst SAS staff in NHS Fife
  • Identify “Station Leaders” at each paramedic base who will receive additional training in diabetes and leadership and that will be responsible for upskilling local paramedics
  • Develop an online training programme for SAS paramedics across Scotland hosted on the NHS Scotland learnPro platform
  • Analyse data from the project in areas such as ambulance call outs rates, A&E attendances, ambulance scene time, and conveyed versus non conveyed patients
  • Produce an evaluation of the project including learnings for the SAS, NHS Fife and MSD that will help shape the role out of the project across other healthboard areas in Scotland

Benefits

Benefit to Patients - Through the enhanced knowledge and confidence of local SAS staff attending to patients, the recording of information in a standardised way and the subsequent follow up by designated HCP’s, patients will have access to a better, more cohesive standard of care and it is anticipated will have better outcomes as a result.

Benefit to the SAS – The project will help to meet a number of the priorities from the SAS Local Delivery Plan 2017‐18 including–

  • Evidence a shift in the balance of care by taking more care to the patient in their homes
  • Enhance clinical skills as a key and integral partner working with primary and secondary care
  • Expand diagnostic capability and use of technology to improve patient care
  • There is potential for reducing demand on acute call outs for hypoglycaemic patients

Benefit to NHS – The project will help to meet a number of the priorities from the NHS Fife Local Delivery Plan 2017‐18 including –

  • Support people more effectively to remain well at home and where need for additional support is needed offer the most appropriate level of intervention possible.
  • Reduce the gap in health inequalities for those from socially deprived communities so that they experience parity in terms of access and outcomes.
  • Potential reduction in avoidable emergency department attendances
  • Potential reduction in avoidable admissions

Benefit to MSD

  • Support and reinforce MSD’s aim to be the healthcare company of choice in Scotland and MSD’s reputation as a trusted and valued partner will be enhanced
  • Healthcare professionals to re‐evaluate existing medication to help reduce hypoglycaemic events, which may be favourable to MSD and other manufacturers

Funding

This project involves a pooling of skills and resources between the SAS and MSD over 18 months

SAS contribution: £9800; MSD Contribution: £9900; Total £19700

Date of Preparation: June 2018 | NOND-1262581-0001

Project Title

Greater Manchester optimal lung cancer pathway project

Organisations involved

MSD

Greater Manchester Cancer Alliance- North West sector

Summary

GM Cancer have commissioned a regional optimal lung cancer pathway which aims to achieve a treatment decision within 14 days of referral and commencement of treatment within 28 days.
The pathway is to be rolled out across all 4 sectors within Greater Manchester.
The role of MSD in this project will be to provide a project manager who will facilitate mapping of local lung pathways with a view to implementing the GM agreed 28 day lung pathway across the North West sector. This will allow optimisation of processes at a local level across the sector and develop evidence for any resource gap that is present. By implementing the optimal diagnostic pathway across the North West Sector there will be predicted improvement in cancer outcomes, survival and patient experience in line with the GM Cancer 5 year plan.

Project Objectives

To deliver high quality, rapid and efficient diagnostic pathways, exceeding national standards, whilst reducing variation across the sector and ensuring all patients receive the highest level of care comparable with the top performing trusts. The overall aim is to achieve the Regional Optimal Lung Cancer 28 day Pathway.

Benefits

Benefits to patients: Patient experience in the North West sector improves based on standardized pathway that reduces wait times and ensures patients receive equitable care in Greater Manchester.

Benefits to NHS: Recommended lung cancer pathway is provided to NHS stakeholders and improvements are made to decrease variation and increase pathway efficiency.

Benefits to MSD: Enhanced reputation of MSD and the wish to work with MSD further, MSD gains a better understanding of customer and patient needs.

Date of Preparation: August 2018 | ONCO-1263999-0002

Project Title

Leicester Diabetes Community Pharmacy Project

Organisations involved

Leicester Diabetes Centre

MSD

Summary

Leicester Diabetes Centre (LDC) and MSD working together to improve the population health needs for Leicestershire for those living with Diabetes, supporting healthcare delivery through the role of Pharmacists; facilitating the development of training and educational tools for pharmacists such as an educational module for medicines usage reviews specifically for diabetes.

The project will be delivered over 12 months, developing the educational tools, delivering the education in a train the trainer approach to a discrete geography with evaluation and measurement of the impact of the project in terms of service and patient outcomes.

Background

The role of the pharmacist in diabetes is an ever increasing one, in order to support pharmacists in delivering much needed interventions to patients with this disease such as the medicines usage review educational support and training tools are needed to ensure pharmacists are up to date with their knowledge and are confident in delivering a high quality and consistent medicines usage review. Therefore LDC and MSD have undertaken this project to facilitate the development of a diabetes MUR education module with appropriate accreditation.

Project Approach

The project has a series of milestones and deliverables;

Firstly the educational module is to be developed utilising key opinion leaders in the field of diabetes and pharmacy, secondly the module will be rolled out in a train the trainer approach in order to disseminate the training. These trainers will be the piloted implementation in a discrete geography so that measurement and evaluation of the impact of the project can be undertaken to then replicate and scale up with other pharmacists.

Project Objectives

Objective Number Objective Description Outcome Benefit
Objective 1
Timing month 1
Develop EDEN Community Pharmacy digital modules and train the trainer approach through multi- stakeholder workshop with community pharmacy NHSE partners to explore ideas and develop project pathway and joint working programme for 12 months

conduct learning needs analysis for 25 community pharmacists working with LDC
Baseline needs analysis to develop bespoke pharmacist modules to meet the needs of community pharmacists

Agree project pathway with all NHS and community pharmacy stakeholder in order to develop a 12 month project plan to further develop the project initiation document.
Objective 2
Month 1-2
LDC EDEN module and training materials both digital and face to face

Proposed Module Content includes:
  • Introduction to diabetes
  • Lifestyle and diet
  • Monitoring and Treatment of Diabetes
  • The 3 treatment targets and 8 care processes
  • Role of pharmacist in diabetes care through bespoke MUR
  • Complications of diabetes
  • Emergencies hypo/ hyperglycaemia, consultations with patient
  • When to refer to healthcare professionals at GP practice
  • Patient self - care
  • Quality of life and outcomes measures
  • Development others’ trainer approach
An evidence based EDEN module for pharmacists to support patients living with diabetes

Robust training with clear aims, objectives and learning outcomes to meet existing high standards of LDC NHSE RPS
Objective 3 Deliver training to 25 community pharmacy partners from Leicester City working with Leicester Diabetes Centre (Lloyds Pharmacy) to improve the confidence and capability of community pharmacists in delivering care to patients with diabetes

Follow up training needs analysis
Pharmacist delivering diabetes care are able to provide high quality evidence-based MURs following robust training and education from specialised centre accredited by the Royal Pharmaceutical Society measured after training and development modules
Objective 4 Pilot bespoke MUR for Diabetes pilot in 25 pharmacies across Leicester Leicestershire and Rutland STP includes service and patient outcome measurements for project evaluation 12 month pilot to benefit the management of diabetes for Leicester City CCG
Objective 5 Develop LLR communications and progress reporting to feedback to LLR STP NHSE stakeholders to inform of project developments and early outcomes To ensure all stakeholders involved with integrated care in LLR STP, NHSE are aware of progress project and impact on strategic plans for improved population health
Objective 6 Develop a written paper publication on this joint working initiative with MSD including impact and outcomes Evidence and learning for other community pharmacist HCPs STPs ICS NHSE to transfer knowledge and approach to other areas

Benefits

Benefit to Patients
  • Improved patient access to population based personalised healthcare through sharing best practice with other healthcare systems.
  • Contribute to the delivery of high quality personalised patient care as set out in the Five Year Forward View (NHS England 2014, 2017)
  • Improve population health outcomes for people living with Diabetes and Long Term Conditions across Leicestershire which has a high prevalence of diabetes. This will include self-management and education in diet lifestyle and medications
Benefits NHS
  • Supporting healthcare delivery through role of Pharmacists to support strategic plans and local health needs and patient outcomes. Supporting NHS England FYFV and role of community pharmacy supporting patients with diabetes.
  • The value of pharmacy services to patients and the NHS and the wider savings which can be created by the effective use of pharmacy will be evidenced.
  • Supporting organisational and leadership development to ensure sustainability and learning health and social care transformation
  • Provide an opportunity to share best practice and learning with key stakeholders in role of pharmacist in the delivery of diabetes care
Benefits to Leicester Diabetes Centre
  • Patient focused joint working opportunity
  • Working with MSD as industry partner helping to facilitate access to global capabilities as a healthcare partner
  • Opportunity for Leicester to support shared learning, communications and organisational and workforce development with other countries.
  • Local and National Diabetes Guideline training to medicines optimisation agenda for patients
  • Potential to develop education and training in other regions /areas.
Benefits MSD
  • Partnering with the NHS to improve patient care, to positively impact population health and exploring ways together to effectively use NHS resources and capabilities.
  • Partnering with Leicester Diabetes Centre, now the largest diabetes centre in Europe and leading unit in diabetes care
  • Local and National Diabetes Guideline training to medicines optimisation agenda for patients
  • Potential to develop education and training in other regions /areas.
  • Demonstration of service provision in community pharmacy and identifying them as key customers and potential partners to deliver value to NHS.

Funding

The project is being funded with equal allocation of resources to the project respectively from LDC and MSD

Date of Preparation: September 2018 | DIAB-1272120-0001

Project Title

Over 65 Vaccine Project Northern Ireland

Project Summary

A joint working partnership arrangement between MSD and Federation of Family Practices ARD C.I.C., with the objective of increasing access to vaccination services in line with Public Health Agency Policy and the National Immunisation Programmes (NIP), and thereby enabling more eligible patients to participate in the various NIPs. This service will be provided by a third party, Chilvers McCrae, commissioned by Federation of Family Practices ARD C.I.C. This will be a 12 month project focusing on the NIPs for influenza, shingles and pneumococcal disease in the over 65 year olds.

Expected Outcomes

Patient Benefit

  • An increased access to NIP services in ARDS Federation in line with Public Health Agency Policy and the NIPs for influenza, shingles and pneumococcal disease in the over 65 years old.
  • Patients will receive vaccinations closer to home due to the establishment of the hub and spoke delivery model
  • Reduce the risk of associated complications of shingles, pneumonia and Influenza from better access to the NIP via the project

NHS Benefit

  • Increase in the respective uptake of vaccinations within their service.
  • Measurement of the impact of the new model in relation to the improved service and access for practices to the NIP across ARDS Federation
  • Measurement of the impact of the new service to assess patient satisfaction and access to the NIP
  • Potentially lead to a sustainable future model – business plan with economic service benefits to take to FSU, PHA and DoH NI

MSD Benefit

  • As a vaccines manufacturer MSD may see an increase in the uptake of certain vaccinations that they produce in line with Public Health Agency Policy and the NIP.
  • There is an additional reputational benefit to be gained through working in collaboration with the NHS to improve outcomes for patients

Start date and duration

September 2018 to August 2019 – 12 month period

Date of Preparation: October 2018 | VACC-1263544-0000