How CCGs can work with pharma to reduce emergency admissions

Clinicians have often been sceptical about partnering with the pharmaceutical industry but a Nottinghamshire CCG is leading the way, writes Neil Durham.

Dr Andrew Parkin: 'There’s always been a bit of scepticism about working with the pharmaceutical industry but I couldn’t recommend it more highly.'
Dr Andrew Parkin: 'There’s always been a bit of scepticism about working with the pharmaceutical industry but I couldn’t recommend it more highly.'

The problem

In an area with strong coal mining roots, prevalence of COPD in Newark and Sherwood in Nottinghamshire is higher than average. Prevalence is 1.72%, according to the QOF, compared with the UK average of 1.57%.

Estimates suggest that there are a further 1,000 people living in the area who have this condition but are as yet undiagnosed. Between April 2010 and March 2011 227 patients were admitted to hospital suffering from an exacerbation of their COPD, the cost of these admissions is estimated at £645,000. A total of 20 patients were admitted more than four times each in one year, which contributes towards higher utilisation of A&E than other CCGs.

Newark and Sherwood Clinical Commissioning Group (CCG) partnered not only with the acute trust, community providers and patients but also with the pharmaceutical industry to create PANNASH, the Pulmonary Advancement Network for Newark and Sherwood Health.

How PANNASH works

The aim was to help people to better manage their condition, access services closer to their home and ultimately reduce the need for emergency admission to hospital.

The COPD pathway has been reviewed and redesigned. Individual workstreams are looking at each stage.

Pharmaceutical company partners contributed resources ‘in kind’ in the form of services the CCG would have had to pay for had it commissioned them itself.

These included the provision of a three-strong COPD specialist nurse team for three months which works with practices to train staff and conduct gold standard treatment reviews of patients in line with NICE guidelines.

The nurses are accountable to PANNASH project manager Jan Balmer and work to CCG clinical guidelines.

A confidence mapping programme was initiated where all healthcare providers, including primary care, underwent an exercise where they had to benchmark themselves and their current confidence in a range of COPD management skills. Targeted training was given where mapping showed providers needed development.

All practices are being trained in spirometry technique. CCG-wide learning events are being held and in total pharmaceutical company partners contributed around £150,000 worth of services.

Why work with pharma?

The CCG says: ‘We are committed to working in partnership with all stakeholders including patients and the private sector. The NHS and pharmaceutical industry have shared goals and this kind of collaborative activity around patient-centred projects is supported by the DH, which has issued guidance to the NHS supporting the approach and advising on appropriate governance procedures.

This guidance is underpinned locally by joint working agreements with each company to ensure open and transparent project governance.

‘Specifically, the pharmaceutical industry has significant skills and expertise that we can utilise and which bring significant benefits to the project and ultimately to our patients. These include: communications and marketing expertise; audit expertise, data analysis and dissemination; training and education programmes and expertise; clinical nurse specialist teams.’

What do those involved with the scheme say?

Dr Andrew Parkin, GP, Newark and Sherwood CCG COPD lead and PANNASH chairman, says: ‘The project team has already produced a new COPD service model, mapped the confidence levels of our clinical colleagues in patient management, increased capacity for the provision of pulmonary rehabilitation and we will be implementing a package of support for GP practices to enable them to increase the level of care they can provide to their COPD patients.

‘This will include provision of COPD clinical nurse specialists and a focused and systematic education programme for clinical staff. This gives us a real foundation for sustainable improvements in patient care.

‘From a clinician’s point of view, there’s always been a bit of scepticism about working with the pharmaceutical industry but I couldn’t recommend it more highly. It’s worked really well. The clinicians have been in the driving seat here.’

PANNASH programme manager Ms Balmer says: ‘The NHS and each of the pharmaceutical companies have a shared interest in improving people’s health and reducing their need for hospital treatment and by pooling our skills, experiences and resources we can benefit patients.’

What have the results been?

The supported implementation phase of the programme is due to complete in July following which its success will be fully evaluated.  However, Dr Parkin says all practices locally have been fully engaged with the project and emergency COPD admissions have already decreased by 18%, in the six months the project has been live which has been remarkable given that this was over the winter period. PANNASH had originally set a target of 16% reduction across the whole year.

* Editor's blog: Why CCGs working with the pharmaceutical industry is a win-win

  • Read our Inside Commissioning blog for the latest thinking on redesigning healthcare
  • GP magazine is a media partner for Commissioning 2012 , an event in London on 27-28 June featuring over 700 GPs and primary care managers. Speakers are expected to include health secretary Andrew Lansley and NHS chief executive Sir David Nicholson.

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