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National Do Once Programme – Making national PGDs a reality Tracy Rogers

National Do Once Programme – Making national PGDs a reality Tracy Rogers. Key Drivers. Carter 1 report recommendations based around efficiency and productivity Carter 2 report: Recommendation 11 – Medicines and Pharmacy Optimisation states:

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National Do Once Programme – Making national PGDs a reality Tracy Rogers

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  1. National Do Once Programme – Making national PGDs a reality Tracy Rogers

  2. Key Drivers Carter 1 report recommendations based around efficiency and productivity Carter 2 report: Recommendation 11 – Medicines and Pharmacy Optimisation states: NHS England’s Specialist Pharmacy Services and the regional medicines optimisation committees developing a national ‘do once’ system for organisational medicines governance, including national standardised medicines policies, patient group directions and other essential organisational governance documents during 2018/19. Medicines Value Programme

  3. Experience from Practice PHE immunisation PGD templates – introduced in 2013 Pan-London initiative – standardisation of PGDs for sexual health services Specialist Pharmacy Service scoping exercise of PGDs used for administration/supply of antimicrobials

  4. Background to abx PGD scoping • Scoping exercise undertaken to explore the extent to which PGDs are used to supply antimicrobials within NHS services and determine whether there are areas of duplication that would meet the principles of operational productivity and performance in the NHS. • Requests made to 44 NHS organisations between November 2017 and February 2018 – spread of organisation type and geography. • 22 organisations responded (acute, community and mental health trusts), 18 of whom used antimicrobial PGDs submitting a total of 199 PGDs.

  5. Variation • There was significant variation in the quality of PGDs across the organisations in the cohort. • Examples included: • a single PGD for the supply and administration of ‘sexual health medication’ to treat multiple clinical conditions. • a PGD for multiple treatments is not in line with NICE guidance. • incomplete information relating to the antimicrobial agent such as strength and quantity to supply. • inclusion criteria made reference to internal organisation guidelines and therefore relied on the guidelines and PGD being updated simultaneously.

  6. Duplication • Across the responding 18 Trusts who had antimicrobial PGDs there were 199 PGDs for provision of antimicrobial therapy. • By removing duplication this could be reduced to 33. • Highlights the significant operational burden of PGDs.

  7. Standardisation of PGDs – the options Three options outlined in the report: • Option 1- do nothing • Option 2 - develop a repository of quality assured example PGDs that are made available to organisations via the SPS website • Option 3 – develop national PGD to standardise treatment and practice in line with national guidance. Report published before Carter 2 report – option 3 reflects Carter recommendations

  8. Progress to date Paper to RMOC to agree the governance structure The MGDO Secretariat is accountable to the RMOC who will approve all output prior to release. Initial focus PGDs PGDs will be developed by Short Life Working Groups (SLWG) made up of nationally recognised subject matter experts (SMEs)

  9. Governance Structure

  10. Work Plan Look at areas where PGDs are not required: Supply of medicines that are GSL Administration of GSL and P medicines Schedule 19 exemptions Schedule 17 exemptions for healthcare professionals Initially the focus will be: Ambulance trusts Antimicrobials Sexual health/family planning In year 2 – medicines policies

  11. How will it work? (1) • Call for existing PGDs • MGDO secretariat produce first draft of national PGD from examples shared • Full SLWG consultation (largely remote communication envisaged). SLWG made up of SMEs (recognised national clinical leaders and full stakeholder engagement) • Comments collated by MGDO secretariat

  12. How will it work? (2) • Comments reviewed by core members (doctor, pharmacist and healthcare professional working under PGD appointed by SLWG), changes agreed and made by MGDO secretariat • Repeat (Where consensus is not obtained this is reported to the full SLWG) • PGD clinical content signed by core members

  13. How will it work? (3) • MGDO secretariat ensure documentation of process, legal requirements and agreement of SLWG • PGD submitted to RMOC for ratification • PGD published on SPS website and other appropriate portals • PGD authorised by individual trusts. Legal requirement (HMR 2012).

  14. Benefits? • Deliver consistent care across England • Reduce variability in PGDs • Reflect national guidance • Deliver increased organisational capacity • Release significant local resource to be redeployed on optimising outcomes from medicines use • Support organisational Governance arrangements

  15. Constraints? • The programme will not develop PGDs for everything • Local PGDs may still be necessary • It will take time to develop national PGDs

  16. Summary National ‘do once’ system Standardise PGDs and medicines policies SLWG with SMEs Collaborative programme with all stakeholders Release resource for other medicines optimisation activities Not the end of local PGDs

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