Case Study - Commissioning and Service Redesign

Strengthening the position of medicines management in the commissioning and service re-design environment: A collaborative approach. Delivered in conjunction with AstraZeneca and facilitated by Healthskills

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Changes in the commissioning of services means that medicines management teams in PCTs need a specific and possibly different skill set to enable them to:

  • Rise to the challenges of changes to the core business and functions of their employing organisations
  • Deliver tangible results in a more commercial healthcare environment
  • Place prescribing and medicines management at the heart of commissioning and service redesign
  • Capitalise and strengthen their role and influence to lead and drive through improvements in prescribing and medicines management

To help with this, NPC Plus developed, tested and evaluated a programme of learning aimed at helping primary care pharmacists and other key stakeholders to better understand the current agenda and position medicines management within the rapidly developing commissioning and service redesign environment

1. The Pilot Programme

The key focus of the pilot programme - Moving forward with prescribing and medicines management in the commissioning environment - was to ensure that medicines management teams in primary care and related key stakeholders are equipped to:

  • Challenge and reposition current services and ensure they are fit for purpose
  • Contribute fully to commissioning and service re-design so that the priority to deliver improved health outcomes in their locality takes account of medicines issues
  • Drive through improvements in prescribing and medicines management.

To enable this, the programme links self-development with policy drivers and was designed to provide:

  • A clear, practical understanding of the current environmental issues and the place of medicines management in this wide agenda
  • An enhanced skill set needed to meet the challenges of working in a new, and ever changing environment
  • The opportunity to network with others working in similar positions.
2. The People

The main strength of this pilot was its collaborative approach. This enabled the strengths of those involved to be used to maximum effect.

  • NPC Plus (operating within the School of Pharmacy at Keele University) was responsible for delivering the programme, funded via a joint working agreement with by Astra Zeneca
  • Individuals with particular expertise in the NHS environment (Shailen Rao and Helen Liddell) were engaged by NPC Plus to contribute to the develop and delivery of the programme
  • Healthskills, an independent organization that focuses on strategic and service leadership and effective team working were commissioned to deliver the skills training elements
  • The programme was delivered to NHS organisations.

The programme was piloted in the following three NHS regions:

  • South Central - This pilot involved collaboration with the Strategic Health Authority. The programme was delivered as an adjunct to compliment an established strategy aimed at medicines optimization across the region and involved Southampton City PCT, NHS Hampshire and NHS Isle of Wight
  • West Midlands - Dudley PCT and Shropshire County PCT
  • Yorkshire and Humberside - Leeds PCT and North Yorkshire and York PCT
3. The Process

The process is case-study based whereby each organisation identifies a ‘real’ situation to work on, including specific outputs to be achieved (e.g. to produce an outline business case for a particular medicines management initiative).

The programme follows a ‘reflective learning set’ approach and consists of three, individual full-day, face-to-face modules, spread over three months and incorporates specific ‘action points’ identified by each pilot site.

Module 1: The strategic view, provides a clear understanding of the place of medicines management in the commissioning and service redesign environment plus strategic approaches needed to develop a service within the provider/commissioner agenda.

Module 2: The operational view, identifies the role and value of medicines management in the commissioning arena including aspects of business planning and marketing involved in the provision of the service.

Module 3: The tactical view, establishes what the service would look like, how it could be used to ensure medicines management is dovetailed into the organisation and how individuals can influence what needs to be done to make that happen at a local level.

Case Study 10 diagram 2
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4. The Performance

Participants are encouraged to feedback to the project team and evaluation is built into the programme at several points:

  • In between each module
  • At the beginning of each module as face-to-face, small group discussion
  • At the end of the final module as face-to-face group work and feedback
  • Some time after completion of the program.

The feedback from the pilot was extremely positive. This was used to build on the identified strengths and refine areas of the programme as needed.

Comments from the participants included:

"There was a well thought out mix of practical activity and interaction"

"The sessions were well planned and didn’t feel rushed"

"The programme provided protected time to look at team development and think about how to move forward"

"Covering the main policy drivers helped frame strategic thinking and move the focus away from operational issues"

"The group work and exercises gave considerable clarity and focus"

"The opportunity to apply theoretical concepts (change theory, marketing, leadership) to real scenarios was invaluable"

"The multi-disciplinary group approach, involving local health economies, allowed more fruitful discussion and gave a head start to engaging participation from a wide range of stakeholders"

"The opportunity and time to work on a particular project and to try out new ‘tools’ made local implementation real and possible"

"The semi-structured approach allowed enough flexibility for each session to be tailored to needs of the individual groups."

5. The Possibilities

Feedback, experience and reflection strongly indicate:

  • The flexibility of the programme means it can be tailored to meet the needs of a range of organisations such as Strategic Health Authorities, Primary Care Trusts, Practice Based Commissioning groups, GP Practices
  • The learning from the programme can be easily applied to other aspects of medicines management.
  • Each module could be delivered as ‘stand-alone’ sessions.
6. Contact Information

If you would like to know more, please contact Trudy Granby, Assistant Director NPC Plus on 01782 734 798 or by email at [email protected]. Alternatively, please visit our website at

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