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Quality payments: clinical effectiveness and public health

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Quality payments: clinical effectiveness and public health

Dawn Williams, head of customer development at Celesio UK, talks contractors through how they can work towards meeting two criteria for the Quality Payment.

2017 is already flying by, and soon the first review date for the new Quality Payments scheme (Friday 28 April) will be upon us – so now is the time to get on board with the funding criteria. 

If you can pass the initial gateway criteria, you’ll then have a chance to qualify for the actual Quality Payments. For those of you that read my previous article about the digital requirements, you’ll know that some things can be done quite quickly, but others will take more time to put in place. Here we are looking at two more of the Quality Payment criteria and how you can maximise your share of the funding.

Clinical effectiveness

Let’s remind ourselves what we need to do to achieve the ‘clinical effectiveness’ criterion:

‘On the day of the review, the pharmacy can show evidence of asthma patients, for whom more than six short-acting bronchodilator inhalers were dispensed without any corticosteroid inhaler within a six month period, are referred to an appropriate healthcare professional for an asthma review.’

The Department of Health has deemed this a priority as it represents another opportunity for pharmacist intervention which could potentially save money for the NHS.

Community pharmacy is in a great position to support patients to make sure they are taking the right medication. If you identify a patient that has been prescribed a number of short-acting inhalers over a six-month period, you need to confirm what condition they have and check their understanding of why they have been given the short-acting medication (bronchodilator) instead of the corticosteroid inhaler.

At this point you could conduct a Medicines Use Review (MUR) with an inhaler technique check if that is appropriate. If there appears to be no reason that the patient requires bronchodilator over corticosteroid, advise them to speak to their GP or an asthma nurse to get a full review. If they give you consent, you can help with the referral.

The next and most crucial step is to ensure that you’ve completed the data collection form as evidence of your referral. This is key to making sure you can prove you qualify for this section of the payments.   

Public health

Another of the Quality Payment criteria concerns the area of public health: ‘On the day of the review, the pharmacy is a Healthy Living Pharmacy level 1 (self-assessment).’ So, what do pharmacies need to do to receive the full level of funding?

The Healthy Living Pharmacy concept is part of a vision for pharmacies to provide more rounded care to their community. As a Healthy Living Pharmacy, you have access to more commissioned services related to public health. It means that you effectively become a community hub for health and wellbeing, catering for the needs of your patients and promoting healthy living in your area.

The opportunity for customer engagement here is exciting. We know this is a priority for the government to ease pressure on our NHS, and reports to date show that HLPs improve access to health services that otherwise wouldn’t be so readily available.

If you’re a pharmacy that wants to evolve and do more, this Quality Payment requirement is a good place to start.

Here are some important things that you can do to get started:

  • Talk to your pharmacy team about Healthy Living Pharmacy status – make sure they understand what’s involved and why it’s important
  • Think about your community – what are the main health and wellbeing challenges, and how can your pharmacy help to tackle them?
  • Check that the relevant members of your team have the right training. You can find out more details on the PSNC website
  • Review your current pharmacy activities against the Quality Payment Criteria to identify how much funding you’re currently entitled to, and what you can do to maximise your entitlement. The online AAH Quality Payment tool can help you with this
  • You can find support packages to help you manage the changes to funding from partners like Careway from AAH.   

For the best chance of securing maximum payment, you should start with these activities as soon as possible. The PSNC website is a great source of information, guidance and tools to help you work through the process.

Important dates and numbers

There are two review dates for the clinical effectiveness and public health criteria:

Friday 28 April 2017 and Friday 24 November 2017

Total value of each criterion over two reviews: £1,280

This could result in a combined earning of £2,560.


Read more: The first article in this series looks at the digital gateway criteria to qualify for Quality Payments.

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