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Make the case for pharmacist prescribing in your organisation

By Mandeep Butt, MSc, MRPharmS, and Jane Nicholls, MSc, MRPharmS

Are you thinking about becoming an independent prescriber? Or have you already qualified but are struggling to get your prescribing service up and running?

Many pharmacists have qualified

as independent prescribers, and many more have the desire to do so, but being able to prescribe is only one part of the picture. To make use of your qualification, you will need to be able to demonstrate to your organisation how it will benefit from you prescribing. So, how do you put forward your case?

The business case

Successful commissioning is a cyclic process in which clinicians assess the needs of the population, review the existing use of resources and identify the areas for improvement; in this context, the role of a business case is to inform commissioning decisions. It is a supported argument in which a provider sets out the details of a service (eg, a non-medical prescribing service), including how that service meets identified needs, and demonstrates that the service is practical and good value for money.

Many generic resources are available to support development of a business case. Pharmacy-specific tips have been published previously in Clinical Pharmacist (2013;5:19) and are summarised in Box 1 (p114). The medicines use and safety division of East and South East England Specialist Pharmacy Services has developed a toolkit to help build a business case that is specific for pharmacist prescribing; here we discuss some of the key points.1

Understand the context

Financial constraints The NHS is under incredible financial pressure, and this should be borne in mind when planning your service and drafting the business case.

Although there might be costs associated with setting up and running a pharmacist prescribing service, depending on the circumstances, such costs might be outweighed by savings the service can generate — a concept known as “investing to save”. When thinking about the cost of your prescribing service, you should consider factors such as employment costs, overheads and the cost of support (eg, mentoring and clinical supervision). However, if these costs are compared with those for alternative mechanisms of prescribing (eg, employing doctors) and if factors such as reduced medicines waste are taken into account, pharmacist prescribing can represent good value for money.

Policy priorities The NHS in England has undergone a major reconfiguration, and there is an ongoing expectation to deliver on key policy priorities while improving productivity and patient safety. But what are these priorities and how can you tailor your business case to address those that are relevant?

Improving medicines management is an obvious place to start; a recent report from the Care Quality Commission2 confirms that there is still a need to improve the quality of care delivered to patients — particularly as drug treatments become more complex and there is substantial growth in comorbidities, increasing the demand on the NHS. Pharmacist prescribers are well placed to take more responsibility for the quality of patient care and the efficient use of NHS resources, while improving patient experience.

But, to secure funding for services, you need to think beyond medicines. You will need to understand and demonstrate how your service will help to deliver on other policy priorities. Examples of such priorities include:

  • Care closer to home — will your clinic allow patients to be managed in primary care, rather than secondary care, for example?
  • Value for money — can you identify a high-risk population (eg, those with uncontrolled hypertension, rather than all patients with high blood pressure)? If so, it may be possible to maximise the benefit from the investment
  • Improving quality — can you address Quality and Outcomes Framework or national service framework targets to demonstrate improved quality?
  • Reducing unnecessary hospital admissions — might your service reduce hospital admissions, and can you demonstrate that this is the case?
  • Access — will your service promote better patient access and engagement with health services?
  • Choice — the Government is keen for patients to have more choice regarding their health, particularly around the providers of their care; can you demonstrate that provision of a pharmacist-led service will improve patient choice?
  • Reducing health inequalities — can you identify areas in which QOF targets are not being met? By focusing on these clinical or geographical areas, you might be able to show that your service aims to reduce health inequalities
  • Personalisation — can you show that your service will provide more personalised care to patients?

Show benefits

As well as addressing policy priorities, you need to set out the benefits of your proposed service — and justify how your service would deliver those benefits. To do so, it is important to understand the difference between a benefit and a feature of a service.

A feature is a factual statement about a product or service. However, features are not what entice customers to buy — that is where benefits come in. A benefit answers the customer’s question: “What’s in it for me?” For example, pharmacists are experts in medicines and can prescribe (features of the pharmacist) and this means that the GP (the customer) could save valuable time or increase their QOF points (benefits).

To persuade your audience that your service is worthwhile, every possible benefit should be considered in the business case, and each should be justified. If your service will reduce costs, then present calculated figures as evidence. If the primary benefit is improved patient care or staff efficiency, then explain how this will happen and what the effects will be. Expected benefits can be qualitative or quantitative, they should be measureable and may include clinical outcomes or financial benefits (see Box 2 for examples).

Measure value

A range of measures can be used to monitor the quality, safety and effectiveness of your service, such as:

  • Prescribing data
  • Clinical outcomes data
  • Significant event monitoring
  • Audit
  • Patient satisfaction questionnaires

In addition to these external measures, you should also undertake self-audit and peer review, so that your clinical practice can be maintained and improved. This is particularly important when prescribing, since it is often undertaken in isolation and because best practice can change quickly.

Development of benchmarking tools that facilitate self-audit and help drive continuous improvement in practice is the next phase required to build pharmacist prescribing further; these could also be used as evidence to support the investment in pharmacist prescribing services.

In short

The changing NHS landscape presents opportunities for prescribing pharmacists to improve patient care by providing innovative services in different settings. To influence decision-makers and to secure funding for their services, prescribing pharmacists must have the ability to write robust business cases and measure the value of their services.

Ongoing peer review and the development of benchmarking tools that support self-audit and continuous professional development will also help ensure the quality and value of the service they provide. 

References

1 East and South East England Specialist Pharmacy Services. How to write a business case — non-medical prescribing Vs1. June 2012. www.nelm.nhs.uk (accessed 17 July 2012).

2 Care Quality Commission. Our market report. June 2012. www.cqc.org.uk/public/our-market-report (accessed 17 July 2012).

Box 1: Top tips for writing a business case

The following tips can be used to help draft a business case:

  • Know your audience — to whom are you pitching the case? What is important to them?
  • Identify clinical allies to support the business case — for example, GPs with special interests, clinical nurse specialists, local hospital specialists
  • Do your homework — research the service, care pathway or clinical area; who are the stakeholders and key decision makers? How can you influence them?
  • Tailor your case to the level of investment — for example, a three-month pilot of a service in one practice may not warrant a full length business case, but a multidisciplinary service that covers a whole hospital would require a full and detailed business case
  • Attention to detail — make your business case concise and accurate with enough detail to inform decision-makers; the case should reflect a sense of professionalism — assumptions must be realistic and the projections credible
  • Review — once you have completed your case, have it reviewed independently; select someone detached from the process who can offer constructive criticism on all aspects of the plan; the review should prompt further questions that will need to be addressed in a revised draft
  • Focus on the opportunity — if you are seeking investment in your service, it is important to describe the investment opportunity clearly, ie, what will the investor get in return? What is the unique selling point of this service, or of using pharmacists?
  • Link benefits to policy drivers or gaps in the system — for example, care closer to home (a policy driver) would warrant changes to the anticoagulant care pathway, identifying the need for community-based services (gap), hence the case for an anticoagulant pharmacist prescriber
  • Use widely available tools to help structure your business case — there are several management tools that may help you structure your thoughts, so you can write your business case clearly, eg, SWOT analysis (looking at strengths, weaknesses, opportunities and threats)
  • Look for the evidence necessary to support your particular circumstances 

 

Box 2: Possible benefits

The following are examples of possible benefits of a pharmacy prescribing service that could be incorporated into a business case:

Clinical benefits

  • Safer care (eg, reducing medication incidents)
  • Improved adherence
  • Improved patient outcomes (eg, control of international normalised ratio or blood pressure)
  • Improved patient access to medicines
  • Financial benefits
  • Budget savings
  • Saved GP or nursing time
  • Increased Quality and Outcomes Framework points
  • Reduced medicines wastage
  • Number of medicines stopped or changed 

Write about CAREER DEVELOPMENT

This Clinical Pharmacist series looks at all aspects of career advancement and development of clinical roles. Any pharmacist with ideas for future pieces or who would like to write for Clinical?Pharmacist is invited to contact the editor.

E: clinicalpharmacist@pharmj.org.uk  T: 020 7572 2425

Mandeep Butt is joint head of medicines management at Central London Community Health-Care and Jane Nicholls is deputy director, medicines use and safety division, East and South East England Specialist Pharmacy Services.

E: jane.nicholls@nhs.net

Citation: Clinical Pharmacist DOI: 10.1211/CP.2013.11120704

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