Domain Three: Governance of Homecare Services

Domain three of the RPS professional standards includes standards for leadership, governance, financial and workforce management. The Chief Pharmacist (or equivalent) is the named individual responsible and accountable for oversight of the homecare organisation.

Standard 8: Leadership

8.1 Strategic Leadership 1 2

The chief pharmacist or equivalent is responsible for ensuring the organisation maintains a clear vision for homecare services and has a homecare policy (see standard 4.1 for further information on homecare policies). A homecare strategy defines the high level strategic aims for the NHS homecare service and may include elements such as:

  • Plans to improve or optimise treatment outcomes
  • Plans to extend patient choice
  • Plans to encourage patient independence and/or engagement with their treatment
  • Improve the patient experience
  • Increase standardisation and consistency across homecare services
  • Improve governance
  • Increasing the range of homecare services
  • Increasing the take-up of homecare service
  • Realise time and economic savings
  • Financial advantages

 

NHS Improvement has published a Strategy Development Toolkit  which provides guidance on each stage involved in the development of a strategy. The guidance is intended for Foundation Trusts but the content is useful to all organisations4

  

 

8.2 Operational Leadership

The chief pharmacist must identify and have access to the type and level of resources required to deliver and support the safe delivery of a homecare medicine services 1 2

Consider the following work streams to meet this standard:

  • Agreed Key Perforace Indicators (KPIs) to enable the internal and external assessment of homecare operational performance
  • Management of performance through SLA and/or contract performance monitoring
  • Operational performance benchmarking exercises against other relevant organisations
  • Monitoring and review of performance

 

8.3 Clinical Leadership

Clinical leadership standards requires the pharmacy team members to have sufficient training and experience on homecare medicines so they are recognised as leading on homecare medicine issues. The pharmacy teams should provide the following functions:1 2

 

 

  • Provide leadership, advice and support to clinicans and staff involved in the homecare service
  • Prodvide education to relevant clinical staff regarding homecare services and medicines
  • Support the development of integrated care pathways which involves homecare medicines
  • Participate in relevant research and clinical audit activities

  

Appendix 6: Example patient pathway for outpatient

 

 

Standard 9: Governance and Financial Management

 

9.1 Homecare System Governance 1 2

The systems for homecare must be establised in a documented and approved set of policies and procedures. Homecare policies and procedures must be approved by an appropriate group such as Drugs & Therpeutic Committees (DTC), Medicine Safety Committee (MSC) or a homecare steering group. The approval groups should comprise of people from areas relevant to homecare, including commissioners.

Processes and procedures should be regularly reviewed and updated. Compliance and effectiveness of procedures should be annually audited with results informing the continous improvement and development of systems.

 

9.2 Financial Governance 1 2

Financial spend on homecare prescribing should be reviewed on a regular basis and should appear as a standing agenda item at finance meetings. Changes in homecare spend should be discussed by clinicians, pharmacy and finance who provide oversight and budget management support.

The trust and/or homecare pharmacist must work collaboratively with commissioners to ensure prescribing delivers value for investments. Subcontrators must be evaluated for financial robustness prior to entering into a contractual agreement. Purchasing authorities must not delay or unreasonably hold payments due to the contractor.

 

9.3 Quality Risk Management

Trusts must adopt a risk management approach in accordance with ICH Q9 in order to safeguard the quality and provision of services to patient. Homecare services should be listed on the trust risk register. 1

Risk is defined as "the combination of the probability of occurance of harm and the severity of that harm" 3

A documented risk assessment must be performed for each homecare service and for each patient prior to initiation. Risk assessments consist of the identification of hazards and the analysis and evaluation of risks associated with exposure to those hazards. It can be useful to consider the following questions when defining risks during an assessment:3

  1. What might go wrong? (Risk identification)
  2. What is the likelihood that it will go wrong? (Risk analysis)
  3. What are the consequences? (Risk evaluation)

Once risks have been identified then appropriate control measures can be implemented to reduce risks. This will lead to either an acceptance or rejection based on the risk score3

 

Homecare services should have a documented process for recording and managing complaints in line with the NHS trusts standard complaints procedure. As homecare is a shared care arrangement which can involve multiple parties, the complaints process must allow the sharing of complaints and stipulate that all parties will co-operate in the investigation of complaints and the implementation of corrective actions2

  • Responsibility for responding to formal complaints will usually be on the organisation who originally received the complaint, unless otherwise agreed between the contracting parties
  • Incidents reported through national reporting systems (ADR, Patient safety incidents etc.) should not be recorded as complaints to avoid duplication of reporting
  • Service failure events where there is a KPI target should not normally be recorded as a complaint as it is recorded through the KPI review
  • Complaints which involve service failures as an aggravating factor should only log the aggravating factor as a complaint
  • If the complaint requires a formal response then the incident should be recorded as a complaint unless this would duplicate reporting

Example list of processes which would benefit from a homecare SOP

  • Accessing and approval of new homecare services
  • Patient risk assessment prior to initiation on homecare services
  • Homecare registration process
  • Processing homecare prescriptions
  • Manging homecare service performance
  • Information Governance
  • Managing homecare complaints and incidents
  • Managing drug shortages in homecare services
  • Controlled drug and unlicensed medicine use in homecare

 

Standard 10: Workforce

 

10.1 Workforce planning1 2

To ensure service quality the homecare workforce must have the right skill mix, capability and capacity to develop and provide quality homecare services. This can involve:

  • A regular plan for reviewing, developing and funding the homecare team to ensure it has sufficient capacity and capability to safely discharge their duties
  • Where the review identifies deficiencies then a corrective plan is implemented to resolve issues
  • Ensure there is sufficient resources to provide services in the event of homecare team members annual leave or sickness absence
  • Create a plan for succession which includes workforce development and personal development plans
  • Homecare team members to have an up-to-date job description so they are aware of their role and responsibilities within the homecare system and the need to maintain competency

 

10.2 Workforce Development1 2

Processes to aid performance management and workforce development includes:

  • Benchmark homecare workforce and skill mix against other relevant organisations
  • Regularly review job descriptions to ensure they are relevant
  • Annual appraisals to include the identification of relevant learning needs and consider what skills are needed to meet the changing needs of the homecare service
  • Allowing job exchanges or secondments within cross-organisation teams to facilitate the transfer of skills and experience
  • Consider shadowing opportunities within other NHS organisations

 

10.3 Education and Training1 2

Homecare training programs must be implemented to ensure staff are trained on all relevant processes. These training programs must be regularly reviewed and adapted to ensure they remain relevant and fit for purpose. Homecare team members should maintain a traning record which relates to their homecare role. Where competency or performance issues are identified then there must be a plan for refresher training and competency assessment. In order to develop expertise within homecare team members, they require the following:

  • Support and superviwion from approprite educational and practice supervisors
  • Given opportunities to undertake further learning and development which would deliver improvements in patient care

 

References

1Professional Standards for Homecare Services in EnglandRoyal Pharmaceutical Society (2013)

2Handbook for Homecare Services in England - Royal Pharmaceutical Society (2014)

3Quality Risk Management Q9ICH Harmonised Tripartite Guidelines

4Strategy Development ToolkitMonitor (2014)

 

 

 

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