““Review of Lymphoedema Review of Lymphoedema Garment Provision: Garment Provision:

FP-10 Project”FP-10 Project”

Gillian McCollumGillian McCollum

Lymphoedema LeadLymphoedema Lead

Belfast HSC TrustBelfast HSC Trust

18 Feb 200918 Feb 2009

Presentation OutlinePresentation Outline

BackgroundBackground Aims and objectives of projectAims and objectives of project Anticipated outcomes of projectAnticipated outcomes of project ProcessProcess Key outcomesKey outcomes Future plansFuture plans SummarySummary

BackgroundBackground

Lymphoedema garments worn on a Lymphoedema garments worn on a life long basis – 2 provided every 6 life long basis – 2 provided every 6 monthsmonths

Service in Belfast City Hospital Service in Belfast City Hospital managing patients from all over the managing patients from all over the regionregion

Increasing prevalenceIncreasing prevalence

BackgroundBackground

2006/07: £30K spent on lymphoedema 2006/07: £30K spent on lymphoedema G&S in Belfast Trust (no specific G&S G&S in Belfast Trust (no specific G&S budget for lymphoedema)budget for lymphoedema)

Increase in order turn around times Increase in order turn around times

(on average 8 weeks)(on average 8 weeks)

Greater range of lymphoedema Greater range of lymphoedema garments available on FP-10garments available on FP-10

BackgroundBackground

CSR 2008/09 – 2010/11: CSR 2008/09 – 2010/11:

Belfast Trust: £343m (3% pa) Belfast Trust: £343m (3% pa)

efficiency savings over efficiency savings over

next 3 yearsnext 3 years

New ways of workingNew ways of working

Main Aims of ProjectMain Aims of Project

Reduce lymphoedema service Reduce lymphoedema service garment expendituregarment expenditure

Ensure patients have timely access Ensure patients have timely access to compression garmentsto compression garments

Objectives of the ProjectObjectives of the Project

Change current practice by Change current practice by instigating the use of FP-10 instigating the use of FP-10 prescriptionprescription

Develop efficient system of Develop efficient system of obtaining compression garments obtaining compression garments on drug tariffon drug tariff

Anticipated OutcomesAnticipated Outcomes

Decrease lymphoedema service Decrease lymphoedema service expenditureexpenditure

Shared funding of garmentsShared funding of garments Increase GP/pharmacist awareness Increase GP/pharmacist awareness Decrease waiting time for Decrease waiting time for

garmentsgarments Maximise benefits of CDTMaximise benefits of CDT Increase patient satisfactionIncrease patient satisfaction

ProcessProcess

Consultation with stakeholdersConsultation with stakeholders BenchmarkingBenchmarking Standardised prescription request Standardised prescription request

form/letter to GPform/letter to GP Data collection form for audit Data collection form for audit Education re FP-10 systemEducation re FP-10 system Patient criteriaPatient criteria

PRESCRIPTION GARMENTS RECORD

Patient name & Tel contact details

Date GP Practice & Pharmacy

Number & full description of garment (to allow for costing)

2 week follow up call comments:

Mrs J Smith028 9099 9999

4/03/08 Dr BrownDunluce HC

Alliance Pharmacy

Combined armsleeve with grip top, standard length, size IV, CL II (x1)

Pt has received garment

KKey Outcomes: Initial Auditey Outcomes: Initial AuditTwo Week Follow Up CommentsTwo Week Follow Up Comments

20%

5%

15%

5%30%

15%

10%

Pt not been to GP yet

Pt not been to pharmacy yet

Pt received incorrect garment

GP unable to find order codes on database

Pt received garment

GP put incorrect details on script

Unable to contact pt

Key OutcomesKey Outcomes

Waiting Time:Waiting Time:

30% of patients received 30% of patients received

garment by 2 week follow upgarment by 2 week follow up

All patients received garment All patients received garment

by end of 10 week periodby end of 10 week period

Key OutcomesKey Outcomes

Expenditure: Expenditure:

£1,752 savings for £1,752 savings for

lymphoedema service lymphoedema service

(over 10 weeks)(over 10 weeks)

Projected annual savings Projected annual savings

of £9,110of £9,110

Next StepsNext Steps

Refined local FP-10 processRefined local FP-10 process Further consultation with GPs and Further consultation with GPs and

pharmacistspharmacists Promotion of drug tariff usage Promotion of drug tariff usage

throughout regionthroughout region Re-audit after 6 months: Re-audit after 6 months:

10 week period (July – Sept 2008)10 week period (July – Sept 2008)

Key Outcomes: Re-auditKey Outcomes: Re-audit

Two Week Follow Up Comments

9%

75%

4%

4%

2%

6%Wrong garmentreceived

Garment received(no issues)

Unable to contactpatient

Patient not beento pharmacy yet

Patient not beento GP yet

Pharmacy issueswith FP-10

Re-Audit – Key OutcomesRe-Audit – Key Outcomes

Waiting Time:Waiting Time:

75% received garment within 2 weeks75% received garment within 2 weeks

Range of time to get garment on FP-10: Range of time to get garment on FP-10:

1 day – 3 weeks (average of 4 days)1 day – 3 weeks (average of 4 days)

Re-Audit – Key OutcomesRe-Audit – Key Outcomes

Expenditure: Expenditure:

62% increase in the number of FP-62% increase in the number of FP-10 requests10 requests

£2,968 savings for BCH £2,968 savings for BCH lymphoedema service (over 10 lymphoedema service (over 10 weeks)weeks)

Projected annual savings of £15,434Projected annual savings of £15,434

Future PlansFuture Plans

Increase awarenessIncrease awareness Audit admin time involved - Audit admin time involved -

business case for admin supportbusiness case for admin support Extended scope practitionerExtended scope practitioner Patient satisfaction questionnairePatient satisfaction questionnaire Potentially decrease number of Potentially decrease number of

face to face reviewsface to face reviews

SummarySummary

Life-long management: Life-long management: major implications on service major implications on service fundingfunding

Need to identify more efficient and Need to identify more efficient and effective ways of workingeffective ways of working

Local drug tariff ordering system Local drug tariff ordering system

improved over a 6 month periodimproved over a 6 month period

SummarySummary

The utilisation of FP-10 to obtain The utilisation of FP-10 to obtain lymphoedema garments resulted lymphoedema garments resulted in significant savings for the BCH in significant savings for the BCH service and has the potential to service and has the potential to greatly reduce patient waiting greatly reduce patient waiting time for garmentstime for garments

For a full list of garments For a full list of garments available available

on FP-10 go to: on FP-10 go to:

www.nhsbsa.nhs.ukwww.nhsbsa.nhs.uk/prescriptions/prescriptions

and click on drug tariff, then and click on drug tariff, then

electronic drug tariff, thenelectronic drug tariff, then

Part lXA appliances –Part lXA appliances –

lymphoedema garmentslymphoedema garments