'What Works?' pharmacy needle exchange

A pharmacy based needle exchange service providing sterile injecting equipment or ‘works’ to drug users in Leeds had no guidelines, governance or contracts - and was becoming increasingly fragmented.

Needle exchange was established in the 1970’s and continues to play an important role in reducing the spread of blood borne viruses through the use of shared equipment. ‘Sharing’ in Leeds however was on the rise.

Through a series of interviews and questionnaires a pharmacy coordinator discovered that users were turning away from the service because of poor attitudes, limited choice of equipment and pharmacies and a lack of confidentiality. Pharmacists concerns centred on limited training and support and insufficient payments.

A significant suggestion from users was a pictorial prescription style ‘What Works?’ pad that would enable confidential access to the full range of equipment in a public setting.

Pharmacy staff place requested needles, condoms, filters etc in an opaque bag. The record of this request along with basic personal details such as gender, post code and principal drugs is used to collect demographic information and drug use trends for commissioners as well as calculating payments and providing data for performance management.

With proposed changes to their practice and more client contact, ownership of the redesign was shared with the pharmacists. Administrative tasks were reduced and payment scales renegotiated while NVQ level 1 and 2 training packages were developed for assistants.

Pharmacy contracts are set to more than double in the next two years while users have more choice and improved contact with healthcare services. The move away from pre-packed equipment also offers the PCT considerable financial savings.

The balance of user engagement and professional input in a difficult healthcare area impressed the judges. They praised the scheme for the simple but effective system redesign, showing good data collection and demonstrable outcomes delivered with passion.

Sam Prince, Director of Operations,

Highly Commended University College London Hospitals Foundation Trust


Getting insulin therapy for children and young people with diabetes right is far from easy. While options exist for how it can be administered, any comparisons or calculations for determining what method suits a child best must be made in relation to their daily life and that of their parents or carers.

Continuous Subcutaneous Insulin Infusion (CSII) or insulin pump therapy is increasingly offered as a safe and effective alternative to multiple daily injections, offering significant improvements in glycaemic control and quality of life. Recent guidelines have identified that these benefits are more likely to be achieved with education and support from a trained multidisciplinary team.

In partnership with families UCL has developed an innovative two-day psycho-educational programme - Pump School - that promotes flexible self-management with promising improvements in psychological adjustment and long-term metabolic control. The 40 young people that have attended the sessions since 2004 have maintained consistent improvements in glycaemia control.

Pump School was recognised by the judges as an innovative project of great importance for children with diabetes in the UK. The scheme was commended for its integration with other diabetes related projects, its user and carer centred approach, positive outcomes and some strong data analysis.

Rebecca Thompson Clinical Nurse Specialist

Central andNorth WestLondonNHS Foundation Trust Brent Relapse Prevention Project: A Patient -Centred Approach

As a treatment for those with serious and enduring mental illness relapse prevention works. It offers a well researched ‘whole system approach’ of partnerships with leadership and expertise from within and beyond the organisation.

The Brent project has developed training modules for all the community to be trained together as equal partners. The sustained growth and development of the project has seen it gain recognition nationally and internationally.

Stakeholders have recognised the trauma and stigma of relapse, the losses associated with illness and the contribution this service makes to reduced hospital admission rates and the associated reinvestment of resources into the community.

Rami Jumnoodoo Project Lead Relapse

Saxmundham Health

Customer centricity in primary care

A small rural general practice in Suffolk believes that patient-centred care – patient-centricity as it likes to call it - should be at the heart of everything it does and is the only real means for effectively tackling the big public health issues of the future.

With this in mind the practice, with considerable input from its own expert patients has developed a number of projects, protocols and leaflets that offer a more clinically and cost effective range of community led and self-help services. The conditions and concerns covered by this approach include COPD, glaucoma, DVT, smoking and obesity.

Dr John Havard, Senior



Norfolk PCT and Health Dialog UK developed Norfolk Healthline to offer free telephone health coaching to patients across five long-term conditions - diabetes, asthma, COPD, CHF and CHD. The project helps patients navigate healthcare services and improve their self-care management.

Specially trained registered nurses – Health Coaches - support patients with an identified emerging risk to manage their condition using Shared Decision Making techniques. Patients more actively engaged in managing their care with health professionals can be shown to have improved outcomes.

Health Coaches have been able to reach 89 per cent of the targeted populations, successfully engaging with 82 per cent reducing hospital admissions and medical costs.

John Sampson - PEC Chair and GP, Norfolk PCT