Transcript Document

WELCOME
Session Chairman:
Teresa Molloy
Director
Regional Supplies Service
Urgent Memo – Please Improve
Performance Whilst Reducing Costs
Andrew Donald
Area Sales Director, ntl:Telewest Business
Getting the Best out of Suppliers
John Wilkinson
Director General, Association of British Healthcare Industries
Demystifying ‘Value’ in
Value for Money
John Warrington
Director of Policy and Innovation, NHS PASA
Cardinal Health
Jean van Soelen
President of Marketing, Lyxis Products International
Session Chairman:
Neil Argyle
Former Director
NHS PASA
Opportunities & threats
facing the equipment
industry - as supply and
service is “transformed”
Is the future market a
retail one?
Julian Cobbledick
Background – “has been!”
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Former Managing Director,
Nottingham Rehab Ltd
He has just stepped down as
President of the British Healthcare
Trades Association
Am now MD of Assistive Partner Ltd
A new, very successful provider of
software specifically designed for
healthcare logistics
Julian Cobbledick
What I will be covering
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Can the NHS Afford to Buy Quality?
Will the patient buy it for them?
Think of spectacles pre say, 1977
The UK equipment sector – for private
use - is very diverse, but significant
Is this going to cause an enormous
paradox for those in H.C. purchasing?
Julian Cobbledick
What are we talking about?
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Community and homecare equipment
Currently provided directly by NHS &
Social Services
Total market value in UK - £1bn pa?
Nominal amounts presently sold retail
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Proposed HUGE changes
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The whole supply chain will be affected
ENGLAND AT PRESENT
Julian Cobbledick
Our roots…. (straight jacket)
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State provision model (status quo)
Buy the most robust (ugly)
Resist change and innovation (old fashioned)
Drive down price (cheap)
Hold significant stocks (iCES stores)
Restrict supply (budget controlled)
Bulk orders - predictability
Julian Cobbledick
The market….
…..suggestion is - that demand could at
least double if the supply system is
allowed to restructure, become
altogether more accessible and if real
marketing of the lifestyle value of our
industry’s products and services takes
place......
This is the “preventative” agenda
Julian Cobbledick
The consultation….
….with the root and branch overhaul
that is being proposed by the
“Transforming Community and
Wheelchair Services” team at the
Department of Health right now - I see
opportunity (and threat) all over the
place, not only for industry but also
those in this room
www.csed.csip.org.uk/
Julian Cobbledick
The likely outcome….
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Retail provision model (prescription)
Choose & browse the market (informed)
Buy the most suitable (style)
Require change and innovation (designer)
Range of prices (value - premium)
No iCES stores (need stocks)
Expand supply (demand controlled)
Individual orders - unpredictability
Julian Cobbledick
Autumn 2007 pilot….
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North West of England – Cheshire & Oldham
All eyes upon it
Include direct payments
Working parties to refine the detail
Will involve third sector
Will finalise the model for 2008 roll-out
Be very afraid informed aware ready
Julian Cobbledick
Change for supply chain
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There is no sector in the UK which is not
influenced in part by the NHS or Social
Services
That could change significantly, opening
up the market to follow more classic
structures
This will pave the way for product
innovation too
Julian Cobbledick
Opportunities for retailers
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The merging of ‘retail’ and ‘professional’
will become increasingly prevalent
Only entities which have a strategy for
both will thrive – IT can bridge
There is a real need for information
Informed purchasers buy more
Target younger generations
Julian Cobbledick
Consumers too....
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The road will have bumps
The final structure will be well worth it
Win - for taxpayers
Win - for prescribers
Win - for suppliers
Win - for retailers
Win - for third sector
Win - for users
Julian Cobbledick
What About Capacity?
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There will be more and more social enterprise
organisations
The third sector generally is here to stay
Can industry (as it is) cope with a twofold
increase in demand
How will an aids/smoking style big-budget
campaign change the market
Is there a will & know-how to take the goods to
the people
How will we all cope with regulation
Julian Cobbledick
Road bumps….
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Product tariff paradox
Reimbursement structure
Capacity of commercial sector
Investment requirement
Innovation
Information
Training & accreditation
Links with prescribers
Julian Cobbledick
The prize?….
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Think of the spectacles market
Just a beginning
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Julian Cobbledick
Wheelchairs
Orthotics
Prosthetics
Stairlifts & other DFG equipment
Audiology
Visual impairment
And.....
The end….
…..or is it the beginning?
Thank you for your
attention
[email protected]
www.assistivepartner.co.uk
www.bhta.com
www.csed.csip.org.uk
Julian Cobbledick
Julian Cobbledick
NHS Supply Chain
Mark Paterson
Development Director, NHS Supply Chain
Julian Cobbledick
Julian Cobbledick
Can the NHS afford
not to buy Quality?
A Trust Provider Perspective
David Dalton
Chief Executive
A Chief Executive’s Dilemma
The Dilemma
The Nation’s (financial) Health
% GDP
55%
50
40
30
20
9.4%
5.9%
2003
2008
2033
Buying Quality or Inequality?
Life Expectancy:
A boy born in Manchester will die nearly
10 years earlier than a boy born in Devon.
Men in the top socio-economic class
outlive those in the bottom class by 7 years
In the last 30 years life expectancy for
professional women has increased by 22 years
but for unskilled women it has risen by only 17 years.
“World Class Commissioning”
“Adding life to years and years to life”
Don’t make timely
decisions
Can’t manage
performance
CEO’s lack experience
and can’t hack real
pressure
Poor clinical engagement
and can’t deliver their
GPs
Special pleading
Don’t understand PCT
priorities
No “improving health”
return on investment
CEO’s insular, arrogant
Resist change/hostile
Consultants think they are
superior to 1o care clinicians
Don’t share information
In Search of a Quality Commissioning Strategy
“I’ve got it too
Omar…
A strange feeling
like we’ve just
being going
around in circles”
CHOICE : Implications
• Oversupply
• Market/competition management
• Service specification
• Monitoring information
• Stimulant to provider
- costing
- marketing
- alliances
- unpredictable behaviour (uncertainty/
flexibility to change)
CHOICE : Questions
• Continuity v– fragmentation
• Stages on pathway v– episodic
v– time defined
• Niche providers v– integrated providers
• “one night stand” v- marriage
A New View
Commissioning Manifesto
Improve
outcomes,
pt exp &
VFM
Priorities –
morbidity of
population
Coherent
plans –
rationale
for
change
Incentives
for
improvement
Optimum
Model
Risks understood
costs/productivity
transparent
Integrated
pathways
promoted
Customer Focus
Old
Micro management stifles provider
innovation
Keeps service users as passive recipients
New
Ownership of results not process
Values customer – defines desired outcome
Transformational
Return on Investment
Shift from scrutiny of inputs
to link investment to outcomes
at a clinical service programme
or individual patient level
Results Based Commissioning
PbR = payment for activity
ABC
P4Q = pay for quality
OBC
= outcome based commissioning
Variation in Procedure Rates
Failing to meet best practice
Breast Cancer
75.7%
73.0%
68.5%
68.0%
64.7%
63.9%
57.7%
57.2%
53.9%
Prenatal Care
Low Back Pain
Coronary Artery Disease
Hypertension
Congestive Heart Failure
Depression
Orthopedic Conditions
Colorectal Cancer
Asthma
53.5%
53.0%
48.6%
Not Getting
45.4%
45.2%
the Right Care
40.7%
at the Right
32.7%
Benign Prostatic Hyperplasia
Hyperlipidemia
Diabetes Mellitus
Headache
Urinary Tract Infection
Ulcers
Hip Fracture
Alcohol Dependence
22.8%
Time
10.5%
Percentage of Recommended Care Received
Pay for Quality Programme (US)
•2003 – 2006
•Evaluation of 270 hospitals
•12% improvement on quality scores
•Reduced medical errors & complications
•Cost elimination for average DGH = c. £1.8m
5 Key Clinical Interventions
Heart
Failure
Acute
Myocardial
Infarction
Community
Acquired
Pneumonia
CABG
Hip & Knee
Surgery
Pay for Quality Programme – NHS NW
Agree Care Protocols based on best evidence
Standardise Clinical Practice
Collect data at each point of patient contact
Report compliance to protocol
Provide rewards for % compliance
Publish comparative performance
Extending Procurement Principles
Agree to standardise – based on best evidence
Measure and report compliance
This has power to:
• Redefine management relationships
• Reset Accountability Framework
Do we do “quality”
• HSMR
• How much harm?
• SUI’s
• Evidence based care
• 25% time on quality
Perception
Board
Shop Floor
Board supports
quality
It’s all about £ &
Performance Targets
Saving Lives and Preventing Harm
2004/05
@ SMR 100
1419 died
2005/06
@ SMR 93
1137 died
@ SMR 75
Best in NHS
= c.500
lives saved
(c/f 2004/05)
Saving Lives and Preventing Harm
All harmful events
= 48/1000 bed days
All harmful events
experienced by
patients
= 12/1000 bed days
7 errors per patient
Av los = 18.9
Reduce Preventable
Harm by 50%
Safety and Quality Improvement Programme
Official Launch
January 2008
3 year Programme
MRSA
Unexpected
CDiff
Deterioration
CHD
Pressure
Ulcers
Stroke
HSMR
VAP
Best in
UK
Complications of
Urinary
Catheter
Infections
HSMR @ 75
Save 500 lives
Device Implant
(≠NoF)
Surgical
Site Infections
Central Line
Infections
Reduce Harm
by 50%
Can we afford NOT to pay for quality
Selling The
Message
Making a Difference
“To do things differently
we must see things differently,
when we see things
that we haven’t noticed before
we can ask questions
we didn’t know to ask before”
safe.clean.personal
Julian Cobbledick
East & South East England Specialist Pharmacy Services
East of England, London, South Central & South East Coast
Procurement of Medicines
in the NHS
Peter Sharott
Director, East & South East Specialist Pharmacy Services
Pharmaceutical Adviser, London Specialised Commissioning Group
Chairman, Pharmaceutical Market Support Group
East & South East England Specialist Pharmacy Services
Subjects Discussed
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My experience in medicines procurement
Definitions
Drivers
Medicines Expenditure Data for 2006/07
National overview of medicines procurement
Generic medicines
Pharmaceutical Market Support Group
(PMSG)
• Branded medicines
• London Procurement Programme
East & South East England Specialist Pharmacy Services
My Experience in Medicines Procurement
• Mid 1970s – Medicines Contracting for South East Thames
Regional Health Authority
• 1980 to 2004 – Established and chaired first Pharmacy
Procurement Consortium for Branded Medicines (Riverside) in
North West London for Branded Medicines
• 1980s to date - involvement in generic contracting and
adjudication for London
• 1990 to date - Member of National Pharmaceutical Supplies
Group
• 2001 to date - Chairman of Pharmaceutical Market Supplies
Group
• 2006 – Strategic Lead for London Procurement Programme’s
Pharmacy & Medicines Management workstream
East & South East England Specialist Pharmacy Services
Drivers
• Medicines expenditure has traditionally been a target as it
represents a high proportion of non-pay expenditure both in
secondary and primary care
• Drugs and Therapeutics Committees have had a longstanding role: hospital and joint formularies with primary
care
• Area Prescribing Committees
• New Drugs Panels and Financial Groups
• Drug Procurement Strategies for generic and branded
medicines
• Payment by Results/High Cost Drug Exclusions
• Commissioning Agenda
Procurement Opportunities
Evidence-based decision-making
Clinical effectiveness vs cost effectiveness
East & South East England Specialist Pharmacy Services
Definitions (1)
• Drug
– active chemical with proven pharmacological activity against a
placebo for a defined clinical effect or outcome (efficacy)
• Medicine
– formulation containing one or more drugs
• (tablet, capsule, oral liquid, injection, suppository, cream, ointment,
patch)
• All medicines must be licensed by the MHRA/EMEA
• Generic Medicines
– Contain drugs whose patents have expired
– Products available from more than one manufacturer (competitive
market)
– Primary Care prices determined by the Drug Tariff
– National SCEP contracting through NHS PaSA
East & South East England Specialist Pharmacy Services
Definitions (2)
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Branded Medicines
– Contains drugs whose patents have not expired
– Product available from one manufacturer only
– Prices set by the manufacturer within the Pharmaceutical Price
Regulation Scheme
– Limited or no discounts available for newer high cost medicines
– Procurement opportunities depend on ability to gain clinical commitment
to use alternative drugs within a therapeutic group through rationalisation
– Contracting through local Pharmacy Purchasing Groups (through PaSA)
& NHS Trusts
Transitional Products
– Drugs whose patents have expired
– Shift from Branded to Generic market
– Shift from Pharmacy Procurement Group to National SCEP contracting
– Biosimilar (biological) products
East & South East England Specialist Pharmacy Services
Medicines Expenditure 2006/07
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England – secondary/tertiary care
– Branded
£2.76 billion
– Generics
£259 m (£250m savings in past 3 years)
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England – primary care (2006)
– All medicines
£8.2 billion
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London – secondary/tertiary care
– All medicines
£750 m
• HIV (antiretrovirals)
£140 m
• Cancer
£ 96 m (NICE £60 m)
• Haemophilia
£ 60 m
London – primary care
– All medicines
£900 m
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East & South East England Specialist Pharmacy Services
Pharmaceutical Market Support Group
(PMSG) Current Terms of Reference (1)
1. Ensure patients at all times have access to medicines of
acceptable quality at an economically sustainable price
2. Provide strategic advice to adjudicating groups to inform the
decision-making process for contracts for pharmaceuticals
so that the long term interests of patients, providers of
secondary care and pharmaceutical chain stakeholders are
taken into account
3. To act as the steering authority for NHS PaSA to ensure
effective contracts are in place at all levels of procurement
deemed appropriate for the product
East & South East England Specialist Pharmacy Services
Pharmaceutical Market Support Group
(PMSG) Current Terms of Reference (2)
4. To engage with all stakeholders in the pharmaceutical supply
chain on behalf of NHS Trusts to develop products,
implement supply chain changes, influence pack design and
product presentation in the interest of patient care, efficiency
and the enhancement of patient safety
5. To advise the DoH on strategies to deal with product
discontinuations and shortages and to implement those
strategies at local level to minimise disruption to patient care
6. To report to every meeting of the National Pharmaceutical
Supplies Group (NPSG) any items of strategic importance
East & South East England Specialist Pharmacy Services
A strategic framework to source
pharmaceuticals for the NHS in England
(Published in October 2005)
Organisational Roles and Responsibilities Defined
for:
• National Pharmaceutical Supplies Group (NPSG)
• Pharmaceutical Market Support Group (PMSG)
• Collaborative Procurement Hubs & Procurement
Confederations
• Pharmacy Purchasing Groups
• NHS PASA
• Specialist Procurement Pharmacists
East & South East England Specialist Pharmacy Services
Pharmaceutical Products & Services List
• Product Group
• Responsible for the Tendering
– Pharmacy Procurement Groups via NHS PaSA tendering
(generic and branded medicines)
– Hubs/Confederations
– NHS Supply Chain
– Trusts via local tendering
• Consultation/Involvement Required by
– National co-ordination via PMSG
– Pharmacy Quality Assurance
– Clinical (pharmacy, dietetics, doctors, clinical networks etc.)
East & South East England Specialist Pharmacy Services
Pharmaceutical Products & Services
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Allergy tests
Antiseptic solutions
Bone cement
Bone cement with antibiotics
Branded Medicines
CAPD solutions
Clotting factors
Condoms
Contact lens solutions
Diagnostic tests (blood/urine)
Endoscopic disinfectants
Enteral feeds
Generic Medicines
Haemodialysis solutions
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Haematology products
Helicobacter breath tests
Hyaluronate sodium
Interactive dressings
IUDs
IV immunoglobulins
Medical gases
Plasma proteins
Pregnancy tests
Sip feeds
Smell kits
Sodium chloride flushes
Stents (medicated)
Stoma/continence products
Vitamins
X-ray contrast media
East & South East England Specialist Pharmacy Services
Medicines Procurement
Key Groups and Stakeholders
National Committees
Specialists
PaSA
Chief Operating Officer
National Pharmaceutical
Supplies Group (NPSG)
Strategic
PaSA
Pharmaceutical
Team
Pharmacists
Pharmaceutical Market
Support Group (PMSG)
Operational
(Procurement,
QA, Production,
Medicines
Information,
and Clinical)
Procurement Groups
Generic Medicines
6 x Regional
SCEP Groups
Branded to
Generic Medicines
Branded Medicines
14 x Local Pharmacy
Procurement Groups
(Four in London)
Customers
NHS
Trust
Pharmacy
Services
and
Clinical
Services
PCTs
Commissioners
Patients: high quality, safe, clinically and cost-effective medicines, available when needed
East & South East England Specialist Pharmacy Services
Medicines Procurement Strategy Outline of NHS Internal Network
National Pharmacy Quality Assurance
NPSA
MHRA
NICE
Prescribers
Prescribing
Committees
Local
Clinical
Networks
Trust Pharmacy
Formularies
DH
Medicines,
Pharmacy
& Industry
Branch
Pharmacy
Purchasing
Groups (14)
(Branded)
Therapeutic
Relationalisation
PCTs
NHS Trusts
National SCEP
Contracting
Groups (6
(Generics)
Commissioners
PMSG
NPSG
Collaborative Procurement Hubs
Confederations
DH
Commercial
Directorate
NHS PaSA Pharma Team (Category Managers)
NHS Pasa Pharma Systems
Phate, Pharmex, PharmaQC, RAMA
NHS PaSA Chief Operating Officer
East & South East England Specialist Pharmacy Services
SCEP Generic Medicines Contracting Structure
Sourcing Groups
Characteristics
Oral generic medicines
mostly single supplier
contracts for two years
 Low risk, dominated by
Primary Care
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Oral generic preparations
and Injectables
two or more suppliers for
two national purchasing
groups every four months
 High risk, dominated by
Secondary Care
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Transition Products
manage according to
market circumstances,
whether oral or injectable,
low risk or high risk
 New generic entrants to
branded market
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 Limited number of lines
with the e-auction potential
 Common start date with
staggered end dates
 Award to two or more
suppliers
Implementation
October
Covering all 6
National Groups
February x 2
June x 2
October x 2
Start date
depends
on availability
East & South East England Specialist Pharmacy Services
Supporting the Generic Medicines
Procurement Process
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NHS PaSA PhATE electronic tendering and contracting system
Pharmex Database
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covers all medicines purchases processed through NHS Trust pharmacy systems
electronic monthly purchase data from the majority of NHS Trusts
volume data used to populate tenders
contract variance reports
benchmarking reports (national, SCEP groups, procurement groups)
NPSA Purchasing for Safety Initiative
– Packaging and labelling to ensure that medication errors do not occur due to incorrect
production selection
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Medication Error Potential Assessment (MEPA)
– High
– Medium
– Low
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PharmaQC database
– Product characteristics, including stability data
– Packaging & Labelling
– MEPA Scores
East & South East England Specialist Pharmacy Services
Contracting for Branded Medicines
• Therapeutic tendering
– group of related drugs – contract awards could
cover two or more drugs in the group
– therapeutic rationalisation – contract for one drug
– prices related to aggregated volume commitment
for the purchasing group
– price consistency for all participating trusts
• Clinical commitment essential
• Cost benefits in Primary Care as well Secondary
Care
East & South East England Specialist Pharmacy Services
Approaches to Branded Medicines
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Procurement
– Review existing consortia contracts for product range and prices
– Identify opportunities for pan-London contracts (e.g. antifungals, cancer drugs,
anti-TNFs)
Therapeutic Tendering
– Identify opportunities to rationalise branded drug use (e.g. low molecular weight
heparins) and tender on a volume commitment basis either within consortia or on
a pan-London basis
– Manage value added services
Therapeutic Rationalisation
– Identify opportunities to switch from branded to generic drugs in secondary and
primary care (e.g. statins, ACE inhibitors)
Others
– Homecare supply arrangements
– Local outpatient prescribing policies
– FP10 supply of specialised, high cost drugs (e.g. EPO)
– FP10 dispensing of unlicensed “specials”
London-wide benchmarking, comparative data, targets and monitoring
Build on local initiatives and guidelines
Primary, secondary and tertiary care coverage
East & South East England Specialist Pharmacy Services
Structure for Pharmacy and Medicines Management Group
Project Lead
Steering Group
Regional Specialist Procurement Pharmacists
Pharmacy Procurement Consortia Chairs
Primary Care Pharmacy Specialists
Primary Care
Lead
Clinical Leads
Antibiotics
Antifungals
Anti-TNFs
Cancer
Cardiovascular
ESAs
Immunosupressants
Mental Health
Respirology
Unlicensed
Medicines &
Specials Lead
Homecare
Lead
NHS Trust & PCT Pharmacy Networks and Clinical Networks
Pharmacy Procurement Consortia
Commissioners
Enteral Feeds
Lead
East & South East England Specialist Pharmacy Services
LPP Pharmacy & Medicines Management Workstream (1)
– Managed by NHS pharmacy staff through the Steering Group on behalf
of all NHS Trusts and PCTs
– All licensed medicines procurement managed through the Steering
Group
– Compatible with A Strategic Framework to source Pharmaceuticals for
the NHS in England published in October 2005
– Identification of savings opportunities on branded medicines primarily
through therapeutic rationalisation at an appropriate level; pan-London,
sector or specialist clinical service (e.g. renal)
– Scoping opportunities for homecare, enteral feeds, contrast media,
unlicensed medicines
– Tendering and Contracting carried out by PaSA pharmacy team
– Use existing networks to disseminate information and facilitate
implementation – Senior Pharmacy Managers, PCT Leads,
Procurement and Clinical Pharmacy networks
– Build on existing trust and sector initiatives and facilitate wider
implementation through a light-touch, non-directive approach
East & South East England Specialist Pharmacy Services
LPP Pharmacy & Medicines Management Workstream (2)
– Engagement with clinicians and commissioners
– Savings/Cost Avoidance Targets
• All savings attributable to the trusts
• Realistic and achievable, with an understanding by LPP
Board that they are not guaranteed
• Based on optimum rather than maximum outcomes
• Some individual projects will over-achieve, while others
will under-achieve
• Full impact will be over more than one financial year and
may depend on up-front infrastructure changes and
investment
– Benefits tracking from IMS and Pharmex databases and
Homecare Suppliers on a monthly basis for NHS Trusts and
ePACT data for PCTs
East & South East England Specialist Pharmacy Services
Stakeholder Engagement
Trust
LPP Pharmacy
Leads
Commissioners
PCT
Pharmaceutical
Advisors
P&MM
Steering
Group
Formulary
Pharmacists
Hospital
Clinicians
/GPs
NHS
PaSA
Clinical
Pharmacists
Procurement
Pharmacists
East & South East England Specialist Pharmacy Services
Branded Medicines – Issues to be considered
• Geographical complexities of London – pan-SHA or sectorbased approach
• Inclusiveness for all trusts/PCTs
• Engagement with primary and secondary care clinicians
• Timescales for achieving commitment and change
• Prioritisation of work for practicality and deliverability
• Impact of imminent branded to generic drugs managed
through SCEP
• Need to fit in with national approach in terms of market
management and product availability
• Willingness of pharmaceutical companies to co-operate and
submit tenders
East & South East England Specialist Pharmacy Services
Therapeutic Groups
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Anti-platelet drugs
Anti-psychotics
Anti-TNFs
Anti-fungals
Antiretrovirals
Antivirals
Aromatase Inhibitors
Beta-Lactam Antibiotics
Bisphosphonates
Botulinum Toxin
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Cancer Chemotherapy
EPO
Gonadorelin Analogues
Growth Hormone
Growth Stimulating
Factors
Hepatitis B
Hepatitis C
Immunosuppressants
Low Molecular Weight
Heparins
East & South East England Specialist Pharmacy Services
Key Success Criteria for the P&MM Project
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Manage geographical complexities: pan-London, sector and
clinical group contracts
Achieve full coverage for all London NHS Trusts and PCTs
Effective engagement with primary and secondary care
clinicians and commissioners
Deliver commitment and change within agreed timescales
Prioritise work for practicality and deliverability
Set and achieve realistic savings targets without
compromising patient care
Manage transfer of imminent branded to generic medicines to
SCEP
Work within national strategy strategies for market
management and maintaining product availability
Achieve full engagement and buy-in from pharmaceutical
companies and homecare suppliers
Develop a longer term approach to maintain pharmacy as the
lead for medicines procurement in London
East & South East England Specialist Pharmacy Services
London NHS Trusts - Protein Pump Inhibitor Dispersible Tablets
Sep 2004 to Aug 2007
14,000
12,000
10,000
-75%
8,000
Packs
6,000
4,000
2,000
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East & South East England Specialist Pharmacy Services
Drugs - C&W/CX Annual
Expenditure
HIVAntiretroviral
- The Antiretroviral
Drugs
Market
Zidovudine
Saquinavir
Amprenavir
Enfurvitide
Zalcitabine
Ritonavir
Efavirenz
Atazanavir
Didanosine
Nelfinavir
Lopinavir
Emtricitabine
Lamivudine
Nevirapine
Trizivir
Tipranavir
Stavudine
Abacavir
Tenofovir
Kivexa
Indinavir
Combivir
Fosamprenavir
£22,000,000
£21,000,000
£20,000,000
£19,000,000
£18,000,000
£17,000,000
£16,000,000
£15,000,000
£14,000,000
£13,000,000
£12,000,000
£11,000,000
£10,000,000
£9,000,000
£8,000,000
£7,000,000
£6,000,000
£5,000,000
£4,000,000
£3,000,000
£2,000,000
£1,000,000
£0
Ma Ju Se De Ma Ju Se De Ma Ju Se De Ma Ju Se De Ma Ju Se De Ma Ju Se De Ma Ju Se De Ma Ju Se De Ma Ju Se De Ma
r- n- p- c- r- n- p- c- r- n- p- c- r- n- p- c- r- n- p- c- r- n- p- c- r- n- p- c- r- n- p- c- r- n- p- c- r96 96 96 96 97 97 97 97 98 98 98 98 99 99 99 99 00 00 00 00 01 01 01 01 02 02 02 02 03 03 03 03 04 04 04 04 05
East & South East England Specialist Pharmacy Services
London – Antiretroviral Drug Expenditure Trends
£250
30.0%
25.0%
£200
20.0%
£150
£m
15.0%
£100
10.0%
£50
5.0%
£0
1999/20 2000/20
2007/08
1998/99
2001/02 2002/03 2003/04 2004/05 2005/06 2006/07
00
01
Proj
Basic NHS Prices + VAT (£m)
£50
£60
£77
£88
£106
£119
£134
£149
£164
£191.38
Actual Prices Paid (£m)
£42
£51
£62
£69
£82
£92
£104
£126
£131
£142.63
15.2%
15.0%
20.0%
21.9%
22.9%
22.9%
22.9%
15.4%
20.1%
25.5%
% Saving Against Basic NHS Prices
0.0%
East & South East England Specialist Pharmacy Services
London NHS Trusts - % Low Cost Statins Prescribing
100.0%
80.0%
60.0%
40.0%
20.0%
0.0%
JanMar
2006
AprJun
2006
JulSep
2006
OctDec
2006
JanMar
2007
AprJun
2007
Highest NHS Trust
75.0%
80.0%
89.0%
90.0%
90.0%
90.0%
Median
60.0%
62.3%
69.3%
71.0%
76.0%
79.0%
Lowest NHS Trust
35.0%
37.7%
39.3%
45.0%
55.0%
50.0%
East & South East England Specialist Pharmacy Services
London PCTs - % Low Cost Statins Prescribing
85.0%
80.0%
75.0%
70.0%
65.0%
60.0%
55.0%
50.0%
45.0%
40.0%
Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-Mar Apr-Jun
2006
2006
2006
2006
2007
2007
Highest PCT
63.0%
64.5%
67.1%
72.3%
78.7%
80.8%
Median
57.8%
60.5%
63.8%
67.5%
73.9%
74.2%
Lowest PCT
52.3%
53.0%
55.1%
60.2%
63.1%
63.8%
East & South East England Specialist Pharmacy Services
% Low Cost Statins (Simvastatin/Pravastatin) Prescribing in London PCTs and Local NHS Trusts
Data Source: PCTs - PPA July 2007, NHS Trusts - IMS July 2007
PCT
PCT
NHS Trust
100.0%
100.0%
90.0%
90.0%
80.0%
80.0%
70.0%
70.0%
60.0%
60.0%
50.0%
50.0%
40.0%
40.0%
30.0%
30.0%
20.0%
20.0%
10.0%
10.0%
0.0%
0.0%
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z AA AB AC AD AE AF AG
NHS Trust
East & South East England Specialist Pharmacy Services
East of England, London, South Central & South East Coast
Chairman’s
Closing Address
Thank you
for attending