What are the challenges of successfully implementing homecare? Phil Deady, Pharmacy Procurement Manager Leeds Teaching Hospitals NHS Trust & Yorkshire and Humber NHS Pharmaceuticals.
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Transcript What are the challenges of successfully implementing homecare? Phil Deady, Pharmacy Procurement Manager Leeds Teaching Hospitals NHS Trust & Yorkshire and Humber NHS Pharmaceuticals.
What are the challenges of successfully
implementing homecare?
Phil Deady, Pharmacy Procurement Manager
Leeds Teaching Hospitals NHS Trust &
Yorkshire and Humber NHS Pharmaceuticals Purchasing Consortia
Plan of session
Leeds Teaching Hospitals’ homecare medicines
management services
Homecare service development: tasks and
challenges
The Leeds team approach to homecare
LTH homecare medicines
management services
First homecare patient early 1980’s
All homecare medicines handled
through Pharmacy except medicinal
blood products
3,300 active patients 07/08
Total spend 07/08 £12.6M (21% of
total medicine spend £59.1M)
23 different homecare therapies
Five homecare companies
LTH homecare Top 10 by spend 07/08
1. Etanercept
2. Medicines for HIV/AIDS
3. Medicines for Multiple Sclerosis
4. Intravenous antibiotics for Cystic Fibrosis
5. Parenteral Nutrition
6. Adalimumab
7. Immunoglobulins
8. Imatanib
9. Erythropoietins
10. Liver transplant medicines
Homecare service development: suggested model
Horizon
scanning
Homecare
service
proposal
HOMECARE
MEDICINES
STRATEGY
Multidisciplinary
Teamwork
PATIENT/CARER
Performance
Management
Liaise with
Commissioners
Service
specification
Change Management
Tender
process
Homecare Medicines Management Strategy
Define homecare medicines management services
Proposed direction and scope for homecare
Reference national policy and guidance
Propose systems and processes for developing
homecare services
Define key stakeholders
Summarise benefits and risks
Propose methods to identify homecare opportunities
Propose methods of tendering and ongoing management
of homecare services
Horizon scanning
Specialist pharmacists routinely do
horizon scanning for medicines due for
launch to the UK market
Need to horizon scan for new
medicines that will be launched with
homecare services included
Need to horizon scan for new
medicines with the potential for
homecare services
Start discussions with commissioners
on new medicines homecare services
at this point?
Homecare service proposals
Ideas can come from specialist pharmacists,
nurses, clinicians, patients/carers (reactive)
Proposals also come from homecare companies
LTH procurement homecare team do an annual
review to identify potentially advantageous
homecare services (pro-active)
LTH procurement staff use a “Homecare
Medicines Submission Form” to gather and
analyse information on homecare service
proposals
Homecare service proposals
“Homecare Medicines Submission Form”
Product information
Drug(s) for consideration
Which disease(s)?
What is the patient population?
How does the patient currently receive treatment?
How is the treatment prescribed?
What monitoring is needed?
Is the medicine self administered or not?
Are there any training needs?
Are any ancillary items needed?
Is aseptic compounding required?
Homecare service proposals
“Homecare Medicines Submission Form”
Financial
Which clinical management team?
Which Consultant(s)?
Current annual spend?
Current VAT status on medicine(s)
Is treatment Tariff or excluded from Tariff?
Is there potential loss of Trust income?
Homecare service proposals
“Homecare Medicines Submission Form”
Option assessment
Advantages
Disadvantages
Risks/Governance issues
Should homecare services be submitted to the
Trust Drug and Therapeutics Committee?
Multidisciplinary teamwork
Ensure thorough involvement with
Pharmacy procurement team
Consultant
Specialist Nurse
Specialist Pharmacist
Patient/Carer representative
Business Manager/Finance Manager
Other health professionals depending on service
Commissioners
When to engage in process?
Depends on your relationship with your local
commissioners
Depends on Tariff status of the medicine
May be as early as horizon scanning
May be at tender specification or later
Potential to include Trust administrative costs
and resource requirements into a business case
Service specification
Work with multidisciplinary team to agree service
specification
Use templates from the National Homecare Medicines
Committee/PASA website
Consider all aspects of the homecare service as per
NHMC/PASA guidance
Consider developing service specifications for non Trustcontracted homecare services (usually pharmacontracted)
Tender process
Define the financial aspects of your homecare
service
Current costs of medicines
Assessment of current non-medicine costs
Assess the method required for tendering
according to your Trust Standard Financial
Instructions (SFIs) and EU Regulations
Competitive quote
Trust tender
EU tender
Tender process
Ensure a multidisciplinary clinical project group is
involved all the way along, including adjudication
Patient and carer involvement
Presentations from homecare companies
Be mindful of need for change management
plans
Change management
Change management planning needed for
Change in supply from hospital to homecare
Change from one homecare provider to another
Multi-Trust homecare services
Points to consider
Agreed start dates (may be phased) and project plan
Be mindful of Data Protection Act
Agree Trust staff roles and responsibilities
Agree Homecare staff roles and responsibilities
Further information on the NHMC/PASA website
Performance management
Essential part of the homecare service
Ensures your patients are getting the service you
require from the homecare provider
Ensure tender specification includes information
on performance management and key
performance indicators
Consider performance management of non
Trust-contracted homecare services
More information in Jane Kelly’s session this
afternoon and the NHMC/PASA website
The Leeds approach to homecare:
The procurement homecare team
Phil Deady
Pharmacy Procurement
Manager
Jane
Pharmacy Procurement
Project Manager
0.75wte Band 8B
Michael
Specialist Technician
Homecare Medicines
Management
1.0wte Band 6
Amanda
Pharmacy Contracts
Manager
1.0wte Band 7
Anne
Pharmacy Procurement
Business Manager
1.0wte Band 6
Sue
Homecare Invoice
Administrator
1.0wte Band 2
Linda
Homecare Invoice
Administrator
1.0wte Band 2
Summary of roles and responsibilities
Pharmacy Procurement Project
Manager
• Manages the Trust’s strategy for
homecare medicines
management
• Identifies new opportunities for
homecare provision
• Assessment of proposed
homecare services for patient
focus and cost effectiveness
• Manages risk management
issues
• Pharmacist expertise for
homecare service development
Specialist Technician Homecare
Medicines Management
• Manages the operational
aspects of homecare medicines
services
• Implements new homecare
services
• Change management of
contracts for homecare services
• Performance management
• Patient involvement
• Error and incident reporting
Summary of roles and responsibilities
Pharmacy Contracts Manager
• CIPS qualified
• Equivalent of PASA Category
Manager
• Has LTH and regional
contracting roles
• Manages the tendering process
for homecare medicines
services
• Contractual reference for
supplier performance
management
• Ensures processes meet EU
and LTH guidance
Pharmacy Procurement
Business Manager
• Manages the order/invoice
process for homecare medicines
services
• Manages a team of
administrative staff responsible
for the certification and payment
of homecare invoices
• Provides expert Pharmacy IT
system (JAC) coding/costing
advice on homecare services
• Acts at interface of homecare
contractors’ finance departments
and LTH
• Manages data for non-tariff
medicines charging to PCOs
Key focus areas for
LTH procurement homecare team
Strategy
Operations
Finance
and Data
LTH Homecare funding
Current staff costs in procurement team and clinical
pharmacy teams for homecare roles ~£164k pa
~£50 per homecare patient pa
Resource bids from LTH or PCO contract savings
Resource bid from regional drug contract management
SLA
Contractual funding as value-added services in
homecare contracts
Re-engineering of existing posts
Summary: What are the challenges for
successfully implementing homecare?
Be patient centred at all times
Have a strategy for homecare medicines services
Keep an eye on new developments
Analyse requests for homecare services
Be pro-active where possible
Work with stakeholders in your own and other
organisations, including all sectors of the NHS, homecare
and pharmaceutical companies
Bid or contract for resource to administer homecare
services
Make use of the National Homecare Medicines
Committee/PASA website