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2. TODAY. NHS reorganisation
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1. 1 NOEL J STAUNTON (BSc, MRPharmS, MBA, Dip H.Econ) Pharmaceutical Consultant-3i consultancy ltd
Work with Pharma companies (Pfizer, GSK, Lilly, BI, Novartis, Shire, Galderma, Stiefel, Takeda, Lundbeck etc, etc)
Mob 07980 148711. E mail noel@3iconsultancy.com
2. 2 TODAY NHS reorganisation – why?
Payment By Results (PBR) – how this encourages prescribing
National and local initiatives to contain prescribing
The future
3. 3 NHS investment hasn’t delivered (Ref. P Hewitt, 20th Sept ’06)
Why reorganise the NHS?
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8. 8 MOST (ALL?) NHS CHANGES REVOLVE AROUND SPENDING MORE IN PRIMARY CARE AND LESS IN SECONDARY CARE PBR
PBC
GP contract, Community Pharmacy contract, Consultants contract
Nurse and Pharmacist Prescribing
White Paper
Managing long term conditions
Etc, Etc, Etc
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UK is still a slow adopter of new medicines and appliances and still spends less than most other developed countries. What about NHS spend on pharmaceuticals?
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12. 12 PBR Copy of US system which DOES reduce hospital stay (Ref HSJ, 9th Dec 04, P 16)
Old system - block contracts
PAY FOR WHOLE POPLUATION
Can’t disinvest from secondary care
New system - PBR
PAY FOR EACH INDIVIDUAL PATIENT
CAN DISINVEST FROM HOSPITALS
13. 13 PBR International phenomenon DRGs first in the USA -Medicare
France uses US DRGs
Italy uses modified version of US DRG system
Germany & Netherlands from 2003
England, Australia, Norway, Austria, Finland, Sweden, Japan and Canada have own case mix tools
14. 14 The tariff covers EVERYTHING that happens to the patient whilst in hospital (drugs, tests etc)
Overseas PBR has stimulated primary care prescribing (in order to prevent expensive hospital tariffs)
Overseas PBR has threatened secondary care prescribing (the hospital earns the same amount regardless of which drug they use) UNLESS the drug reduces length of stay
Birth of real pharmaco economics in UK? PBR
15. 15 National and local incentives to contain prescribing Local schemes include:
PCT prescribing incentive schemes.
Grey lists/drugs less desirable/red lists
National schemes include:
NHS Institute for Innovation – targets to prescribe patent expired drugs.
Clinical reviews e.g. NICE, SMC, NPC, UKMI, MTRAC etc).
GMS contract appendix 8, excessive or inappropriate prescribing and medicines management points.
PBC savings
16. 16 What action can a PCT actually take against a high prescribing GP? PCTs interpret things differently.
In July 2002 the WHO asked the UN:
“What, in your honest opinion, can we do to solve the problem of the shortage of food in the rest of the world?”
17. 17 Didn’t work because: East Europeans didn’t understand the word “honest”
Chinese didn’t understand – “opinion”
Middle Easterners didn’t understand – “solve”
South Americans didn’t understand – “problem”
Western Europeans didn’t understand – “shortage”
Africans didn’t understand – “food”
Americans didn’t understand – “rest of the world”
18. 18 What action can a PCT actually take against a high prescribing GP? Clause 304 of the GP contract legislation states:
“The Contractor shall not prescribe drugs, medicines or appliances whose cost and quantity, in relation to any patient, is, by reason of the character of the drug, medicine or appliance in question, in excess of that which was reasonably necessary for the proper treatment of that patient”. (http://www.dh.gov.uk/assetRoot/04/12/67/07/04126707.pdf)
A PCO would therefore have to identify excessive prescribing for an individual patient
19. 19 Short term
Continued emphasis on cost minimisation of prescribing
Medium term
PBR kicks in and the UK starts to see prescribing as an investment
Long term
UK has similar prescribing rates to rest of Europe and N America The Future?
20. 20 NOEL J STAUNTON (BSc, MRPharmS, MBA, Dip H.Econ) Pharmaceutical Consultant-3i consultancy ltd
Work with Pharma companies (Pfizer, GSK, Lilly, BI, Novartis, Shire, Galderma, Stiefel, Takeda, Lundbeck etc, etc)
Mob 07980 148711. E mail noel@3iconsultancy.com