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National Medicines Procurement changes, future direction and how do we add value ?

National Medicines Procurement changes, future direction and how do we add value ?. Andrew Alldred Clinical Director / Director of Pharmacy Harrogate NHS FT Chair – National Pharmaceutical Supply Group November 2011. Brief. National Medicines Procurement Structure

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National Medicines Procurement changes, future direction and how do we add value ?

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  1. National Medicines Procurement changes, future direction and how do we add value ? Andrew Alldred Clinical Director / Director of Pharmacy Harrogate NHS FT Chair – National Pharmaceutical Supply Group November 2011

  2. Brief National Medicines Procurement Structure What are the roles of the groups? Are they effective? How will they impact on the future NHS?

  3. Outline Context Some of the opportunities and challenges Where does the agenda sit ? First 12 months of a “new” NPSG Is the system effective ? Where next ….?

  4. The context ……

  5. Equity and Excellence: Liberating the NHS • Patients and Public First • “No decision about me without me” • Lots about choice • Any qualified provider • Closer integration with social care • Personal budgets • Focus on LTC’s , Cancer, Stroke etc

  6. Equity and Excellence: Liberating the NHS • Improving Outcomes • Focus on outcome measures not process targets • Quality stds – NICE continues • Value based pricing of medicines • Better access to drugs and greater VFM • Cancer drug fund • Payment according to performance (CQUINS)

  7. Equity and Excellence: Liberating the NHS • Autonomy / Accountability / Legitimacy • Localism • Clinical commissioning groups • Abolishment of SHA’s and PCT’s • Joint social and health care working • NHS Commissioning Board • Stronger Regulation (CQC / Monitor) • Public Heath protected

  8. Equity and Excellence: Liberating the NHS • Cutting Bureaucracy and Improving Efficiency • £20 billion savings by 2014 • 45% reduction in management costs • Radically “delayer” and simplify NHS • Reduce DoH functions • Reduce number of ALB’s • QIPP staying

  9. The Conundrum HIGHER QUALITY PATIENT CENTRED Greater Demand Greater expectations IMPROVED SAFETY MORE EFFICIENT

  10. Setting out the Opportunities and Challenges (1) • Patient / Clinical Focus • Absolute Patient Focus • Supply chain stability and security • Purchasing for Safety • Homecare • Delivery of the QIPP agenda to deliver efficiency • National / SHA / Local • Back office functions and procurement role

  11. Setting out the Opportunities and Challenges (2) • Profile and building relationships • Engagement of Chief Pharmacists in this agenda • Continuing to raise the profile of medicines procurement • Developing relationships with third parties • NPSG and PMSG role development • Maintaining strong relationships with Pharma • Collaboration and not Competition ? • With all stakeholders

  12. Setting out the Opportunities and Challenges (3) • Sharing Best Practice and Innovation • Being ahead of the game • Sharing best practice • Innovative procurement programmes • Maximise clinical engagement • New Cancer Drug Fund • PPRS and value based pricing

  13. So where does this agenda sit in the NHS… ?

  14. Collaborative Clinical Medicines Procurement in England: Organisational Chart from 2010 National Committees/Groups Specialist Support Procurement Groups Trusts/PCTs NHS Trusts & PCT Pharmacy Networks Clinicians Clinical Networks PCT Commissioners Specialised Commissioners NHS CMU Pharmacy Non-Executive Board Commercial Support Units ??? 6 x Regional SCEP Groups Generic Medicines National Pharmaceutical Supply Group Pharmaceutical Market Support Group NHS Commercial Medicines Unit SHA Pharmacy Procurement Groups Branded Medicines Therapeutic Rationalisation QIPP National Homecare Medicines Committee Pharmacy Business Technology Group Generic Medicines Sub-Group Branded Medicines Sub-Group Transitional Products Sub-Group Specialist Medicines Sub-Group NHS Pharmacists (Procurement, QA, Production, Medicines Information and Clinical)

  15. Core Functions of NPSG • To ensure safe and cost effective purchasing and use of medicines • Support (and challenge) policy development • To develop the strategy and support delivery through PMSG, Regional Groups and Trusts etc • Support the development of strong relationships • Ensure Chief Pharmacist engagement • NPSG agenda will reflect this backdrop being directly influenced by the national NHS policy drive

  16. Who is on the group • Chairman: • Andrew Alldred • Membership: • PMSG Chairman and two other PMSG members • QC Pharmacist representing National Pharmaceutical QC Group • PCT Pharmaceutical Adviser • PCT Commissioning Pharmacist • Northern Ireland, Scotland & Wales representatives • Department of Health representative • NHS CMU General Manager, Principal Pharmacist & Lead Category Managers (2) • SHA Commercial Support Unit/CPH representative • NHS Trust Chief Pharmacists representing 10 SHA pharmacy networks • ATHP Representative • National Advisory Board for Hospital Manufacturing Representative

  17. Chief Pharmacists Sarla Drayan (London) Ian Clacher (S West) Dennis Lauder (South Central) Ann Jacklin (ATHP) Maggie Dolan (Scotland) Mike Scott (Northern Ireland) (Wales) – to be confirmed Philip Dean (North East) Alastair Gibson(North West) Ian Bournes (SE Coast) Ian Cawthorne (Yorks) Martin Shepherd (East Midlands) Bruce McElroy (West Midlands) Carol Farrow (East of England)

  18. What have been the Medicines Procurement Priorities for NPSG? • Three Priorities for 2010/11and 2011/12 • QIPP and Collaborative Procurement • Homecare • Chief Pharmacist engagement and support

  19. The Financial Environment and QIPP • UK Health Economy and Public debt • Efficiencies in Trusts around 20%-25% over 4-5 years • £15-£20 Billion for NHS (front line protection!) • Focus on Medicines Spend • Focus on Medicines Management Services • Medicines Savings Opportunities • QIPP + Opportunity for savings • ~15% growth in secondary care • Flat “growth” in primary care

  20. UK Annual Drug Expenditure (£m) Data Source: IMS

  21. Initial focus around QIPP Maximise the opportunities through collaborative medicines procurement Develop therapeutic tendering programmes Share best practice and innovation Reduce variation Savings plus quality plus safety Requires Chief Pharmacist support

  22. National Homecare Review Chair: Mark Hackett – CEO Southampton NHS Foundation Trust Report in 2011 Policy development and recommendations to NHS Data / information handling etc Opportunities in relation to QIPP Appropriate models of care Relationship with other supply routes

  23. Chief Pharmacist Engagement • Going forward going to be crucial • Multiple challenges within the system at all levels • Lots of opportunities through utilising medicines procurement functions e.g. branded medicines and therapeutic tendering • Clinical services and medicines procurement delivering quality patient care

  24. Importance of Chief Pharmacist Engagement

  25. So - are we effective… ?

  26. In many ways – Yes ? • Patients are getting their medicines • Outcomes are improving • Safety is improving • New medicines are being developed • People are living longer • We are saving money • Evidence of excellent collaboration • Good clinician and patient engagement etc…………………………….

  27. But are we really getting it right ….? • Medicines Optimisation • Still significant waste in the system • Still high numbers of medicines related incidents • Still significant admissions caused by medicines (8%) • Still 50% of patients don’t take medicines as intended • Still patients say they don’t get enough or the right information

  28. The next 12 + months ….. • Adjust in line with the environment • Making sense of the NHS reforms / environment • Dialogue with CPhO and CMU Board re direction • Continue to influence policy makers at DH e.g. • Medicines optimisation • Branded Medicines Strategy / effective medicines contracting (incl national contracting) • Value Based Pricing • Homecare • Engagement with NHS Commissioning Board

  29. The next 12 + months….. • Continued engagement with QIPP Agenda • Support Medicines Optimisation Agenda • Support Medicines Safety Agenda • Continue medicines efficiencies • Personalised medicines agenda • Pharmaceutical Supply Chain Review ? • Supply chain options • Distribution models (inc homecare, outsourcing, links with community) • Shortages • Emergency Preparedness • E.g. Flu

  30. The next 12 + months • Access and Affordability of New Medicines • Managing shortages • Commissioning decisions • PPRS Value Based Pricing • Cancer Drug Fund • Other Providers – competition / partnerships

  31. Delivery through…. • NPSG / PMSG and CMU Board and DoH • Continued engagement • Policy Makers to NPSG • Policy alignment • Confirmation of strategic direction • “Strategic Planning” session early 2012 • Commissioned work • Joint programmes of work

  32. What is our general approach? • We should continue to expect, be ready for and be well prepared for challenges that lie ahead • We should be on the top of our game • We should not be defensive • We should continue to deliver on what we are good at • VFM • Quality • Safety • We should make the most of the opportunities, if we don’t others will

  33. Summary Broad agenda but well positioned to influence Cohesive strategy developing Requires Chief Pharmacist Leadership NPSG / PMSG to support Chief Pharmacists Shift of emphasis around medicines optimisation Use medicines procurement to deliver key objectives

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