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HIV Homecare – the London Experience

HIV Homecare – the London Experience. Philip Aubrey Medicines Procurement Specialist – London & East of England LPP – P&MM Operational Lead National Homecare Symposium - 15 th January 2009. Overview. Commissioning of HIV services in London Background to HIV homecare in London

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HIV Homecare – the London Experience

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  1. HIV Homecare – the London Experience Philip Aubrey Medicines Procurement Specialist – London & East of England LPP – P&MM Operational Lead National Homecare Symposium - 15th January 2009

  2. Overview • Commissioning of HIV services in London • Background to HIV homecare in London • Tendering for a London HIV Homecare Service • Retender of London HIV Homecare 2008 • Outcome of London HIV Tender 2008

  3. Commissioning of HIV services in London • The London HIV Consortium manages the overall commissioning and provision of HIV services across London • London Specialised Commissioning Group (LSCG) manage the commissioning of HIV services from the 31 PCTs to the 24 HIV provider trusts across London • 2007/08 budget - £211m (65% on ARVs) • Growth in activity - 7.6%

  4. Background to HIV homecare in London • In 2004/05 - the HIV Consortium decided that London HIV patients should be offered the opportunity to receive their antiretroviral therapy through a home supply arrangement. • This followed previous experience at the Royal Free Hospital who at the time had 380 patients on HIV homecare. • Other London trusts with HIV homecare activity – UCLH, GOS and C&W.

  5. Background to HIV homecare in London • Drivers: • Provides patient choice • More convenient for some patients • Patients can choose between their medicines being delivered by van or via the post • Frees up NHS staff time for other HIV duties • Removes a burden from already overloaded hospital pharmacy dispensaries • Financial benefit as medicines are VAT exempt

  6. Tendering for a London HIV Homecare Service • Agreement of stakeholders on how to construct tender • Design of tendering model • NHS PaSA to undergo tender on behalf of the London HIV Consortium • Specification of tender – used NHMC original specification • No of patients eligible • Homecare market intelligence • From Royal Free model 25% of patients on treatment should be eligible for homecare

  7. Stakeholders

  8. Design of Tendering Model - 2005 • Framework contract • Suppliers are invited to price for a van or postal delivery depending on the number of patients they have on service • Patient bandings • 3 monthly supply of patient medication (4 deliveries per year) • List A – ARVs (pan London contract prices) • List B – miscellaneous (source at lowest cost) • Suppliers must provide financial data to LSCG on a monthly basis

  9. London HIV homecare contract - 2005 • Commenced 1st July 2005 • Duration - 2+2 • Awarded to 4 suppliers • Each supplier awarded geographically: • HaH – North Central London (except UCLH) • Firstplus – North West London (except C&W) • HCL – North East London • Intecare – South London • Note – Firstplus – terminated contract in Mar 07

  10. London HIV homecare contract - 2005 • Homecare suppliers buy ARVs at list price • They then provide manufacturers with dispensing data • Manufacturers reimburse homecare suppliers difference between list price and contract price • Provider trusts are allowed to keep 20% (now increased to 25%) of any savings to fund infrastructure costs

  11. Retender of London HIV Homecare 2008 • Similar model to 2005 • Homecare suppliers invited to price (van and postal) on patient numbers up to 6000+ in bandings of 500 for 3, 4, 5 or 6 monthly deliveries • Evening, weekend and emergency delivery prices were also requested • Patient numbers on therapy are confirmed by the trusts

  12. Example of pricing by patient banding

  13. Retender of London HIV Homecare 2008 • New NHMC specification used for tender • Suppliers were requested to supply monthly management information and KPI data to PaSA • Pre-tender meeting with all homecare suppliers – 8th May 2008 • 6 suppliers submitted tenders • Shortlisted to 5 after PQQ

  14. Retender of London HIV Homecare 2008 • Tenders were scored using the eAward system by myself, NHS PaSA and 2 HIV Pharmacy Leads • Final adjudication – 1st Aug 2008. • Adjudication panel consisted of: • Procurement pharmacists • NHS PaSA • Prescribing Advisor to HIV Consortium • Patient – Public Engagement representative • Commissioners • HIV Pharmacy Leads

  15. Weightings

  16. Outcome of London HIV Tender 2008 • Awarded the existing 3 homecare suppliers to the framework • This was mainly due to higher service charges from the other two tenderers • New patients in Supplier A trusts will commence with Supplier B

  17. Percentage market share of London HIV homecare patients by supplier

  18. London HIV Homecare Savings

  19. Any Questions?

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