QIPP – viewed from a Foundation Trust

1. QIPP – viewed from a Foundation Trust Tony West PDIG Committee Member Chief Pharmacist, Guy’s & St Thomas’ NHS Foundation Trust

2. The Background • GSTFT - < £1 bn turnover • Part of King’s Health Partners • KCH, SLaM & KCL... . £2 bn turnover • 2/3 activity is ‘specialist’ care • 1 million patient contacts per year • No PFI build • Viewed as ‘successful’... up until now!!!

3. London SHA – the perfect storm ? Shift to ‘lower cost’ setting

4. London SHA – the perfect storm ? Decommissioning

5. Add in the national picture... • ‘Growth’ at 0.1 % above GDP deflator • Tariff • Zero growth in PbR tariff... so any growth funding for NHS will barely cover volume increase • Non-elective capped at 2008/09 activity, over activity only paid at 30 % • Looking to not pay anything for re-admissions • %age of tariff ‘withheld’ for quality... CQUINs

6. What does that mean ? • CIP target for: • 2010 / 11 – 10% • 2011 / 12 – 5 - 10% • 2012 / 13 – 5 - 10% = • Much more for the same or • Same for much less or • Less for an awful lot less

7. Which brings me nicely to medicines.. • London SHA planning assumptions • ‘core’... £286 m savings by 2016/17 • ‘aggressive’.... £455 m savings • GSTFT • £ 75 m.... > 10% of ‘clinical’ spend • 2/3 of which is PbR excluded... pass thru • Local PCTs looking for savings on above • PbR excluded medicines charged at acquisition cost... i.e. we add NO overhead • 2.5 % rise in VAT adds £1m extra cost

8. QIPP - KHP • Quality • Safety • Outcome • Patient experience • Innovation • Prevention • Performance • Excellence in • Clinical care • Education & training • Research ( + application of research) • Partners, whether NHS or Academia have to address financials

9. So... what can you do to help us ? • Understand our, i.e. NHS, environment • Cash will be tight... must recognise that • we cannot afford waste • we have to drive efficiency • we must get value for money • NHS, patients and tax payers generally • we must not compromise quality • Revolution rather than evolution ?

10. What doesn’t work for us ? • Supply chain inefficiency • Out of stock • Short orders • Exceeding ‘quota’ • Packaging incompatible with our automation • Multiple coding • Lack of integration

11. What doesn’t work for us ? • For the introduction of new medicines (which we DO want to see) • Duplication of effort... • Patient Access schemes • ‘Phoney’ orphan medicines • Blatant attempts to extend patent life while offering little or no value

12. What doesn’t work for us ? • Lack of transparency • Homecare • Valuable, but if don’t know what it actually costs how can we determine real ‘value for money’ ? • Where a tied deal is with one provider.. what room for innovation and the use of ‘small businesses’ such as community pharmacists ? • VAT • UK position unique in EU... it will get challenged • Tax avoidance not a sound base for any business • Do current initiatives offer the UK tax payer true value for money ?

13. The sad facts... UK has one of poorest access to new medicines for its citizens Patients still don’t get benefit from medicines they are prescribed... the adherence / concordance agenda Transfer of care still a major problem

14. The opportunities... • NHS structural changes... high risk but right direction • ‘Value based pricing’... the end of the UK being the ‘reference price’ ? • Supply chain is inefficient.. there must be savings for all? • Collaboration... possibly partnerships given the ‘any willing provider’ thrust of White Paper