The Medicines use and Procurement QIPP Programme

1. The Medicines use and Procurement QIPP Programme PDIG June 2012 Clare Howard National Lead for QIPP Medicines use and Procurement

2. Success Factors • A well established network of senior pharmacists • Executive sponsorship (REG) • Leadership from SHA • Great project management • A simple plan • Good data and reporting • Communication (meetings, newsletter, heat map) • Integrating local resources e.g. Procurement Pharmacist, Specialist Pharmacists etc.

3. Successes and challenges in 2011/12 The Headlines: • Delivery above and beyond planned QIPP savings estimated at £26.4 million (still confirming) • Regional roll-out of Inhaler Technique project (almost 5,000 interventions) • National launch of New Medicines Service and Targeted MURs • Regional social marketing campaign on tackling medicine waste – with widespread media interest • Development of Patient Safety Metrics and association of cost savings – with plans for National database

4. The NHS Change Model Inhaler technique Waste Heat map SHA Anne Eden CEO Senior Pharmacists Meds rec INR Allergy Senior Pharmacists Network Pharmacy teams LPCs REG Linda Tait REG Gain sharing NMS Discharge MURs Quality Schedule CQIUNS Heat map Asthma and COPD admissions Money £ Primary care prescribing

5. Project issues and challenges • Executive leadership role (REG) • Maintaining continuity and avoiding loss of momentum with current programme management structure. (SHA) • Continued Primary Care engagement • Securing CCG support, engagement and ownership • Progress on Community Pharmacy NMS currently lags slightly behind national levels

6. Key milestones and delivery for 2012/13 • Annual planning event 20th June • Medicines waste social marketing report – July 2012 • Launch of national database to record medicines safety metrics across teaching hospitals – July 2012 • Evaluation of inhaler technique project - July 2012 • Development of opportunities in secondary care through collaborative working • Pilot of ‘medicines safety pathway’ approach at OUH • Focus on medicines waste in secondary care and zero tolerance approach to pharmacy returns • Regional stock take of Home Care toolkit - September • Delivery of £17.5million in QIPP savings – March 2013

7. Clare Howard National QIPP lead for Medicines use and procurement.

8. How well are we doing?

9. QIPP Medicines use and Procurement • Need to ensure that the programme isn't over reliant on the primary care prescribing budget. • Programme to encompass the breath of the medicines pathway. • Will set the foundations for the medicines optimisation agenda.

10. Have separated the work out into categories. • Primary Care Prescribing • Secondary Care procurement • Home Care • Community based support for patients taking medicines • Medication waste • Medication safety • Patient/ public/ Professional and Industry engagement.

11. Primary Care Prescribing QIPP Prescribing Comparators New KPIs to be added to BSA Toolkit Implement the planned modernisation of the prescribing and dispensing information system. Work with Primary Care National QIPP work stream to prioritise QIPP comparators for CCGs

12. Secondary care procurement Promote regional collaboration on procurement initiatives • To drive up the collaborative arrangements for procurement in secondary care • To develop and embed a framework for sharing efficiencies around PbR excluded drugs. • To support wider clinical engagement in the procurement process. • To support and develop wider patient engagement in the procurement process. • To develop a culture of performance management and holding to account in regional procurement arrangements. • To outline a picture of “best practice procurement arrangements” and to support all regions in reaching the standard. Framework to share PbR excluded drugs. Work with PMSG and NPSG to ensure QIPP is integrated into their annual plans Smarter use of Hospital Medicines data

13. Secondary care procurement Work with PMSG and NPSG to each region has a procurement plan in place Promote regional collaboration on procurement initiatives Support CMU to appoint two posts to scope current regional arrangements and recommend best practice models. Agree more uniform method of collating the data Work with PMSG/NPSG to develop PbR excluded drugs framework. Framework to share PbR excluded drugs. Work with Mark Hackett to engage CEO s around gain sharing. Begin to work with CCGs to understand gain sharing. Work with PMSG and NPSG to ensure QIPP is integrated into their annual plans Support regional collaboration between QIPP and Procurement specialists where it doesn't already exist. Ensure each region is able to identify savings Ensure each region is able to benchmark Trust efficiencies Smarter use of Hospital Medicines data Support the project plan to develop Pharmex data

14. Good practice, integrated procurement model £££ Safety Improved outcomes Leadership in Procurement Performance management Clinical engagement

15. Home Care Work with Mark Hackett to ensure CEO level engagement with both the report and the QIPP potential Implementation of National Home Care Report Back Office Collaboration Data capture Improved financial and clinical governance

16. Homecare Sub Groups • Patient Engagement • Acute Trust Engagement • Systems: Homecare Modules and Functionality • PbR Excluded drugs • Expertise, Toolkit and Standards (kitemarking) • Development of Procurement Model

17. Outline of potential products - This work will produce a wealth of products aimed at supporting the NHS to implement the Hackett report. Products include • A framework for gain sharing across PbR excluded drugs • A set of standards for companies wishing to provide Homecare services to the NHS • A template annual report for Trusts to use at Board level • An initial “quick” stock take outlining current status of Homecare by region • An in depth national assessment of progress on Homecare built up from every Trust self-assessment. • A specification for Homecare modules for e prescribing systems • A specification for Homecare providers (e invoicing etc.) • A procurement model to support consistent procurement processes. • A template Patient charter for Homecare provision.

18. Community based support for patients taking medicines Data capture/ evaluation Shared decision making QIPP/ Medicines Optimisation and Community Pharmacy Post discharge MURs

19. Medicines Waste • will be further refined on publication of the waste report Await the national report and then identify areas where QIPP can support implementation. Support the implementation of QIPP related aspects of the national waste report Primary Care/ Community Pharmacy Secondary Care Care Homes

20. Medication safety National benchmarking of Medicines Reconciliation rates Controlled drugs Baseline of all region-wide medication safety initiatives Omitted and delayed doses PODs Translation of safety initiatives into QIPP efficiencies. Reduction of low dose antipsychotics for patients with dementia

21. Engaging patients/ public and other healthcare professionals Stakeholder development Scope successful regional initiatives. Develop a plan for patient engagement/ comms Promote the concept of shared decision making

22. Medicines Optimisation The issues highlighted at the beginning mean that we can’t keep doing more of the same. Medicines optimisation offers a step change in the way we address these issues Key differences • Patient engagement • Outcome focussed • Pharmaceutical leadership