Andrew Alldred

Clinical Director / Director of Pharmacy

Harrogate NHS FT

Chair – National Pharmaceutical Supply Group

November 2011

• National Medicines Procurement Structure

• What are the roles of the groups?

• Are they effective?

• How will they impact on the future NHS?

• 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 ….?

• 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

• 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)

• 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

• 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

HIGHERQUALITY

MOREEFFICIENT

IMPROVEDSAFETY

PATIENT CENTRED

Greater DemandGreater expectations

• 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

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

• Sharing Best Practice and InnovationBeing ahead of the gameSharing best practiceInnovative procurement programmesMaximise clinical engagementNew Cancer Drug FundPPRS and value based pricing

So where does this agenda

sit in the NHS… ?

NHS CMU Pharmacy Non-Executive Board

National Pharmaceutical

Supply Group

SHA Pharmacy Procurement GroupsBranded Medicines

TherapeuticRationalisation

QIPP

6 x Regional SCEP Groups

Generic Medicines

NHS Pharmacists(Procurement,

QA, Production, Medicines Informationand Clinical)

NHS CommercialMedicines

Unit

NHS Trusts & PCT

Pharmacy Networks

Clinicians

ClinicalNetworks

PCTCommissioners

SpecialisedCommissioners

National Committees/Groups Specialist Support Procurement Groups Trusts/PCTs

Commercial Support

Units ???

Pharmaceutical Market Support

Group

National Homecare Medicines CommitteePharmacy Business Technology Group

Generic Medicines Sub-GroupBranded Medicines Sub-Group

Transitional Products Sub-GroupSpecialist Medicines Sub-Group

• 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

• 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

• 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)

• 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

• Three Priorities for 2010/11and 2011/12

–QIPP and Collaborative Procurement

–Homecare

–Chief Pharmacist engagement and support

• 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

£0

£2,000

£4,000

£6,000

£8,000

£10,000

£12,000

Jul-05 Jul-06 Jul-07 Jul-08 Jul-09 Jul-10 Proj.

Jul-11 Proj.

Jul-12 Proj.

Jul-13 Proj.

Jul-14 Proj.

Primary Care Secondary Care

Data Source: IMS

• 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

• 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

• 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

So - are we effective… ?

• 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…………………………….

• 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

Adjust in line with the environmentMaking sense of the NHS reforms / environmentDialogue with CPhO and CMU Board re direction

Continue to influence policy makers at DH e.g.Medicines optimisationBranded Medicines Strategy / effective medicines

contracting (incl national contracting)Value Based PricingHomecare

Engagement with NHS Commissioning Board

Continued engagement with QIPP AgendaSupport Medicines Optimisation AgendaSupport Medicines Safety AgendaContinue medicines efficienciesPersonalised medicines agenda

Pharmaceutical Supply Chain Review ?Supply chain optionsDistribution models (inc homecare, outsourcing, links with

community)Shortages

Emergency PreparednessE.g. Flu

Access and Affordability of New MedicinesManaging shortagesCommissioning decisionsPPRS Value Based PricingCancer Drug Fund

Other Providers – competition / partnerships

• 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

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 gameWe should not be defensiveWe should continue to deliver on what we are good

atVFMQualitySafety

We should make the most of the opportunities, if we don’t others will

• 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