Module 2
Contents
1. How can I help the pharmacy ordering office to obtain a new medicine?
2. Why should I talk to my procurement staff when I don’t work there?
3. What training is available in pharmacy procurement ?
4. Industry can offer value added services. Are these ok to access and how
should we deal with them ?
5. What is the best way to manage reps?
6. How do we go about sourcing a product out of hours when procurement
staff are not here?
Question 1
How can I help the pharmacy ordering office to obtain a new medicine?
Answer
Placing an order for a medicine is not a simple task of picking up the phone and
ordering. There are a number of steps necessary before proceeding.
1. Source of Supply
Many medicines are easy to source (details of suppliers are in BNF, MIMS etc.).
However others are not, especially trial materials, unlicensed medicines etc.
Always try to have a source available, or at least the name of another centre that
is using the product so a source can be obtained.
2. Supplier Evaluation
The NHS will always try to source products from suppliers that have been
evaluated. There is a national mutual recognition process involving QA
pharmacists that ensures suppliers are only evaluated once by the NHS.
3. Formulary Considerations
Procurement staff are often the last line in formulary management systems. If a
request is non formulary then a referral may need to be made to authorise the
request. This will vary depending on in house systems.
4. Adding to Pharmacy System
A new medicine will not necessarily be present on the pharmacy system, and will
have to be added. This process may be restricted to senior staff and hence may take
some time.
5. Ordering
All medicines ordered in secondary care have to have a clear audit trail. That is the
trust auditor has to be able to see a complete record of all transactions. (This is
obviously to prevent fraud and theft). To accomplish this all orders have to be
undertaken through the pharmacy system with an official order number. It may be
that some suppliers require a minimum value before an order will be processed (this
can be overcome in an emergency if a fee is paid).
6. Lead time
Many medicines are available the same or next day from a wholesaler. However not
all medicines are stocked by wholesalers and the time to obtain them (lead time)
may be extended; especially if the medicine has to be imported from abroad.
Procurement staff will normally be able to predict a typical lead time for a supplier.
Questions
1. Describe three steps that are required to be undertaken before a medicine
can be obtained safely.
Question 9.
Why should I talk to my procurement staff when I don’t work there ?
It is essential that all sections of pharmacy department communicate effectively.
The following table explains the types of communications necessary to ensure a
seamless service to customers.
Questions
1. Name two subjects of communication between formulary pharmacists and
procurement staff
9. What training is available in pharmacy procurement
Several forms of procurement training are available (indeed you are undertaking
one now!)
1. Regional procurement training.
Several regions provide procurement training for trust staff. Contact regional
E&T or procurement specialist for details.
2. CMU Courses
The courses run by CMU as part of their training for buyers have recently been
made available for non CMU staff. These are free of charge to NHS staff. They
are also useful and give a non pharmacy perspective that is valuable.
Procurement Training (Cont).
3. CIPS Training
CIPS (Chartered Institute for Procurement and Supply) has accredited
courses from Certificates to PhD’s in procurement. Details are available
on the CIPS website. You do not necessarily have to be a member to sit
these.
4. NVQ’s
There are a series of NVQ’s in ordering and supply. Details are
available on the web.
Questions
1. List the training options available in pharmacy procurement?
Additional resources
CMU training from CMU website http://cmu.dh.gov.uk/
London Education and Training information
www.londonpharmacy.nhs.uk
CIPS training available from CIPS website
www.cips.org
Question 10
Industry can offer value added services. Are these ok to access and how should
we deal with them ?
Answer
Pharmaceutical industry commonly offers all sorts of support to the NHS. This is
governed by the ABPI code of practice and should be directed at the NHS service
not individuals. Any individual benefit needs to be carefully assessed against
professional and trust policy (all trusts will have a bribery policy). If benefits are
taken up they need to be declared on a trust declaration of interest form. This is
in your best interest.
“Value added” services include any offers made to trusts as part of a tender that
are not related to the price of the medicine. They may include training support,
extra equipment or even payment for staff to help implement a
work programme relating to the use of the product (e.g. a trials
nurse). The use of “value added” elements allows trusts access
to suppliers marketing budgets and hence the offer may be
more economically beneficial than simply asking for price
reductions on the product. However it is important that
“value added” services are considered and included in a
formalised and equitable way.
Ideally the types of services which are to be included in
a tender should be identified beforehand and included
in the product specification. A rule of thumb is that only
those items which a trust would pay for in any event
should be included as 2value added”. Just because
something is “nice” does not mean it should be included
in the tender. Once the list of services to be included has
been agreed, these should be costed at the price to the trust
(i.e. what it would cost to provide these if the trust were
paying for them and not the cost to the providing supplier).
A bid can then be relatively easily assessed as to which
provides the most benefits to the trust.
The DoH, RPSGB and CIPS all provide guidance on
working ethically with the pharmaceutical industry.
Questions
1. Do you know how to find you trust bribery policy? If not then find a copy.
2. Why is it important to consider costs at trust prices and not the suppliers?
3. Why not just ask for prices off the cost of the drugs. How does this relate to
PPRS?
4. Why is it important that all “value added” services are registered at trust level?
Additional resources
ABPI code of Practice www.abpi.org.uk
CIPS guidelines available from CIPS website www.cips.org
RPSGB guidelines available fro RPSGB website www.rpsgb.org.uk
DoH guidelines “Commercial Sponsorship- Ethical Standards for the NHS” on
DOH website www.doh.gov.uk
Question 11
What is the best way to manage reps?
Answer
Pharmaceutical representatives are paid by manufacturers to sell their products. They
can be a useful source of information and resources for buyers, but can also waste a lot
of time. Remember that some companies still measure reps results by call rates that is
they are paid by the number of times they see you whether or not the call is useful to
you.
Most experienced buyers will only see reps by appointment at designated times. This
could be two mornings a week for example.
Some find out the subject of the call beforehand and only grant an appointment if
the meeting will be of benefit. For example a rule of thumb could be:-
“New rep, New Drug, New Deal”
That is the buyer will see a new rep to explain the local policies about visiting,
how the D&T works etc. (Some insist that this visit is documented, that written
instructions are given to reps who sign to show they accept the local rules). The
buyer will see a rep to discuss a new drug and how this is to be dealt with by
D&T etc. And the buyer will see a rep to discuss any new purchasing
arrangements either initiated by the trust or by the company.
The ABPI have a code of practice to which members must adhere. This outlines
the way in which products can be marketed and behaviour of reps. A breach of
this code is a serious offence and one that companies have to take seriously. If
you have a complaint about a rep then the first port of call would be their area
manager. If this is unsuccessful and/or the complaint breaches the ABPI code,
then a formal complaint can be made to the ABPI.
Questions
1. Why is it important to see reps by appointment only?
2. What sanctions can a buyer take to deal with unacceptable behavior from a rep?
Additional resources
ABPI Code of Practice or www.abpi.org.uk
Question 12
How do we go about sourcing a product out of hours when procurement staff are
not here?
Answer
Sourcing a new medicine is a crucial pharmaceutical skill. It is important that
this process is done efficiently and speedily and in a way that is commensurate
with patient need. It is easy to overreact to clinical demands, although it is
essential that real patient needs are met. Consider the following questions. NB
these are not in any particular order. The order they should be considered will
depend on individual circumstances. For example it may be best to go straight to
a therapeutic alternative for a stimulant laxative if a product is temporarily
unavailable. However the exact form and dose of an iv antibiotic may be
essential in a septic crisis.
Short Term Measures
It is obviously important that the short term issues in obtaining the medicine are
resolved. However it is also important that all activities are recorded and
communicated to procurement staff as soon as possible. This is vital if the ordering
and invoicing are to be resolved. A supplying hospital may not be so keen to make
a supply on a future occasion if there are difficulties in payment as a result of
incomplete information being available to procurement staff.
1. How important is the drug?
What is the real clinical need of the patient? Does the patient’s indication and
condition demand an all out attempt to source the exact medicine required come
what may, or could suitable alternatives be considered? What is the maximum
time delay acceptable before the next dose must be given?
Are other strengths available and in stock that could be used as an alternative?
Is the drug available in the hospital as stock on a ward
(e.g. ITU Theatres Clinics)or has it recently been issued?
2. Google it
There will be a lot of information on the web.
Not least the manufacturer.
Short Term Measures (Cont)
3. Contact other hospitals
It may be necessary to contact other hospitals. For commonly used
medicines this is probably best done on a geographical basis (i.e. contact the
nearest hospitals first). However for rare medicines this could be time
consuming (and out of hours disturb a lot of on call colleagues). A list of
Rarely Used Medicines (RUM List) has been produced by medicines
information to facilitate this process. This contains a list of medicines
stocked by hospitals in the South East.
However the medicine is sourced, it is vital to make sure transport
arrangements are resolved. Normally the requesting hospital will be
expected to make arrangements and to pay for both the transport and the
medicine.
4. Consider other drugs (therapeutic substitution).
It may be possible or necessary to substitute the prescribed medicine with a
suitable clinical alternative and hence make a therapeutic substitution.
This is easier in some cases than others. Obviously the prescribers opinion
must be sought and any dosage changes implemented
Longer Term Solutions
These would normally be dealt with by procurement staff although the general
principals may be useful to all pharmacy personnel.
1. “Solutions” UCLH bulletin
The “Solutions” website run by UCLH pharmacy store is a valuable resource
for information on shortages AND possible ways to deal with them (hence the
name). It is available either as a printout (once a week) or on-line at
www.uclhsolutions.com
This should be your first port of call as it avoids unnecessary
phone calls, is simple and easy to use. “Solutions”
gives information on duration of the problem, the cause
and possible alternative medicines. The site is also used as
a way to monitor the performance of suppliers (i.e. the more
they appear the worse their record).
Longer Term Solutions (Cont)
2. Contact manufacturer
If the current problem does not appear on “Solutions” then it will be necessary
to contact the supplier to find out the information for yourself. (In this case
consider alerting “Solutions” so they can update the database). Manufacturers
customer service departments are the best place to start although it is often
difficult to obtain the information you require. This is
•
How long is the problem likely to last and when will stock be available
again?
•
In the meantime is the supplier offering any alternatives?
Occasionally manufacturers will purchase alternative stocks and make
these available.
Longer Term Solutions (Cont)
3. Contact other generic suppliers
It may well be that the product or a close equivalent is available from an
alternative supplier. If this is the case then obviously you can order from them
in the normal way. Note that if the item is on contract with the defaulting
supplier, you may be able to claim compensation for any difference in price you
have to pay. This may be complex but if you give details to the regular
procurement staff of what you have bought, from whom and at what price, then
they can sort this out.
4. Use the Directory of Medicines &Devices (DM&D)
The DM&D is a coding system introduced by the NHS for medicines. It
individually codes products by manufacturer. Thus it can be used to find out
which manufacturers have been allocated a code for a product. This does not
mean the product still exists nor are all products coded. However it may help.
To access the list go to www.dmd.nhs.uk go to the browser and search for the
products under the AMP.
Longer Term Solutions (Cont)
5. Contact Importers ( Like IDIS or Durbin)
Durbin and IDIS are specialist pharmaceutical importers although there are
many others As such they will import unlicensed pharmaceuticals on
requests from customers. These companies work closely with the MHRA and
are not allowed to import a product for which there is a licensed alternative in
this country. As such they have to have complete and up to date data on
which products are available from whom.
Thus if you contact them and ask about a product they will do one of two
things.
• Tell you they cannot import the product. This means there is at least one
existing supplier in this country. If you ask them the importer will give
you that information.
• Tell you there is no supplier and that they will import the product for you.
In this case you have found a source of the product!
6. Look on Pro File
Pro File is a list of NHS manufactured products and who makes them. This
may help.
Longer Term Solutions (Cont)
7. Consider getting special made.
If you receive a request for a specialised pharmaceutical that is not generally
available it may be appropriate to consider commissioning a specials
manufacturer to manufacture you an unlicensed formulation. You will need
to have a good idea of the specification for the product (clinical papers may
help see below) but it may be that the manufacturer has a similar product
already. You will need to explain the legal consequences of using a special to
any prescribers and comply with trust policy on unlicensed medicines. You
should also consider cost here. Would a more “normal” alternative be as
good and avoid unnecessary cost and risk for the trust? A list of specials
manufacturers is in the Buyers Guide of the Chemist and Druggist Directory.
Longer Term Solutions (Cont)
8. Clinical Papers as a source.
Although very few clinical papers give a full specification of the medicines
used in the trial together with the source (if only!!), they may provide useful
information that can help source a product. Namely the company sponsoring
the trial, the hospitals involved together with the form and strength. It may
be that contacting either the pharmacy departments in the participating
hospitals or the manufacturer will give you a lead to a source.
9. Give in
It may be that you just can’t find a source and will have to go back to the
prescriber to discuss the issue further. This may lead to alternatives being
considered. If you are considering an expensive difficult or risky sourcing
operation than it may be appropriate to explain to clinicians what the risks
are as they may not have considered this.
Questions
1. When might it be appropriate to give an injection orally?
2. What is “Solutions” and how can it help in sourcing a product?
3. Why might manufacturers be reluctant to give exact details of how long their
product will be unavailable for?
4. What is the function of IDIS or Durbin and how can they help source a
product?
5. When should you go back to the prescriber with a sourcing problem?
Additional resources
Rarely Used Medicines List (RUM) on DIZone website www.dizone.nhs.uk
Solutions website www.uclhsolutions.com
Pro File
http://www.pro-file.nhs.uk/