QUALITY, INNOVATION, PRODUCTIVITY
&
PREVENTION (QIPP)
Peter Rowe
National Workstream Lead for Medicines & Procurement
(Chief Executive, NHS Ashton Leigh and Wigan)
“Save twenty billion pounds!”
–
“you’re having a laugh?”
Sir David Nicholson,
Chief Executive Officer,
National Health Service
“We have had a welcome commitment to real terms
growth for the NHS in each year of this Parliament.
This may be less than we’re used to but is an excellent
settlement compared to the rest of the public sector.”
Andrew Lansley, Secretary of State – Priorities
• A patient-led NHS: the Coalition Agreement gives patients a voice through
locally elected representatives sitting on PCT boards; patients will be able
to choose any healthcare provider, including registering with any GP they
want to; and patients will make more decisions about their own care.
• Delivering better health outcomes: patients will be able to rate hospitals
according to the quality of care; and data about the performance of health
care providers will be published online.
• A more autonomous and accountable system: GPs’ powers will be
strengthened, enabling them to commission care on a patient’s behalf;
and doctors and nurses will have more freedom to use their professional
judgement about what is right for their patients.
• Improved public health through a new public health delivery system:
GPs will be given greater incentives to improve local primary care;
and local communities will have greater influence over improving public
health for their areas.
Andrew Lansley, Secretary of State – Priorities
…..continued
• A focus on reforming long-term care: an independent commission will be
established to look at the funding of long-term care; elderly people will be
helped to live at home for longer.
The Government intends to establish a new independent NHS Commissioning
Board, tasked with driving up quality of care for all patients, and delivering better
value for the taxpayer. It will oversee NHS commissioning, with providers regulated
by Monitor, which will become an economic regulator, and the Care Quality
Commission (CQC) regulating quality.
National QIPP WORKSTREAMS
Urgent and emergency care
Primary care
Technology and digital vision
Procurement
End of life care
Productive care
Back office functions
Medicines Use and Procurement
Clinical Support Services
Right Care
Safe Care
Long Term Conditions
QIPP context
Jim Easton (NHS Director – Improvement & Efficiency)
The NHS faces an immediate short term funding issue but also a long term chronic
financial problem. The team are working on the assumption that HS funding in cash
terms will stay flat over the next 3 years.
The strategy to deal with this is to focus on driving up quality whilst identifying £1520bn of efficiency savings. Approximately half of the savings will be made through
driving out waste( e.g. tightening up the way the NHS procures, changing the system of
tariff and payment) and half will be delivered through the way the NHS provides care
(e.g. moving care to cheaper settings). There is an expectation that reviewing the
management of Long Term Conditions will save £3-5bn.
It is recognised that the NHS had never driven change at this scale and that they
journey would contain points of crisis and difficultly. A change in government would
not change the financial situation the NHS faces.
Why a medicines workstream?
• After pay costs, medicines are the largest single item of healthcare
spending.
• Making the best possible use of medicines will support strategic
NHS objectives about care being provided in the most appropriate
settings.
THE NATIONAL PROGRAMME
3 WORKSTREAMS
PROJECT 1 - EFFICIENT MEDICINES USE IN PRIMARY CARE
Provision of evidence on specific savings opportunities - National Prescribing Centre
(NPC) document “The primary care prescribing contribution to QIPP”
Re-publicise and then update NPC’s document – “What you need to know about
prescribing, the ‘drugs bill’ and medicines management. A guide for all NHS
managers.
Expand existing set of Better Care Better Value (BCBV) indicators and review how
they are presented with a specific focus on specials (i.e. specially prepared
medicines) and nutritional supplements.
Develop a programme of work to improve the way the NHS manages the
prescribing of “specials”
i) General awareness raising on prescribing “specials”.
ii) Develop guidance targeting prescribers and commissioners
highlighting how costly some “specials” are and how/when to
consider them as an appropriate route
iii) Make recommendations on any national/structural changes that may be
required to minimise inappropriate use.
PROJECT 2
COMMISSIONING FOR EXCELLENCE IN MEDICINES MANAGEMENT
Further develop World Class Commissioning capacity on medicines management:
- Build on NPC’s ‘Commissioning for Integrated Medicines Management
programme
- Build on PCT local decision making work
Develop resources to help PCT’s and NHS Trusts to work together to improve
Medicines management in Secondary Care:
i)
Best practice advice for pharmacists working in secondary care including
a “Top ten tips” document.
ii)
Develop good practice tool for medicines management in their assessment of
competencies. Integrate NICE’s commissioning guides
as appropriate and look to the NHS Evidence QIPP portal and WCC mechanisms
to promulgate best practice.
iii)
Make optimum use of IT enhancements such as e-prescribing to support the
programme.
PROJECT 2
COMMISSIONING FOR EXCELLENCE IN MEDICINES MANAGEMENT
Continued…….
Align NHS Commercial Medicines Unit medicines procurement programme
to QIPP
PROJECT 3 – SUPPORTING PATIENTS
Improving outcomes from medicines
•
Including reducing adverse drug events?
•
Reducing unnecessary admissions due to inappropriate use of
medicines (e.g. underuse of medicines)
•
Self-care
WHAT HAPPENS NEXT?
•
Final sign off by Department of Health
•
Secretary of State to speak at NHS Confederation on Friday
25th June 2010 – may choose to launch the QIPP programme
•
Stakeholder engagement plan being developed
•
Roll out via Strategic Health Authorities