East & South East England Specialist Pharmacy Services
East of England, London, South Central & South East Coast
Delivered and Deliverables
The Role of the National Advisory Board
Tim Root
Specialist Pharmacist
Clinical Governance & Technical Services
East & South East England Specialist Pharmacy Services
East of England, London, South Central & South East Coast
“Ask not what the NAB has done for you
but, rather, ask what you can do for the
NAB”
East & South East England Specialist Pharmacy Services
Background
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Modernisation Board & Programme 2003-7
£46m capital investment
NPSA Medication Safety Package
PaSA Purchasing for Safety initiative
National Advisory Board
Work Plan 2010-2011
Epidurals, potassium
Critical Care Drugs
IV Guide monographs
Dose banded cytotoxics
B.A.D dermatologicals
East & South East England Specialist Pharmacy Services
NAB membership
Medicines
Procurement
Devolved
Administrations
NHS Medicines
Manufacturing
NPSA
Director of
Specialised
Commissioning
Radio
Pharmacy
MHRA
SHA
PaSA/CMU
East & South East England Specialist Pharmacy Services
East of England, London, South Central & South East Coast
NAB functions
Oversight and coordination…
Configuration of an integrated national service
Collaboration to deliver priorities for manufacture,
preparation & use of UMPs
Raising awareness & advising on manufacture and
use of UMPs
East & South East England Specialist Pharmacy Services
East of England, London, South Central & South East Coast
NAB Terms of Reference
Capital Investment, revenue & Income management
Capacity & capability
Manpower & workforce
BP monographs
Inventory rationalisation & management
East & South East England Specialist Pharmacy Services
The NAB work programme
1. Rationalisation of cytotoxic chemo dose banding
products Burhan@zavery@nhs.net
2. Identification of priorities, development and sourcing
of safer “high-risk” injectable intensive care
medicines hazel.meakin@stockport.nhs.uk
3. Development & publication of monographs for
priority products susan.keeling@imperial.nhs.uk
4. New product specifications
5. National IV guide monographs
6. BP monographs
East & South East England Specialist Pharmacy Services
The NAB work programme
4. Standardisation of adult, paediatric & obstetric
epidural infusions for acute pain
clare.crowley@orh.nhs.uk
5. Promoting awareness of and compliance with the
BAD-preferred list of skin products sbath@nhs.net
East & South East England Specialist Pharmacy Services
Some (National) priority products
 Noradrenaline
 4,8,16mg in 50ml;
 8,16,32mg in 100ml
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Insulin: 50 units in 50ml
Phenylephrine 1mg in 10ml
Heparin 1000unit in 1ml
Amiodarone 300mg in 50ml; 900mg in 500ml
East & South East England Specialist Pharmacy Services
The importance of being rational
 Increases familiarity, reduces risks of error by all
 Reduces user training needs
 More users=less extemps = cost-effective manufacture of
Specials = more sales = more chance of a licensed product
 even pan-NHS-only products are no longer commercially
very attractive
• But…..
X Most doctors and nurses don’t get this!
East & South East England Specialist Pharmacy Services
Potassium acid Phosphate
9mmol in 500ml
Sodium chloride Injection
0.9%
Potassium acid Phosphate
10mmol in 250ml
Water for Injections
“The difference is clinically significant?”: discuss
East & South East England Specialist Pharmacy Services
NAB needs you
East & South East England Specialist Pharmacy Services
Where do NHS Medicines preparative
services fit in?
…..as a key part of a mixed economy
East & South East England Specialist Pharmacy Services
NHS role in medicines manufacturing
NHS is less good at high-use products & logistics
NHS capacity must be retained & protected for
Specific product types
Independent sector is well suited to high use,
long shelf-life etc
East & South East England Specialist Pharmacy Services
Opportunities
Hubs & NHS Commercial
Medicines Unit (= PaSA)
Market management
Quality management
New technology
Do we have the right tools?
Can we afford and exploit them?
Primary Care
Unmet need
IMPs
Unmet need
Dose banded cytos
Increase service capacity
Logistics partnerships
One-stop shop;
cross docking
Licensed PN bags
Could meet 40-80% of total
demand?
NHS Medicines manufacturing
Inc
East & South East England Specialist Pharmacy Services
Threats, risks, opportunities
Foundation Trusts and the financial climate
Are pharmacy technical services core NHS business?
Recruitment & Staffing
Competition
Tendering
Regulatory burden
Cost
East & South East England Specialist Pharmacy Services
Risk or opportunity?
Centralised labs
Validation & commissioning of
equipment, facilities
QA services
Stability data
formulation development
Pharmacovigilance
Label design
East & South East England Specialist Pharmacy Services
NHS collaborative working
Marketing &
Communications
Tendering/contracting
Patient Information
Shared Services
Pharmacovigilance
Pro-File/Formulary
Label design
East & South East England Specialist Pharmacy Services
The future
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Core Business
NHS must want it
2.
NHS Medicines Manufacturing Inc New Business Model
3.
Rationalisation of Products
Products: Local & national
product lists (formularies)
3.
Rationalisation of NHS Units
Fewer, bigger licensed units
batch manufacturing
Local (aseptic) units making
only what no-one else can
4.
Mixed economy
Work with hubs & independent
Pharma to manage the market
East & South East England Specialist Pharmacy Services
So what…?
….do we do next
East & South East England Specialist Pharmacy Services
Mix with the right people!
Talk & listen
Beware non-pharmacists bearing ideas!
Share information, ideas
Progress…..and business opportunities
Be patient!
Be transparent about potential
costs & prices in advance
Don’t make assumptions
East & South East England Specialist Pharmacy Services
We have to work at it…..
East & South East England Specialist Pharmacy Services
The National IV Guide?
• For more information…..
http://www.injguide.nhs.uk/docs/Frequently%20asked%
20Questions%20and%20answers%20May%202010.
pdf
East & South East England Specialist Pharmacy Services
Thanks to…..
• Fellow NAB members, Kevan Wind, Clare Crowley,
Susan Keeling, Mark Borthwick…..to name but a few