QIPP –
viewed from a
Foundation Trust
Tony West
PDIG Committee Member
Chief Pharmacist,
Guy’s & St Thomas’ NHS Foundation Trust
The Background
• GSTFT - < £1 bn turnover
• Part of King’s Health Partners
– KCH, SLaM & KCL... . £2 bn turnover
•
•
•
•
2/3 activity is ‘specialist’ care
1 million patient contacts per year
No PFI build
Viewed as ‘successful’... up until now!!!
London SHA – the perfect storm ?
Shift to ‘lower cost’
setting
Elective
core
20 %
aggressive
20 %
Non- elective
Out-patients
A &E
10 %
40 %
50 %
10 %
55 %
60 %
London SHA – the perfect storm ?
Decommissioning
Elective
core
5%
aggressive
7%
Out-patients
A &E
Diagnostics
5%
50 %
10 %
10 %
60 %
15 %
Add in the national picture...
• ‘Growth’ at 0.1 % above GDP deflator
• Tariff
– Zero growth in PbR tariff... so any growth funding
for NHS will barely cover volume increase
– Non-elective capped at 2008/09 activity, over
activity only paid at 30 %
– Looking to not pay anything for re-admissions
– %age of tariff ‘withheld’ for quality... CQUINs
What does that mean ?
• CIP target for:
– 2010 / 11 – 10%
– 2011 / 12 – 5 - 10%
– 2012 / 13 – 5 - 10%
=
• Much more for the same or
• Same for much less or
• Less for an awful lot less
Which brings me nicely to medicines..
• London SHA planning assumptions
– ‘core’... £286 m savings by 2016/17
– ‘aggressive’.... £455 m savings
• GSTFT
– £ 75 m.... > 10% of ‘clinical’ spend
– 2/3 of which is PbR excluded... pass thru
– Local PCTs looking for savings on above
– PbR excluded medicines charged at acquisition
cost... i.e. we add NO overhead
– 2.5 % rise in VAT adds £1m extra cost
QIPP
• Quality
– Safety
– Outcome
– Patient experience
• Innovation
• Prevention
• Performance
-
KHP
• Excellence in
– Clinical care
– Education & training
– Research ( + application
of research)
• Partners, whether NHS
or Academia have to
address financials
So... what can you do to help us ?
• Understand our, i.e. NHS, environment
• Cash will be tight... must recognise that
– we cannot afford waste
– we have to drive efficiency
– we must get value for money
• NHS, patients and tax payers generally
– we must not compromise quality
• Revolution rather than evolution ?
What doesn’t work for us ?
• Supply chain inefficiency
– Out of stock
– Short orders
– Exceeding ‘quota’
– Packaging incompatible with our automation
– Multiple coding
– Lack of integration
What doesn’t work for us ?
• For the introduction of new medicines (which
we DO want to see)
– Duplication of effort...
– Patient Access schemes
– ‘Phoney’ orphan medicines
– Blatant attempts to extend patent life while
offering little or no value
What doesn’t work for us ?
• Lack of transparency
– Homecare
• Valuable, but if don’t know what it actually costs how
can we determine real ‘value for money’ ?
• Where a tied deal is with one provider.. what room for
innovation and the use of ‘small businesses’ such as
community pharmacists ?
– VAT
• UK position unique in EU... it will get challenged
• Tax avoidance not a sound base for any business
• Do current initiatives offer the UK tax payer true value
for money ?
The sad facts...
• UK has one of poorest access to new
medicines for its citizens
• Patients still don’t get benefit from medicines
they are prescribed... the adherence /
concordance agenda
• Transfer of care still a major problem
The opportunities...
• NHS structural changes... high risk but right direction
• ‘Value based pricing’... the end of the UK being the
‘reference price’ ?
• Supply chain is inefficient.. there must be savings for all?
• Collaboration... possibly partnerships given the ‘any
willing provider’ thrust of White Paper