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
HIGHER
QUALITY
PATIENT
CENTRED
Greater Demand
Greater expectations
MORE
EFFICIENT
IMPROVED
SAFETY
• 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 Innovation
Being ahead of the game
Sharing best practice
Innovative procurement programmes
Maximise clinical engagement
New Cancer Drug Fund
PPRS and value based pricing
So where does this agenda
sit in the NHS… ?
National Committees/Groups
Specialist Support
NHS CMU Pharmacy
Non-Executive Board
Commercial
Support
Units ???
National
Pharmaceutical
Supply Group
Pharmaceutical
Market Support
Group
National Homecare Medicines Committee
Pharmacy Business Technology Group
Generic Medicines Sub-Group
Branded Medicines Sub-Group
Transitional Products Sub-Group
Specialist Medicines Sub-Group
NHS
Commercial
Medicines
Unit
NHS
Pharmacists
(Procurement,
QA, Production,
Medicines
Information
and Clinical)
Procurement Groups
Trusts/PCTs
NHS Trusts
& PCT
Pharmacy
Networks
6 x Regional
SCEP Groups
Generic Medicines
SHA Pharmacy
Procurement Groups
Branded Medicines
Therapeutic
Rationalisation
QIPP
Clinicians
Clinical
Networks
PCT
Commissioners
Specialised
Commissioners
• 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
• 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)
• 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
Primary Care
Secondary Care
£12,000
£10,000
£8,000
£6,000
£4,000
£2,000
£0
Jul-05
Data Source: IMS
Jul-06
Jul-07
Jul-08
Jul-09
Jul-10
Proj.
Jul-11
Proj.
Jul-12
Proj.
Jul-13
Proj.
Jul-14
Proj.
Yorkshire and Humber SHA – Medicines
and Procurement QIPP Programme
Quality: CQUIN Targets, Quality
Observatory
Primary Care
e.g. BCBV, Prescribing
Initiatives, NPC, Waste
Secondary care
Collaborative
Procurement, BCBV,
Benchmarking, SHA Top
500 / spend, Top Tips
Safety: NPSA,
PSF, Learning
from Events
Mental Health
Prescribing initiatives,
BCBV, Top Tips
• 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
National
NPSG Profile
Coherent Strategy
Focus on delivery
Regional
Plurality of provision – new players in the
market
Maximise collaboration
Local
Concern that back office function review could have negative
impact
Use medicines procurement to support medicines optimisation
agenda locally
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 environment
 Making sense of the NHS reforms /
environment
 Dialogue with CPhO and CMU Board re
direction
 Continue to influence policy makers at
DH e.g.
 Medicines optimisation
 Branded Medicines Strategy / effective
medicines contracting (incl national
 Continued engagement with QIPP
Agenda
 Support Medicines Optimisation Agenda
 Support Medicines Safety Agenda
 Continue medicines efficiencies
 Personalised medicines agenda
 Pharmaceutical Supply Chain Review ?
 Supply chain options
 Distribution models (inc homecare,
outsourcing, links with community)
 Shortages
 Access and Affordability of New Medicines
 Managing shortages
 Commissioning decisions
 PPRS
Value Based Pricing
 Cancer 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 game
 We should not be defensive
 We should continue to deliver on what we are
good at
 VFM
 Quality
 Safety
 We should make the most of the
• 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