NHS England High Cost Drug Minimum Dataset (MDS) Digital Medicines and Hospital Pharmacy Transformation Plans Events October/ November 2016 Malcolm Qualie/Suzy Heafield

High Cost Drug Data Improvement Why is this a priority? “NHS England does not have the information it needs to drive service improvements in specialised services.” “For services, including high-cost drugs and devices, there are no consistent national data available.” “NHS England does not have the information—on costs, access and outcomes —necessary to assess how to improve services.” “The lack of consistent data means NHS England does not know whether it is meeting its objectives in improving patient outcomes and reducing inequalities across geographic areas”.

Carter Review – HPTP Plans Recommendation 3d) “Each Trust’s Finance Director, working with their Chief Pharmacist, ensuring that coding of medicines, particularly high cost drugs, is accurately recorded within NHS Reference Costs.” From a Trust perspective one of the highest priorities is to implement the recommendations made by the Carter Review with NHS Improvement having a mandate to ensure the review is fully implemented across all Trusts The recommendations include: working closely with neighbouring Trusts to improve efficiency and reduce costs Pharmacy and medicines optimisation has been identified as the area with the 2nd highest potential for efficiency savings with an estimated minimum opportunity of £0.8b over 3 years. To reflect this each Trust must develop a hospital pharmacy transformation programme (HPTP) plan which need to be in place by April 2017

NHS England Specialised Services Commissioning Intentions 2017-2019 “Provision of nationally defined datasets is a condition of reimbursement and accurate, patient-level itemised high cost drug expenditure is an immediate priority” “Trusts will be required to provide dm+d drug codes as part of the MDS which aligns with the requirement for Trusts and system suppliers to implement the dm+d information standard by June 2017” “Dashboards will be developed to monitor MDS data quality from each provider and these will be published on the NHS Improvement Model Hospital portal”

Current MDS https://www.england.nhs.uk/wp-content/uploads/2016/08/drugs-tax-mds-1617.xlsx Highlighted are all Key fields to conduct basic drug validation

MDS Compliance at Month 5 Provider Outcome is based on the 10 critical fields Provider Outcome Definition of Outcome Number of Trusts Pass 9 or more fields ≥ 90% accuracy 54 Borderline 8 fields >90% accuracy with 1 field achieving between 80% and 89% 23 Fail Criteria for Pass or Borderline has not been achieved. 71

How Is Poor Compliance Being Addressed?

Contractual Mechanisms If Trust has signed up to full completion of MDS and is not providing full dataset then Information Breach Notice will be issued – may lead to financial penalties If Trust has signed up to Data Quality Improvement Plan (DQIP) the Trust will be monitored against that plan 2017/19 Contract: Trusts will receive CQUIN monies to adopt dm+d code within agreed timescales

Other Work Ongoing work with Pharmacy System Suppliers Enable use of dm+d codes Development of standardised reports to feed MDS Work with NHSi Development of drugs MDS dashboards to be published on Model Hospital website Identification of outliers Ensure NHSE drugs MDS is aligned with other drug data requirements (intraoperability) Work with NHS Digital Understand where dm+d codes do not exist and develop solutions Development of Information Standard for NHSE drugs MDS which can also be applied to other commissioners

Next Steps Include dm+d requirement and NHS England drugs MDS in HPTP plans Work with contract, finance and informatics teams to understand implications of MO CQUIN, i.e. current position and requirements to meet triggers Review Model Hospital dashboard to identify Trusts who are compliant with requirements Speak to Pharmacy Systems Suppliers about dm+d implementation and standard reports

Any Questions?

Why are these fields important to commissioners? Data Item Example Purpose Justification Month/year DD/MM/YYYY To identify the relevant month and year at the point of payment To identify activity per month/year upon receipt of data Create date Date of data creation Date and time that will be used to ascertain the latest version of the dataset submitted. Required to ensure correct version used Organisation code (provider) ODS code of provider submitting invoice related to backing data To identify who requires reimbursement for the treatment already provided. Required to match activity, to provider and ensure payment Organisation code (commissioner) ODS code of commissioner To identify responsible commissioner NHS England Commissioned Service Category SS, AF, HJ The NHS England Service Category Code should be derived with reference to the published hierarchy for assigning NHS England-commissioned services To identify appropriate NHS England-commissioned service

Data Item Example Purpose Justification NHS Number   The unique identifier for the patient Needed to determine if the individual is the responsibility of the commissioner and to determine whether patient has received correct number of treatments Local Patient Identifier Local patient identifier To ensure any issue or payment is attributed to the same patient To identify the individual to the healthcare provider. Particularly as NHS Number is not always known Person Birth Date Date of birth To identify patient age Needed to determine if the individual is the responsibility of the commissioner. Where applicable required to confirm policy compliance Where appropriate used for validation purposes eg child in adult specialty Postcode of Usual Address To identify usual residence This is required for identifying the usual residence of patients General Medical Practice Code (Patient Registration) SUS Derived Practice To ensure that the appropriate commissioner is identified. This identifies the approximate location of the patient and the fact they are in receipt of medical care. Identifying the relevant practice helps to determine the relevant commissioner. Required to map specialised services to CCG geographies for collaborative commissioning purposes.

Data Item Example Purpose Justification Hospital Provider Spell Number/ Outpatient Attendance Identifier Hospital Provider Spell Number/AE or OP Attendance identifier unique within Provider for the patient event   To ensure that spell number can be linked to drug administration To allow validation between spell number and drug administration Specialised Service Code NCBPS01c To identify the treatment and source of the invoice, to facilitate any challenges Describes service or location to identify point of challenge Where applicable required to confirm policy compliance Service line reporting nationally Issue type Inpatient (Via Internal Pharmacy) To determine dispensing route for medication To distinguish between different dispensing routes Drug Delivery Date Administration date for IP Admissions; Prescription Date for OP. To ensure that drug delivery can be linked with patient spell Therapeutic Indication Hepatitis C Indication for treatment Describes indication for treatment to identify point of challenge, particularly for drugs with multiple commissioners Activity Treatment Function Code 370 Proxy for indication in Trusts without electronic prescribing. Drug Code 386919002 To identify the prescribed drug or help commissioner confirm that the invoice payment is appropriate. To identify commissioner (for example, those determined by NICE Guidelines) and whether prescription is justified or a non-brand alternative is available. Note codes mandated from June 2017- see link http://www.nhsbsa.nhs.uk/PrescriptionServices/4906.aspx.

Data Item Example Purpose Justification Drug name BNF name To identify the prescribed drug or help commissioner confirm that the invoice payment is appropriate. To identify commissioner (for example, those determined by NICE Guidelines) and whether prescription is justified or a non-brand alternative is available. Drug Mode of Delivery ORAL Details should be inserted when the drug code is not given Strength 100mg Volume 100ml To identify commissioner (for example, those determined by NICE Guidelines) and whether prescription is justified or a non-brand alternative is available. Complete if a liquid delivery, else leave blank. Pack Size 28 Quantity 56 This may be packs size X pack, the quantity of drug given (when pack size and no. of packs is not relevant) or the weight of the drug (ensuring unit of measurement is also given) To determine quantity issued

Data Item Example Purpose Justification Supplier Unit Price £ Unit price paid to supplier To identify price paid by Trust with no on-costs Commissioner Unit Price Unit price charged to commissioner to include agreed on costs Allows commissioners to easily identify what charges relate to the drug and what relate to the on-cost for that drug Home Delivery Charge Charge for home delivery Allows commissioners to easily identify what charges relate to the drug and what relate to the home delivery charge for that drug VAT charged Yes/no To determine if VAT has been applied to charges The price charged to NHS England should include VAT only for medicines dispensed via Trust internal pharmacies. The price charged for medicines dispensed via outsourced/ subsidiary pharmacies or homecare, should exclude VAT, i.e. NHS England should only be charged the net cost of the drug