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 core aggressive Elective 20 % Non- elective 10 % Out-patients 40 % 55 % A & E 50 % 60 %

London SHA – the perfect storm ? Decommissioning core aggressive Elective 5 % 7 % Out-patients 10 % A & E 50 % 60 % Diagnostics 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: Much more for the same or 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 - KHP Quality Innovation Prevention Performance Excellence in Safety Outcome Patient experience Innovation Prevention Performance 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