This event has been accredited by the College of Pharmacy Practice against the Royal Pharmaceutical Society's CPD competency framework.

Allan Karr, MRPharmS, DipM, MBA. Chairman, National Homecare Medicines Committee Update What is happening in the medicines homecare market? Allan Karr, MRPharmS, DipM, MBA. Chairman, National Homecare Medicines Committee

Medicine Homecare Services Support patients with chronic and acute illnesses in the community. Aim is to :

Medicines Supply Chain Hospital pharmacy Production unit R&D Manufacturer Original patent holder Specials Manufacturer Generic Supplier PI Supplier Patient Production unit Community pharmacy Dispensing doctor Ward MEDICINES MANAGEMENT EMEA MHRA EMEA MHRA Distributor & Wholesaler Homecare delivery service Production unit

Homecare Service Process Consider product and type of service – obtain approval e.g. DTC, PCTs Methodology for recruiting/registering patients Prescription process e.g. clinical check, chasing Rx Agree performance standards with provider Contract with Homecare services provider Communication process between all parties Invoice and Payment Monitor and audit performance Home care company can then provide the service e.g. purchase, dispense, deliver and administer medicines. General/Value added e.g. Collection of waste, education and support. Data management, Training, Clinical Governance & Audit

Risk Management Potential Increasing value added service Delivery Process Nurse Administration Increasing Risk & Increasing Cost & Increasing Complexity Dispensing Process Delivery Process Dispensing Process Delivery Process Dispensing Process Nurse Administration Preparation Aseptic

Existing Therapeutic Areas Cardiology Oncology Cystic fibrosis Dermatology Gastroenterology Haematology Haemophilia HIV Hypopituitarism Lyposomal storage disorders Multiple Sclerosis Post-menopausal Osteoporosis Primary Immunodeficiency Disease Renal dialysis and transplant Schizophrenia Respiratory disease Rheumatoid arthritis Rheumatology Thalassaemia

Current medicinal products that have been supplied via Homecare Services Home parental nutrition IVF Treatments Adult growth hormone Milrinone Trastuzumab Epoetin Anitbiotics Etanercept Efalizumam Methotrexate Adalimumab Imiglucerase Epoetin Blood coagulation factor VIII & IX Anti-retrovirals Somatropin (human growth hormone) Desferrioxamine Interferon Beta-interferon Topotecan Teraparatide IV/SC immunoglobulin Darbepoetin Immunosuppressants for renal transplant Clozapine Terbutaline Adalimumab Infliximab Teraparatide Methotrexate Desferrioxamine Herceptin

Market Size & Growth

Current List of Homecare Providers DHL Medco Baxter/Willow Mawdsley BrooksPolarspeedBupa/Clinovia Nutricia Clinical CareIntecare Evolution (AAH/Celesio) Health Care at Home/ADS Flexible Home Care Central Home Care (Alliance Unichem) CareologyCalea UkAir products

What are the benefits of Medicines Homecare Policy Capacity Efficiency Control Patient choice Financial Primary care Capacity gains Reduces stress in the dispensary Refocuses skill mix and clinical priorities Reduced waiting times for non-home care patients. Pharmacy Increased choice Time saving - no waiting in OPD Reduced travel Convenience Quality of life – less hassle Less risk of HCAI Patient Discharge patients sooner Reduce non-essential OPD appointments & admissions Moves workload from dispensary to administration Reduced waiting times Financial? Organisation

Benefits/Drivers Pharma Industry Perspective Company is closer to the patient. Increase opportunity for DTC marketing? Fewer control systems? Ability to offer reduced prices to customers without loss of profit e.g. part of NICE patient access scheme process. More control over the supply chain

The Procurement Framework and Contracting Models 1. Host Trust Tender Model Trust selects the service Specification developed and tendered Trusts selects a preferred provider 2. Pharma Company Model Pharma tender or selection New distribution route No NHS involvement

Models of Distribution Tendering Relationship? No Tendering Tendering Relationship? No Tendering Hospitals/ PCTs/CPHs Homecare Supplies Pharmaceutical Manufacturers Hospitals/ PCTs/CPHs Homecare Supplies Pharmaceutical Manufacturers

The Governance and Quality Issues - with outsourcing comes risk Absence of inventory from trust perspective People as part of the service Greater involvement of customers Greater difficulties in maintaining quality standards Importance of time factor Services are not the same as products e.g.

The Governance and Quality Issues - with outsourcing comes risk Prescription checking and validation Aseptic preparation and administration Technical and clinical advice Responsibilities and liabilities of each party Performance standards Error and complaint monitoring

The Clinical Governance Framework Risk management e.g. assessment and risk reduction techniques Establishment of quality systems and performance standards Inclusion in Trust Clinical Governance procedures Must have a clear contractual relationship between purchaser & provider

What are the Outstanding Issues? NHS strategy e.g. private sector, do-it- yourself (OPAT), FP10(HP)? Confirmation/clarity on VAT position Agreed product list for home care Ensure adherence to professional practice & Clinical Governance. Operational systems need improving e.g. employing home care co-ordinators, electronic links with home care suppliers. Data management

What are the Outstanding Issues? Clarification of PCT/GP/Commissioners role Fit in new financial structure e.g.Tariffs, Financial resources Relationship between manufacturer, home care service provider and Trusts Managing a contracted service effectively Development and use of common contracts Development of performance standards & audit arrangements? Unbundling of costs from products

What are the Outstanding Issues? What will be the impact of new home care services suppliers Recognition that the home care market exists and is becoming more important

Role of the National medicines Homecare Committee Hospitals/PCTs/CPHs Pharmaceutical Manufacturers Home Care Supplies NHMC role Effective Working Relationships

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