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 MORE EFFICIENT IMPROVED SAFETY PATIENT CENTRED Greater Demand Greater expectations

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… ?

NHS CMU Pharmacy Non-Executive Board National Pharmaceutical Supply Group SHA Pharmacy Procurement Groups Branded Medicines Therapeutic Rationalisation QIPP 6 x Regional SCEP Groups Generic Medicines NHS Pharmacists (Procurement, QA, Production, Medicines Information and Clinical) NHS Commercial Medicines Unit NHS Trusts & PCT Pharmacy Networks Clinicians Clinical Networks PCT Commissioners Specialised Commissioners National Committees/Groups Specialist Support Procurement Groups Trusts/PCTs Commercial Support Units ??? 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

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 being directly influenced by the national NHS policy drive

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) Carol Farrow (East of England) 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 –Flat “growth” in primary care

Data Source: IMS

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 contracting) Value Based Pricing Homecare Engagement with NHS Commissioning Board

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 Emergency Preparedness E.g. Flu

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 opportunities, if we don’t others will

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 objectives