QUALITY, INNOVATION, PRODUCTIVITY & PREVENTION (QIPP) Peter Rowe National Workstream Lead for Medicines & Procurement (Chief Executive, NHS Ashton Leigh and Wigan)

“Save twenty billion pounds!” – “you’re having a laugh?”

Sir David Nicholson, Chief Executive Officer, National Health Service “ We have had a welcome commitment to real terms growth for the NHS in each year of this Parliament. This may be less than we ’ re used to but is an excellent settlement compared to the rest of the public sector. ”

Andrew Lansley, Secretary of State – Priorities A patient-led NHS: the Coalition Agreement gives patients a voice through locally elected representatives sitting on PCT boards; patients will be able to choose any healthcare provider, including registering with any GP they want to; and patients will make more decisions about their own care. Delivering better health outcomes: patients will be able to rate hospitals according to the quality of care; and data about the performance of health care providers will be published online. A more autonomous and accountable system: GPs ’ powers will be strengthened, enabling them to commission care on a patient ’ s behalf; and doctors and nurses will have more freedom to use their professional judgement about what is right for their patients. Improved public health through a new public health delivery system: GPs will be given greater incentives to improve local primary care; and local communities will have greater influence over improving public health for their areas.

Andrew Lansley, Secretary of State – Priorities ….. continued A focus on reforming long-term care: an independent commission will be established to look at the funding of long-term care; elderly people will be helped to live at home for longer. The Government intends to establish a new independent NHS Commissioning Board, tasked with driving up quality of care for all patients, and delivering better value for the taxpayer. It will oversee NHS commissioning, with providers regulated by Monitor, which will become an economic regulator, and the Care Quality Commission (CQC) regulating quality.

Urgent and emergency care Primary care Technology and digital vision Procurement End of life care Productive care Back office functions Medicines Use and Procurement Clinical Support Services Right Care Safe Care Long Term Conditions National QIPP WORKSTREAMS

QIPP context Jim Easton (NHS Director – Improvement & Efficiency) The NHS faces an immediate short term funding issue but also a long term chronic financial problem. The team are working on the assumption that HS funding in cash terms will stay flat over the next 3 years. The strategy to deal with this is to focus on driving up quality whilst identifying £ bn of efficiency savings. Approximately half of the savings will be made through driving out waste( e.g. tightening up the way the NHS procures, changing the system of tariff and payment) and half will be delivered through the way the NHS provides care (e.g. moving care to cheaper settings). There is an expectation that reviewing the management of Long Term Conditions will save £ 3-5bn. It is recognised that the NHS had never driven change at this scale and that they journey would contain points of crisis and difficultly. A change in government would not change the financial situation the NHS faces.

Why a medicines workstream? After pay costs, medicines are the largest single item of healthcare spending. Making the best possible use of medicines will support strategic NHS objectives about care being provided in the most appropriate settings.

THE NATIONAL PROGRAMME - 3 WORKSTREAMS

PROJECT 1 - EFFICIENT MEDICINES USE IN PRIMARY CARE Provision of evidence on specific savings opportunities - National Prescribing Centre (NPC) document “The primary care prescribing contribution to QIPP” Re-publicise and then update NPC’s document – “What you need to know about prescribing, the ‘drugs bill’ and medicines management. A guide for all NHS managers. Expand existing set of Better Care Better Value (BCBV) indicators and review how they are presented with a specific focus on specials (i.e. specially prepared medicines) and nutritional supplements. Develop a programme of work to improve the way the NHS manages the prescribing of “ specials ” i) General awareness raising on prescribing “ specials ”. ii) Develop guidance targeting prescribers and commissioners highlighting how costly some “ specials ” are and how/when to consider them as an appropriate route iii) Make recommendations on any national/structural changes that may be required to minimise inappropriate use.

PROJECT 2 COMMISSIONING FOR EXCELLENCE IN MEDICINES MANAGEMENT Further develop World Class Commissioning capacity on medicines management: - Build on NPC’s ‘Commissioning for Integrated Medicines Management programme - Build on PCT local decision making work Develop resources to help PCT ’ s and NHS Trusts to work together to improve Medicines management in Secondary Care: i)Best practice advice for pharmacists working in secondary care including a “ Top ten tips ” document. ii)Develop good practice tool for medicines management in their assessment of competencies. Integrate NICE ’ s commissioning guides as appropriate and look to the NHS Evidence QIPP portal and WCC mechanisms to promulgate best practice. iii)Make optimum use of IT enhancements such as e-prescribing to support the programme.

PROJECT 2 COMMISSIONING FOR EXCELLENCE IN MEDICINES MANAGEMENT Continued ……. Align NHS Commercial Medicines Unit medicines procurement programme to QIPP

PROJECT 3 – SUPPORTING PATIENTS Improving outcomes from medicines Including reducing adverse drug events? Reducing unnecessary admissions due to inappropriate use of medicines (e.g. underuse of medicines) Self-care

WHAT HAPPENS NEXT? Final sign off by Department of Health Secretary of State to speak at NHS Confederation on Friday 25 th June 2010 – may choose to launch the QIPP programme Stakeholder engagement plan being developed Roll out via Strategic Health Authorities