East & South East England Specialist Pharmacy Services East of England, London, South Central & South East Coast Delivered and Deliverables The Role of the National Advisory Board Tim Root Specialist Pharmacist Clinical Governance & Technical Services

East & South East England Specialist Pharmacy Services East of England, London, South Central & South East Coast “Ask not what the NAB has done for you but, rather, ask what you can do for the NAB”

East & South East England Specialist Pharmacy Services Background  Modernisation Board & Programme  £46m capital investment  NPSA Medication Safety Package  PaSA Purchasing for Safety initiative  National Advisory Board Epidurals, potassiumCritical Care Drugs IV Guide monographsDose banded cytotoxicsB.A.D dermatologicals Work Plan

East & South East England Specialist Pharmacy Services NAB membership Director of Specialised Commissioning Medicines Procurement NPSAMHRASHAPaSA/CMU Radio Pharmacy NHS Medicines Manufacturing Devolved Administrations

East & South East England Specialist Pharmacy Services East of England, London, South Central & South East Coast Oversight and coordination… Configuration of an integrated national service Collaboration to deliver priorities for manufacture, preparation & use of UMPs Collaboration to deliver priorities for manufacture, preparation & use of UMPs Raising awareness & advising on manufacture and use of UMPs Raising awareness & advising on manufacture and use of UMPs NAB functions

East & South East England Specialist Pharmacy Services East of England, London, South Central & South East Coast NAB Terms of Reference Capital Investment, revenue & Income management Capacity & capability Manpower & workforce BP monographs Inventory rationalisation & management

East & South East England Specialist Pharmacy Services The NAB work programme 1.Rationalisation of cytotoxic chemo dose banding products 2.Identification of priorities, development and sourcing of safer “high-risk” injectable intensive care medicines 3.Development & publication of monographs for priority products 4.New product specifications 5.National IV guide monographs 6.BP monographs

East & South East England Specialist Pharmacy Services The NAB work programme 4.Standardisation of adult, paediatric & obstetric epidural infusions for acute pain 5.Promoting awareness of and compliance with the BAD-preferred list of skin products

East & South East England Specialist Pharmacy Services Some (National) priority products Noradrenaline 4,8,16mg in 50ml; 8,16,32mg in 100ml Insulin: 50 units in 50ml Phenylephrine 1mg in 10ml Heparin 1000unit in 1ml Amiodarone 300mg in 50ml; 900mg in 500ml

East & South East England Specialist Pharmacy Services The importance of being rational Increases familiarity, reduces risks of error by all Reduces user training needs More users=less extemps = cost-effective manufacture of Specials = more sales = more chance of a licensed product even pan-NHS-only products are no longer commercially very attractive But….. XMost doctors and nurses don’t get this!

East & South East England Specialist Pharmacy Services Potassium acid Phosphate 9mmol in 500ml Sodium chloride Injection 0.9% Potassium acid Phosphate 10mmol in 250ml Water for Injections “The difference is clinically significant?”: discuss

East & South East England Specialist Pharmacy Services NAB needs you

East & South East England Specialist Pharmacy Services Where do NHS Medicines preparative services fit in? …..as a key part of a mixed economy

East & South East England Specialist Pharmacy Services NHS role in medicines manufacturing NHS is less good at high-use products & logistics NHS capacity must be retained & protected for Specific product types NHS capacity must be retained & protected for Specific product types Independent sector is well suited to high use, long shelf-life etc Independent sector is well suited to high use, long shelf-life etc

East & South East England Specialist Pharmacy Services Opportunities Hubs & NHS Commercial Medicines Unit (= PaSA) Market management Quality management New technology Do we have the right tools? Can we afford and exploit them? Primary Care Unmet need IMPs Unmet need Dose banded cytos Increase service capacity Logistics partnerships One-stop shop; cross docking Licensed PN bags Could meet 40-80% of total demand? NHS Medicines manufacturing Inc

East & South East England Specialist Pharmacy Services Threats, risks, opportunities Foundation Trusts and the financial climate Are pharmacy technical services core NHS business? Foundation Trusts and the financial climate Are pharmacy technical services core NHS business? Recruitment & Staffing Competition Tendering Regulatory burden Cost

East & South East England Specialist Pharmacy Services Risk or opportunity? QA services Stability data formulation development Stability data formulation development Centralised labs Validation & commissioning of equipment, facilities Validation & commissioning of equipment, facilities Pharmacovigilance Label design

East & South East England Specialist Pharmacy Services NHS collaborative working Shared Services Marketing & Communications Tendering/contracting Patient Information Label design Pharmacovigilance Pro-File/Formulary

East & South East England Specialist Pharmacy Services The future 1. Core BusinessNHS must want it 2. NHS Medicines Manufacturing Inc New Business Model 3. Rationalisation of ProductsProducts: Local & national product lists (formularies) 3. Rationalisation of NHS UnitsFewer, bigger licensed units batch manufacturing Local (aseptic) units making only what no-one else can 4.Mixed economy Work with hubs & independent Pharma to manage the market

East & South East England Specialist Pharmacy Services So what…? …. do we do next

East & South East England Specialist Pharmacy Services Mix with the right people! Talk & listen Share information, ideas Progress…..and business opportunities Be patient! Be transparent about potential costs & prices in advance Don’t make assumptions Beware non-pharmacists bearing ideas!

East & South East England Specialist Pharmacy Services We have to work at it…..

East & South East England Specialist Pharmacy Services The National IV Guide? For more information… Questions%20and%20answers%20May% pdf

East & South East England Specialist Pharmacy Services Thanks to….. Fellow NAB members, Kevan Wind, Clare Crowley, Susan Keeling, Mark Borthwick…..to name but a few