1. Opportunities in 2012 and Beyond The Way Forward Stuart Semple Director of Pharmacy and Medicines Management Barts Health NHS Trust

2. Specials – Chief Pharmacist View Secondary Care often seen as part of the problem Demand generated from specialist clinicians, e.g. paediatricians, dermatologists. Not necessarily ‘our’ problem, as ongoing costs are borne in primary care.

3. But can be part of the solution….. Elements of a Specials ‘Pathway’ Needs Assessment – clinical review. Prescribing of alternative intervention. Ethical Procurement. Quality Manufacturing. Delivery of Product to Patient.

4. Needs Assessment Is a special actually necessary? Could a licensed product be substituted? Could a different drug be prescribed? Link to a wider medication review MUR+ / NMS Full clinical pharmacist review Could be carried out by hospital or community pharmacists, in primary or secondary care locations.

5. Prescribing / Advice More pharmacists are prescribers and could action the intervention. GP could be advised on an intervention. Specialist clinical pharmacists / PWSI commonly run their own patient lists.

6. Ethical Procurement Is a specialism in its own right within secondary care Advice could be given to procuring community pharmacists Could be procured through tendered homecare schemes, including delivery to the patient

7. Quality in Manufacturing Secondary Care manufacturing units are increasingly competing in the specials market. Most are in a unique position due to close links to clinicians and patients. Taking products to license is an un-explored avenue. Capacity and capability are different from specials houses, so looking for lower volume, higher margin opportunities. Capacity/capability issues could be addressed through collaboration.

8. Commissioning of specials ‘Pathway’ Commissioned via acute trust / private provider – tariff-based. Commissioned via community pharmacist – LES. Delivered by GPs. Specials tariff has gone part-way to resolving the issues around cost, but not the demand.

9. Collaboration – a history Modernising NHS manufacturing – investment was predicated on an expectation of rationalising NHS units To date, has not happened in any meaningful way, due to units ?seeking to protect existing income streams in a landscape of budgetary pressures. NPSA 20 has not been fully implemented due to a difficulty in making the case to ‘move’ nursing resource into pharmacy manufacturing. Investment based on risk reduction is always more of a challenge

10. Collaborative Model – a vision Pan European supplier of specialist pharmaceutical products within 10 years Product range includes licensed pharmaceutical products, unlicensed products (Specials) and medical devices Major supplier of products for use in global clinical trials Significant innovation, research and product development focus delivering a new product pipeline Achieve financial returns of 30% EBITDA and 20% net profit

11. Collaborative Model – a strategy To grow the “Specials” business by increasing market share, broadening therapeutic ranges, expanding into new markets and introducing new products. To develop, licence, acquire and market a portfolio of branded licensed products. To utilise capacity and expertise for contract and clinical trials manufacturing for third parties. To acquire businesses which complement and support the strategic vision.

12. Collaborative Model-Market Opportunities Commercialisation of existing product supplies Expansion of product sales nationally Nursing homes PCT contracts for specials International growth Unmet clinical needs Clinical trials supplies and manufacturing contracts Licensing products and developing IP QA services

13. Collaborative Model-Operations Integrated pharmaceutical business with its own management structure. Deliver economies of scale. Streamline capability and capacity to maximise efficiency. Consolidate support functions. Establish a central base for support functions including a distribution centre. Operate multiple dedicated manufacturing units.

14. Collaborative Model-other aspects Management team Governance structure-board of directors Branding Sales and Marketing Capability