1. QIPP – viewed from a Foundation Trust Tony West PDIG Committee Member Chief Pharmacist, Guy’s & St Thomas’ NHS Foundation Trust

2. The Background GSTFT - < £1 bn turnover Part of King’s Health Partners – KCH, SLaM & KCL.... £2 bn turnover 2/3 activity is ‘specialist’ care 1 million patient contacts per year No PFI build Viewed as ‘successful’... up until now!!!

3. London SHA – the perfect storm ? coreaggressive Elective 20 % Non- elective 10 % Out-patients 40 % 55 % A & E 50 % 60 % Shift to ‘lower cost’ setting

4. London SHA – the perfect storm ? Decommissioning coreaggressive Elective 5 % 7 % Out-patients 5 % 10 % A & E 50 % 60 % Diagnostics 10 % 15 %

5. Add in the national picture... ‘Growth’ at 0.1 % above GDP deflator Tariff – Zero growth in PbR tariff... so any growth funding for NHS will barely cover volume increase – Non-elective capped at 2008/09 activity, over activity only paid at 30 % – Looking to not pay anything for re-admissions – %age of tariff ‘withheld’ for quality... CQUINs

6. What does that mean ? CIP target for: – 2010 / 11 – 10% – 2011 / 12 – 5 - 10% – 2012 / 13 – 5 - 10% = Much more for the same or Same for much less or Less for an awful lot less

7. Which brings me nicely to medicines.. London SHA planning assumptions – ‘core’... £286 m savings by 2016/17 – ‘aggressive’.... £455 m savings GSTFT – £ 75 m.... > 10% of ‘clinical’ spend – 2/3 of which is PbR excluded... pass thru – Local PCTs looking for savings on above – PbR excluded medicines charged at acquisition cost... i.e. we add NO overhead – 2.5 % rise in VAT adds £1m extra cost

8. QIPP - KHP Quality – Safety – Outcome – Patient experience Innovation Prevention Performance Excellence in – Clinical care – Education & training – Research ( + application of research) Partners, whether NHS or Academia have to address financials

9. So... what can you do to help us ? Understand our, i.e. NHS, environment Cash will be tight... must recognise that – we cannot afford waste – we have to drive efficiency – we must get value for money NHS, patients and tax payers generally – we must not compromise quality Revolution rather than evolution ?

10. What doesn’t work for us ? Supply chain inefficiency – Out of stock – Short orders – Exceeding ‘quota’ – Packaging incompatible with our automation – Multiple coding – Lack of integration

11. What doesn’t work for us ? For the introduction of new medicines (which we DO want to see) – Duplication of effort... – Patient Access schemes – ‘Phoney’ orphan medicines – Blatant attempts to extend patent life while offering little or no value

12. What doesn’t work for us ? Lack of transparency – Homecare Valuable, but if don’t know what it actually costs how can we determine real ‘value for money’ ? Where a tied deal is with one provider.. what room for innovation and the use of ‘small businesses’ such as community pharmacists ? – VAT UK position unique in EU... it will get challenged Tax avoidance not a sound base for any business Do current initiatives offer the UK tax payer true value for money ?

13. The sad facts... UK has one of poorest access to new medicines for its citizens Patients still don’t get benefit from medicines they are prescribed... the adherence / concordance agenda Transfer of care still a major problem

14. The opportunities... NHS structural changes... high risk but right direction ‘Value based pricing’... the end of the UK being the ‘reference price’ ? Supply chain is inefficient.. there must be savings for all? Collaboration... possibly partnerships given the ‘any willing provider’ thrust of White Paper