1. A Hospital without a Pharmacy - building a first class pharmacy service Anne Cope Associate Director of Pharmacy University Hospital Birmingham NHS Foundation Trust

2. Introduction Strategic context Medicines Management Workforce redesign New Hospital Decentralised pharmacy service Challenges ahead Summary

3. Strategic context Commissioning a patient led NHS Choice, access and responsiveness National programme for IT – Connecting for Health Our Health, Our Care, Our Say Shifting the balance of power Foundation Trusts Payment by Results Cost Improvement Programmes

4. Strategic context – medicines management Medicines Management Framework A Vision for Pharmacy Building a Safer NHS for Patients Standards for Better Health Choosing Health through Pharmacy The Best Medicine

5. Medicines Management Healthcare Commission Acute Hospital Portfolio – The Best Medicine Mental Health Linked to Annual Health Check Patient focus Clinical focus Efficiency and capability Benchmarking

6. Changes to Pharmacy Workforce Prescribing roles Consultant Pharmacists Skill-mix changes Pharmacists with a Special Interest

7. What do patients want The best from their medicines Safe passage Information Flexibility And FAST !

8. About UHB Currently two sites –Queen Elizabeth (1938) and Selly Oak (1897) £357m annual income ~1200 beds 500,000 patient contacts per year 6,700 employees Foundation Trust since June 2004 Broad range of specialties Royal Centre for Defence Medicine R&D centre

9. Pharmacy and medicines at UHB 135 staff £35M pa on medicines UHB Medicines “lead manufacturing unit” Some “ward based pharmacy” services Electronic prescribing (PICS) Strong support within Trust for leadership and modernisation Rating of “Fair” for Medicines Management in Acute Hospital Portfolio

10. Why have a hospital without a pharmacy Deliver a high quality, patient focused service, through safe, clinical and cost effective use of medicines Make the best use of the skills of the pharmacy team, within a multidisciplinary environment Develop and utilise innovative technology to gain efficiencies and free up staff Work collaboratively with patients and all partners, including the local health community and the private sector

11. New Hospital Overview

17. How do we plan to deliver an effective medicines supply chain? Decentralised automation and pharmacy service Linked with e-prescribing and administration Supplier delivery direct to automation? Joint venture with private sector Contingency Plan

18. Working with commercial partners The 4 tests: Is it in the interest of patients? Is it consistent with local/national strategies? Is it VFM? Is it consistent with public sector values?

19. Current Patient Journey

20. In-Patient Supply New Hospital Medication prescribed electronically Professionally checked by pharmacist and supply authorised if needed Medication collected from automation module

21. Out-Patient Supply New Hospital Options: Automated “in house” pharmacy in New Hospital Private sector run pharmacy Electronic transmission of prescriptions (ETP) to private sector supplier Homecare services

22. Pharmacy Stores Options: Some retained stores function Direct delivery by supply partner to clinical area or automation units UHB Warehouse -WDL

23. Challenges: decentralised pharmacy service Selling the vision Ward based pharmacy/medicines management team Patients own medication/ self administration/ dispensing for discharge Role of clinical specialists Corporate/Clinical Governance Short timescale Supply chain issues

24. Challenges: Supply chain issues Availability of products through a single supplier Ensuring Value for Money Prescribers and key stakeholders as integral part of decision making Response to emergencies Non robot inventory Medicines governance arrangements: -JIT - notification of shortages -interchangeability of products -potential for medication errors -critical medicines – stock holding -cold chain maintenance

25. Where are we now? Competitive Dialogue Procurement Process OEJU issued Jan 2007 followed by PPQ and Information Memo in Feb 2007 Divided into Lots 1 and 2 ITD1 bidders responses received and currently under evaluation ITD2 documentation being prepared

26. Next Steps Notify bidders of outcome of ITD1 Issue ITD2 (probably end of July) Evaluate ITD2 bidder responses Undertake face to face dialogue with bidders Issue ITT documentation Plan SOH pilot Contingency plan

27. Summary NHS continues to undergo significant transition. Changing the existing pharmacy delivery model will be challenging. This will require a resilient corporate and clinical governance framework to ensure delivery of optimal organisational and patient benefits.