1. What are the challenges of successfully implementing homecare?
Phil Deady, Pharmacy Procurement Manager
Leeds Teaching Hospitals NHS Trust &
Yorkshire and Humber NHS Pharmaceuticals Purchasing Consortia

2. Plan of session
Leeds Teaching Hospitals’ homecare medicines management services
Homecare service development: tasks and challenges
The Leeds team approach to homecare

3. LTH homecare medicines management services
First homecare patient early 1980’s
All homecare medicines handled through Pharmacy except medicinal blood products
3,300 active patients 07/08
Total spend 07/08 £12.6M (21% of total medicine spend £59.1M)
23 different homecare therapies
Five homecare companies

4. LTH homecare Top 10 by spend 07/08
1. Etanercept
2. Medicines for HIV/AIDS
3. Medicines for Multiple Sclerosis
4. Intravenous antibiotics for Cystic Fibrosis
5. Parenteral Nutrition
6. Adalimumab
7. Immunoglobulins
8. Imatanib
9. Erythropoietins
10. Liver transplant medicines

6. Homecare service development: suggested model
PATIENT/CARER

7. Homecare Medicines Management Strategy
Define homecare medicines management services
Proposed direction and scope for homecare
Reference national policy and guidance
Propose systems and processes for developing homecare services
Define key stakeholders
Summarise benefits and risks
Propose methods to identify homecare opportunities
Propose methods of tendering and ongoing management of homecare services

8. Horizon scanning
Specialist pharmacists routinely do horizon scanning for medicines due for launch to the UK market
Need to horizon scan for new medicines that will be launched with homecare services included
Need to horizon scan for new medicines with the potential for homecare services
Start discussions with commissioners on new medicines homecare services at this point?

9. Homecare service proposals
Ideas can come from specialist pharmacists, nurses, clinicians, patients/carers (reactive)
Proposals also come from homecare companies
LTH procurement homecare team do an annual review to identify potentially advantageous homecare services (pro-active)
LTH procurement staff use a “Homecare Medicines Submission Form” to gather and analyse information on homecare service proposals

10. Homecare service proposals
“Homecare Medicines Submission Form”
Product information
Drug(s) for consideration
Which disease(s)?
What is the patient population?
How does the patient currently receive treatment?
How is the treatment prescribed?
What monitoring is needed?
Is the medicine self administered or not?
Are there any training needs?
Are any ancillary items needed?
Is aseptic compounding required?

11. Homecare service proposals
“Homecare Medicines Submission Form”
Financial
Which clinical management team?
Which Consultant(s)?
Current annual spend?
Current VAT status on medicine(s)
Is treatment Tariff or excluded from Tariff?
Is there potential loss of Trust income?

12. Homecare service proposals
“Homecare Medicines Submission Form”
Option assessment
Advantages
Disadvantages
Risks/Governance issues
Should homecare services be submitted to the Trust Drug and Therapeutics Committee?

13. Multidisciplinary teamwork
Ensure thorough involvement with
Pharmacy procurement team
Consultant
Specialist Nurse
Specialist Pharmacist
Patient/Carer representative
Business Manager/Finance Manager
Other health professionals depending on service

14. Commissioners When to engage in process?
Depends on your relationship with your local commissioners
Depends on Tariff status of the medicine
May be as early as horizon scanning
May be at tender specification or later
Potential to include Trust administrative costs and resource requirements into a business case

15. Service specification
Work with multidisciplinary team to agree service specification
Use templates from the National Homecare Medicines Committee/PASA website
Consider all aspects of the homecare service as per NHMC/PASA guidance
Consider developing service specifications for non Trust- contracted homecare services (usually pharma-contracted)

16. Tender process Define the financial aspects of your homecare service
Current costs of medicines
Assessment of current non-medicine costs
Assess the method required for tendering according to your Trust Standard Financial Instructions (SFIs) and EU Regulations
Competitive quote
Trust tender
EU tender

17. Tender process
Ensure a multidisciplinary clinical project group is involved all the way along, including adjudication
Patient and carer involvement
Presentations from homecare companies
Be mindful of need for change management plans

18. Change management Change management planning needed for
Change in supply from hospital to homecare
Change from one homecare provider to another
Multi-Trust homecare services
Points to consider
Agreed start dates (may be phased) and project plan
Be mindful of Data Protection Act
Agree Trust staff roles and responsibilities
Agree Homecare staff roles and responsibilities
Further information on the NHMC/PASA website

19. Performance management
Essential part of the homecare service
Ensures your patients are getting the service you require from the homecare provider
Ensure tender specification includes information on performance management and key performance indicators
Consider performance management of non Trust-contracted homecare services
More information in Jane Kelly’s session this afternoon and the NHMC/PASA website

20. The Leeds approach to homecare: The procurement homecare team

21. Summary of roles and responsibilities
Pharmacy Procurement Project Manager
Manages the Trust’s strategy for homecare medicines management
Identifies new opportunities for homecare provision
Assessment of proposed homecare services for patient focus and cost effectiveness
Manages risk management issues
Pharmacist expertise for homecare service development
Specialist Technician Homecare Medicines Management
Manages the operational aspects of homecare medicines services
Implements new homecare services
Change management of contracts for homecare services
Performance management
Patient involvement
Error and incident reporting

22. Summary of roles and responsibilities
Pharmacy Contracts Manager
CIPS qualified
Equivalent of PASA Category Manager
Has LTH and regional contracting roles
Manages the tendering process for homecare medicines services
Contractual reference for supplier performance management
Ensures processes meet EU and LTH guidance
Pharmacy Procurement Business Manager
Manages the order/invoice process for homecare medicines services
Manages a team of administrative staff responsible for the certification and payment of homecare invoices
Provides expert Pharmacy IT system (JAC) coding/costing advice on homecare services
Acts at interface of homecare contractors’ finance departments and LTH
Manages data for non-tariff medicines charging to PCOs

23. Key focus areas for LTH procurement homecare team

24. LTH Homecare funding
Current staff costs in procurement team and clinical pharmacy teams for homecare roles ~£164k pa
~£50 per homecare patient pa
Resource bids from LTH or PCO contract savings
Resource bid from regional drug contract management SLA
Contractual funding as value-added services in homecare contracts
Re-engineering of existing posts

25. Summary: What are the challenges for successfully implementing homecare?
Be patient centred at all times
Have a strategy for homecare medicines services
Keep an eye on new developments
Analyse requests for homecare services
Be pro-active where possible
Work with stakeholders in your own and other organisations, including all sectors of the NHS, homecare and pharmaceutical companies
Bid or contract for resource to administer homecare services
Make use of the National Homecare Medicines Committee/PASA website