Presentation on theme: "What are the challenges of successfully implementing homecare?"— Presentation transcript:
1What are the challenges of successfully implementing homecare? Phil Deady, Pharmacy Procurement ManagerLeeds Teaching Hospitals NHS Trust &Yorkshire and Humber NHS Pharmaceuticals Purchasing Consortia
2Plan of sessionLeeds Teaching Hospitals’ homecare medicines management servicesHomecare service development: tasks and challengesThe Leeds team approach to homecare
3LTH homecare medicines management services First homecare patient early 1980’sAll homecare medicines handled through Pharmacy except medicinal blood products3,300 active patients 07/08Total spend 07/08 £12.6M (21% of total medicine spend £59.1M)23 different homecare therapiesFive homecare companies
4LTH homecare Top 10 by spend 07/08 1. Etanercept2. Medicines for HIV/AIDS3. Medicines for Multiple Sclerosis4. Intravenous antibiotics for Cystic Fibrosis5. Parenteral Nutrition6. Adalimumab7. Immunoglobulins8. Imatanib9. Erythropoietins10. Liver transplant medicines
6Homecare service development: suggested model PATIENT/CARER
7Homecare Medicines Management Strategy Define homecare medicines management servicesProposed direction and scope for homecareReference national policy and guidancePropose systems and processes for developing homecare servicesDefine key stakeholdersSummarise benefits and risksPropose methods to identify homecare opportunitiesPropose methods of tendering and ongoing management of homecare services
8Horizon scanningSpecialist pharmacists routinely do horizon scanning for medicines due for launch to the UK marketNeed to horizon scan for new medicines that will be launched with homecare services includedNeed to horizon scan for new medicines with the potential for homecare servicesStart discussions with commissioners on new medicines homecare services at this point?
9Homecare service proposals Ideas can come from specialist pharmacists, nurses, clinicians, patients/carers (reactive)Proposals also come from homecare companiesLTH 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
10Homecare service proposals “Homecare Medicines Submission Form”Product informationDrug(s) for considerationWhich 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?
11Homecare service proposals “Homecare Medicines Submission Form”FinancialWhich 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?
12Homecare service proposals “Homecare Medicines Submission Form”Option assessmentAdvantagesDisadvantagesRisks/Governance issuesShould homecare services be submitted to the Trust Drug and Therapeutics Committee?
13Multidisciplinary teamwork Ensure thorough involvement withPharmacy procurement teamConsultantSpecialist NurseSpecialist PharmacistPatient/Carer representativeBusiness Manager/Finance ManagerOther health professionals depending on service
14Commissioners When to engage in process? Depends on your relationship with your local commissionersDepends on Tariff status of the medicineMay be as early as horizon scanningMay be at tender specification or laterPotential to include Trust administrative costs and resource requirements into a business case
15Service specification Work with multidisciplinary team to agree service specificationUse templates from the National Homecare Medicines Committee/PASA websiteConsider all aspects of the homecare service as per NHMC/PASA guidanceConsider developing service specifications for non Trust- contracted homecare services (usually pharma-contracted)
16Tender process Define the financial aspects of your homecare service Current costs of medicinesAssessment of current non-medicine costsAssess the method required for tendering according to your Trust Standard Financial Instructions (SFIs) and EU RegulationsCompetitive quoteTrust tenderEU tender
17Tender processEnsure a multidisciplinary clinical project group is involved all the way along, including adjudicationPatient and carer involvementPresentations from homecare companiesBe mindful of need for change management plans
18Change management Change management planning needed for Change in supply from hospital to homecareChange from one homecare provider to anotherMulti-Trust homecare servicesPoints to considerAgreed start dates (may be phased) and project planBe mindful of Data Protection ActAgree Trust staff roles and responsibilitiesAgree Homecare staff roles and responsibilitiesFurther information on the NHMC/PASA website
19Performance management Essential part of the homecare serviceEnsures your patients are getting the service you require from the homecare providerEnsure tender specification includes information on performance management and key performance indicatorsConsider performance management of non Trust-contracted homecare servicesMore information in Jane Kelly’s session this afternoon and the NHMC/PASA website
20The Leeds approach to homecare: The procurement homecare team
21Summary of roles and responsibilities Pharmacy Procurement Project ManagerManages the Trust’s strategy for homecare medicines managementIdentifies new opportunities for homecare provisionAssessment of proposed homecare services for patient focus and cost effectivenessManages risk management issuesPharmacist expertise for homecare service developmentSpecialist Technician Homecare Medicines ManagementManages the operational aspects of homecare medicines servicesImplements new homecare servicesChange management of contracts for homecare servicesPerformance managementPatient involvementError and incident reporting
22Summary of roles and responsibilities Pharmacy Contracts ManagerCIPS qualifiedEquivalent of PASA Category ManagerHas LTH and regional contracting rolesManages the tendering process for homecare medicines servicesContractual reference for supplier performance managementEnsures processes meet EU and LTH guidancePharmacy Procurement Business ManagerManages the order/invoice process for homecare medicines servicesManages a team of administrative staff responsible for the certification and payment of homecare invoicesProvides expert Pharmacy IT system (JAC) coding/costing advice on homecare servicesActs at interface of homecare contractors’ finance departments and LTHManages data for non-tariff medicines charging to PCOs
23Key focus areas for LTH procurement homecare team
24LTH Homecare fundingCurrent staff costs in procurement team and clinical pharmacy teams for homecare roles ~£164k pa~£50 per homecare patient paResource bids from LTH or PCO contract savingsResource bid from regional drug contract management SLAContractual funding as value-added services in homecare contractsRe-engineering of existing posts
25Summary: What are the challenges for successfully implementing homecare? Be patient centred at all timesHave a strategy for homecare medicines servicesKeep an eye on new developmentsAnalyse requests for homecare servicesBe pro-active where possibleWork with stakeholders in your own and other organisations, including all sectors of the NHS, homecare and pharmaceutical companiesBid or contract for resource to administer homecare servicesMake use of the National Homecare Medicines Committee/PASA website