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HIV Homecare – the London Experience Philip Aubrey Medicines Procurement Specialist – London & East of England LPP – P&MM Operational Lead National Homecare.

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Presentation on theme: "HIV Homecare – the London Experience Philip Aubrey Medicines Procurement Specialist – London & East of England LPP – P&MM Operational Lead National Homecare."— Presentation transcript:

1 HIV Homecare – the London Experience Philip Aubrey Medicines Procurement Specialist – London & East of England LPP – P&MM Operational Lead National Homecare Symposium - 15 th January 2009

2 Overview Commissioning of HIV services in London Commissioning of HIV services in London Background to HIV homecare in London Background to HIV homecare in London Tendering for a London HIV Homecare Service Tendering for a London HIV Homecare Service Retender of London HIV Homecare 2008 Retender of London HIV Homecare 2008 Outcome of London HIV Tender 2008 Outcome of London HIV Tender 2008

3 Commissioning of HIV services in London The London HIV Consortium manages the overall commissioning and provision of HIV services across London The London HIV Consortium manages the overall commissioning and provision of HIV services across London London Specialised Commissioning Group (LSCG) manage the commissioning of HIV services from the 31 PCTs to the 24 HIV provider trusts across London London Specialised Commissioning Group (LSCG) manage the commissioning of HIV services from the 31 PCTs to the 24 HIV provider trusts across London 2007/08 budget - £211m (65% on ARVs) 2007/08 budget - £211m (65% on ARVs) Growth in activity - 7.6% Growth in activity - 7.6%

4 Background to HIV homecare in London In 2004/05 - the HIV Consortium decided that London HIV patients should be offered the opportunity to receive their antiretroviral therapy through a home supply arrangement. In 2004/05 - the HIV Consortium decided that London HIV patients should be offered the opportunity to receive their antiretroviral therapy through a home supply arrangement. This followed previous experience at the Royal Free Hospital who at the time had 380 patients on HIV homecare. This followed previous experience at the Royal Free Hospital who at the time had 380 patients on HIV homecare. Other London trusts with HIV homecare activity – UCLH, GOS and C&W. Other London trusts with HIV homecare activity – UCLH, GOS and C&W.

5 Background to HIV homecare in London Drivers: Drivers: Provides patient choiceProvides patient choice More convenient for some patientsMore convenient for some patients Patients can choose between their medicines being delivered by van or via the postPatients can choose between their medicines being delivered by van or via the post Frees up NHS staff time for other HIV dutiesFrees up NHS staff time for other HIV duties Removes a burden from already overloaded hospital pharmacy dispensariesRemoves a burden from already overloaded hospital pharmacy dispensaries Financial benefit as medicines are VAT exemptFinancial benefit as medicines are VAT exempt

6 Tendering for a London HIV Homecare Service Agreement of stakeholders on how to construct tender Agreement of stakeholders on how to construct tender Design of tendering model Design of tendering model NHS PaSA to undergo tender on behalf of the London HIV Consortium NHS PaSA to undergo tender on behalf of the London HIV Consortium Specification of tender – used NHMC original specification Specification of tender – used NHMC original specification No of patients eligible No of patients eligible Homecare market intelligence Homecare market intelligence From Royal Free model 25% of patients on treatment should be eligible for homecare From Royal Free model 25% of patients on treatment should be eligible for homecare

7 Stakeholders London HIV Homecare Tender Commissioners Patient – Public Engagement (PPE) Clinicians HIV Pharmacists Procurement Pharmacists NHS PaSA HIV Consortium Prescribing Advisor Senior Pharmacy Managers HIV nurses

8 Design of Tendering Model Framework contract Framework contract Suppliers are invited to price for a van or postal delivery depending on the number of patients they have on service Suppliers are invited to price for a van or postal delivery depending on the number of patients they have on service Patient bandings Patient bandings 3 monthly supply of patient medication (4 deliveries per year) 3 monthly supply of patient medication (4 deliveries per year) List A – ARVs (pan London contract prices) List A – ARVs (pan London contract prices) List B – miscellaneous (source at lowest cost) List B – miscellaneous (source at lowest cost) Suppliers must provide financial data to LSCG on a monthly basis Suppliers must provide financial data to LSCG on a monthly basis

9 London HIV homecare contract Commenced 1 st July 2005 Commenced 1 st July 2005 Duration Duration Awarded to 4 suppliers Awarded to 4 suppliers Each supplier awarded geographically: Each supplier awarded geographically: HaH – North Central London (except UCLH) HaH – North Central London (except UCLH) Firstplus – North West London (except C&W) Firstplus – North West London (except C&W) HCL – North East London HCL – North East London Intecare – South London Intecare – South London Note – Firstplus – terminated contract in Mar 07 Note – Firstplus – terminated contract in Mar 07

10 London HIV homecare contract Homecare suppliers buy ARVs at list price Homecare suppliers buy ARVs at list price They then provide manufacturers with dispensing data They then provide manufacturers with dispensing data Manufacturers reimburse homecare suppliers difference between list price and contract price Manufacturers reimburse homecare suppliers difference between list price and contract price Provider trusts are allowed to keep 20% (now increased to 25%) of any savings to fund infrastructure costs Provider trusts are allowed to keep 20% (now increased to 25%) of any savings to fund infrastructure costs

11 Retender of London HIV Homecare 2008 Similar model to 2005 Similar model to 2005 Homecare suppliers invited to price (van and postal) on patient numbers up to in bandings of 500 for 3, 4, 5 or 6 monthly deliveries Homecare suppliers invited to price (van and postal) on patient numbers up to in bandings of 500 for 3, 4, 5 or 6 monthly deliveries Evening, weekend and emergency delivery prices were also requested Evening, weekend and emergency delivery prices were also requested Patient numbers on therapy are confirmed by the trusts Patient numbers on therapy are confirmed by the trusts

12 Example of pricing by patient banding

13 Retender of London HIV Homecare 2008 New NHMC specification used for tender New NHMC specification used for tender Suppliers were requested to supply monthly management information and KPI data to PaSA Suppliers were requested to supply monthly management information and KPI data to PaSA Pre-tender meeting with all homecare suppliers – 8 th May 2008 Pre-tender meeting with all homecare suppliers – 8 th May suppliers submitted tenders 6 suppliers submitted tenders Shortlisted to 5 after PQQ Shortlisted to 5 after PQQ

14 Retender of London HIV Homecare 2008 Tenders were scored using the eAward system by myself, NHS PaSA and 2 HIV Pharmacy Leads Tenders were scored using the eAward system by myself, NHS PaSA and 2 HIV Pharmacy Leads Final adjudication – 1 st Aug Final adjudication – 1 st Aug Adjudication panel consisted of: Adjudication panel consisted of: Procurement pharmacistsProcurement pharmacists NHS PaSANHS PaSA Prescribing Advisor to HIV ConsortiumPrescribing Advisor to HIV Consortium Patient – Public Engagement representativePatient – Public Engagement representative CommissionersCommissioners HIV Pharmacy LeadsHIV Pharmacy Leads

15 Weightings MeasureWeighting Homecare supplier infrastructure 20 Quality Assurance 12 Storage and distribution 20 Customer service 18 Price30 Total100

16 Outcome of London HIV Tender 2008 Awarded the existing 3 homecare suppliers to the framework Awarded the existing 3 homecare suppliers to the framework This was mainly due to higher service charges from the other two tenderers This was mainly due to higher service charges from the other two tenderers New patients in Supplier A trusts will commence with Supplier B New patients in Supplier A trusts will commence with Supplier B

17 Percentage market share of London HIV homecare patients by supplier

18

19 London HIV Homecare Savings YearSaving £999, £1,200, £268,609

20 Any Questions?


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