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

2. Overview Commissioning of HIV services in London
Background to HIV homecare in London
Tendering for a London HIV Homecare Service
Retender of London HIV Homecare 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
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)
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.
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.

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

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

7. Stakeholders

8. Design of Tendering Model - 2005
Framework contract
Suppliers are invited to price for a van or postal delivery depending on the number of patients they have on service
Patient bandings
3 monthly supply of patient medication (4 deliveries per year)
List A – ARVs (pan London contract prices)
List B – miscellaneous (source at lowest cost)
Suppliers must provide financial data to LSCG on a monthly basis

9. London HIV homecare contract - 2005
Commenced 1st July 2005
Duration - 2+2
Awarded to 4 suppliers
Each supplier awarded geographically:
HaH – North Central London (except UCLH)
Firstplus – North West London (except C&W)
HCL – North East London
Intecare – South London
Note – Firstplus – terminated contract in Mar 07

10. London HIV homecare contract - 2005
Homecare suppliers buy ARVs at list price
They then provide manufacturers with dispensing data
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

11. Retender of London HIV Homecare 2008
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
Evening, weekend and emergency delivery prices were also requested
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
Suppliers were requested to supply monthly management information and KPI data to PaSA
Pre-tender meeting with all homecare suppliers – 8th May 2008
6 suppliers submitted tenders
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
Final adjudication – 1st Aug 2008.
Adjudication panel consisted of:
Procurement pharmacists
NHS PaSA
Prescribing Advisor to HIV Consortium
Patient – Public Engagement representative
Commissioners
HIV Pharmacy Leads

15. Weightings Measure Weighting Homecare supplier infrastructure 20
Quality Assurance 12
Storage and distribution
Customer service 18
Price 30
Total
100

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

17. Percentage market share of London HIV homecare patients by supplier

19. London HIV Homecare Savings
Year
Saving
£999,020
£1,200,488
£268,609

20. Any Questions?