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1 NOEL J STAUNTON (BSc, MRPharmS, MBA, Dip H.Econ) Pharmaceutical Consultant-3i consultancy ltd Work with Pharma companies (Pfizer, GSK, BI, Novartis,

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Presentation on theme: "1 NOEL J STAUNTON (BSc, MRPharmS, MBA, Dip H.Econ) Pharmaceutical Consultant-3i consultancy ltd Work with Pharma companies (Pfizer, GSK, BI, Novartis,"— Presentation transcript:

1 1 NOEL J STAUNTON (BSc, MRPharmS, MBA, Dip H.Econ) Pharmaceutical Consultant-3i consultancy ltd Work with Pharma companies (Pfizer, GSK, BI, Novartis, Flynn, Shire, Galderma, Stiefel, Solvay, Takeda, Lundbeck etc, etc) Mob 07 980 148 711. E mail noel@3iconsultancy.comnoel@3iconsultancy.com

2 2 TODAY NHS reorganisation –Why? PBR PBC WCC

3 3 TODAY Darzi Polyclinics Pharmacy White Paper PCO levers

4 In July 2002 the WHO asked the UN Security Council: What, in your honest opinion, can we do to solve the problem of the shortage of food in the rest of the world? Remember, people interpret things differently.

5 Didnt work because: East Europeans didnt understand the word honest Chinese didnt understand – opinion Middle Easterners didnt understand – solve South Americans didnt understand – problem Western Europeans didnt understand – shortage Africans didnt understand – food Americans didnt understand – rest of the world

6 6 NHS REORGANISATION - WHY? Were spending more £s per head on health than EU15 and EU27 countries but our outcomes are poor

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13 13 MOST (ALL?) NHS CHANGES REVOLVE AROUND SPENDING MORE IN PRIMARY CARE AND LESS IN SECONDARY CARE PBR PBC World Class Commissioning GP contract, Community Pharmacy contract, Consultants contract Nurse and Pharmacist Prescribing Managing long term conditions Etc, Etc, Etc

14 14 PBR Old system - block contracts PAY FOR WHOLE POPULATION Dont know how much hospital care costs Cant disinvest from secondary care New system - PBR PAY FOR EACH INDIVIDUAL PATIENT National tariff CAN DISINVEST FROM HOSPITALS

15 15 PBR England only (but Celtic nations eventually) Copy of US system which DOES reduce hospital stay (Ref HSJ, 9 th Dec 04, P 16) International phenomenon DRGs first in the USA -Medicare France uses US DRGs Italy uses modified version of US DRG system Germany & Netherlands from 2003 England, Australia, Norway, Austria, Finland, Sweden, Japan and Canada have own case mix tools

16 16 A 55 year old man with a history of heart disease is admitted to coronary care with an MI. His condition is complicated by heart failure. He is discharged after 32 days. PBR - example acute MI

17 17 Patient is discharged from hospital. Hospital finance clerk reads patients notes and types into her computer: Primary diagnosis – MI Secondary diagnosis -CHF PBR software spews out a code – HRG E11 PBR - example acute MI

18 18 HRG E11 - non-elective spell = £4,787 2 extra days @ £183=£366 Total charged to PCT=£5,153 PBR - example acute MI

19 19 The tariff covers EVERYTHING that happens to the patient whilst in hospital (drugs, tests etc) Overseas PBR has stimulated primary care prescribing (in order to prevent expensive hospital tariffs) Overseas PBR has threatened secondary care prescribing (the hospital earns the same amount regardless of which drug they use) UNLESS the drug reduces length of stay Birth of real pharmaco economics in UK? PBR

20 20 Fund holding DID change how many patients went into hospital (unlike HAs, PCTs, and other NHS changes) (Ref Health Foundation, Oct 04) PBC born in England only (April 05) and voluntary Resuscitated in April 06 through the GMS contract PBC

21 21 Practices meant to keep at least 70% of any freed up resources This wasnt happening so BMA said dont do PBC UNLESS you get a written agreement (HSJ 19 th April 07, P8). Resources freed up may be spent on: Equipment; Training, clinical and non-clinical staff; Premises development with specific PCT board approval; Freed up resources can be shared across a wider group of practices Practice Based Commissioning: achieving universal coverage Jan 06 PBC efficiency gains

22 22 PBC Currently – results arent great Audit Commission said: Weve not yet seen any real evidence of it (PBC) leading to the redesign and transformation of services that was hoped. They blame PCTs and the way they have set PBC budgets. (Ref HSJ 22 Nov 07, P 7). However PBC is here for medium term at least NHS to use private firms to assist PC clusters with business cases (Ref HSJ 24 July 08, P 6)

23 23 World Class Commissioning Adding life to years and years to life. Commissioning Assurance Handbook, dated 4 June 2008. PCTs will be assessed against three elements – Outcomes, Competencies and Governance. PCTs need to complete a self assessment and submit materials by end October 2008. PCTs to be ranked from 1 to 5 (5 = a WCC)

24 24 DARZI-Polyclinics Each PCT in England must have a new Polyclinic Also over 100 new GP practices in under-doctored PCTs (mainly NE and NW England) Contracts will be awarded Dec 08 Real reason for doing this is to introduce some fat into the fire of change Many private companies bidding including Virgin, United Healthcare, BUPA. Virgin have had expressions of interest from 300 GP practices, Ref HSJ 22 May 08, P 11 but have now PULLED out of opening GP surgeries (Ref GP 26 th Sep 08)

25 25 DARZI - Polyclinics Set-up costs met by DOH - £250-800m. Winners will develop new services funded by start-up monies in competition with existing practices Some existing practices may go bust Practices will increasingly work in groups with shared approaches to medicines management Practices won by United Health, Care UK, Virgin, will restrict access, employ GPs and look to widespread formularies and prescribing policies

26 Pharmacy White Paper (Green paper, White Paper, Bill, Legislation) White paper proposes that pharmacies will: prescribe certain common medicines, be first port of call for minor ailments, saving every GP the equivalent of around one hour per day; provide support for people with long-term conditions; be able to screen for vascular disease and certain STDs, such as Chlamydia; work much more closely with hospitals to provide seamless care; play a bigger role in vaccination. 26

27 Pharmacy White Paper Lets not forget: Pharmacies currently only doing 85 MURs each (*allowed to do 400) (Ref PJ 2 Aug 08, P 121) Lots of previous false dawns for pharmacy PWSI announced 2 years ago but only 2 (yes 2) in England 27

28 Some things are obvious

29 PCO LEVERS PCOs are proven to influence prescribing National audit office survey of 2,000 GPs in 07 Atorvastatin + Losartan in decline Prescribing incentive scheme is main lever PCOs reserve powerful levers for top priorities (normally big cost savings)

30 PCO LEVERS Prescribing incentive schemes 5* lever, only for big savings (e.g. statins, sartans, antidepressants etc) Practice support pharmacists 5* lever, only for big savings ScriptSwitch 3* lever, smaller cost savings and quality issues Monthly Rx newsletters/Guidelines etc 2* lever, reinforce others Guidelines 1* lever, let someone else waste time on these

31 31 NOEL J STAUNTON (BSc, MRPharmS, MBA, Dip H.Econ) Pharmaceutical Consultant-3i consultancy ltd Work with Pharma companies (Pfizer, GSK, BI, Novartis, Flynn, Shire, Galderma, Stiefel, Solvay, Takeda, Lundbeck etc, etc) Mob 07 980 148 711. E mail noel@3iconsultancy.comnoel@3iconsultancy.com


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