2. Collaborative Clinical Medicines Procurement (CCMP) “Getting Value for Money” Colette Whigham Category Manager – Pharmacy NHS National Procurement, Scotland Thursday 11 th November 2010

3. National Procurement Commenced activities in Scotland in 2005 following recommendations made by the McClelland review of public sector procurement. Purchasing activities across the NHSS historically had been managed:- – In a sporadic manner – Limited coordination across NHS Scotland – Little aggregation of spend across NHS Scotland and more than 23 procurement organisations

4. Workstream Activity Redesign Logistics Strategic Sourcing Maximise the potential savings by NHS Scotland by sharing the benefits of collaborative buying power. These are realised by the application of best practice strategic sourcing processes and working with suppliers to obtain best value products and services. eP&S Coordinate the deployment of world class procurement technology across Health Boards. This offers users access to a variety of tools that support strategic and transactional procurement and enable new methods of collaboration. Simplify the physical supply chain using managed distribution systems to achieve economies of scale delivered from the National Distribution Centre. (Non Pharmaceuticals)

5. Scottish Pharmacologistics Governance Framework CLINICALINPUTCLINICALINPUT PROCUEMENTPROCUEMENT

6. National Contracting Strategy for Medicines Key Elements :- – Procurement Regulations – Clinical Involvement – Specification Design – Contract Shape – Supplier Conditioning – Anticipated Outcomes – Implementation

7. National Contracting Strategy for Medicines Key Features:- – Clear – Transparent – Planned – Efficient – Joined Up – Delivers Savings Consistently – Clinical Governance – Financial Governance

8. National Contracting Challenges Resistance to and fear of change Lack of awareness of procurement regulations Lack of understanding of market dynamics Industry Resistance Lack of clinical resource to implement change It’s too ambitious No one asked me It will take to long! It’s too expensive I don’t have authority It’s impossible We can’t take the chance It’s too complicated They won’t fund it What’s in it for me? We’ve always done it this way ! It’s too political We are doing ok as it is !! We don’t have the staff It’s not my job!! We tried that before I’m all for it, but… They really don’t want to change We’ve never done that before There’s not enough time It needs more thought It’s not our problem!! It won’t work in this department

9. Clinical Peer Groups in Scotland actively engaged with National Procurement Diabetes Action Plan – Scottish Government Hepatitis C Action Plan – Scottish Government Scottish HIV Action Group - Scottish Government Scottish Antimicrobial Pharmacy Group Scottish Radiological Society Scottish Society for Rheumatology Scottish Plasma Expert Panel Scottish Haemophilia Directors Scottish Cancer Networks Scottish Fertility Group Total Parenteral Nutrition Managed Clinical Network Scottish Neonatal and Paediatric Pharmacists Scottish Critical Care Pharmacy Group Scottish Pharmacists Quality Assurance Group Patient Access Scheme Advisory Group (PASAG)

10. Lessons Learned Communication (Stakeholders and Industry) Planning Change for sake of change Well developed specifications Anticipate outcomes Shared resource (Reduced representation at Clinical Level but endorsed nationally via peer groups)

11. Thankfully there are not too many of these !!

12. Examples of Successful Collaborative Clinical Medicines Procurement in Scotland Low Molecular Weight Heparin – Product Standardisation Hepatitis C Action Plan – Volume Matrix Botulinum Toxin Type A – Clinical Substitution without rationalisation IVF Fertility – Price Normalisation Insulin Pumps – Ranked Framework Clozapine – Single Supplier Framework Homecare – Single Supplier Framework, HIV & Clotting Factors Blood Glucose Monitoring Strips – Supplier Rationalisation Contrast Media – Supplier Rationalisation, release market share G-CSF – Scotland Wide Clinical Input Gonadorelin Analogues - Clinical Substitution without rationalisation Total Parenteral Nutrition Erythropoetin Stimulating Agents Transitional Medicines – Time to market, when is the right time?

13. We do not always get it right first time!!

14. Collaborative Clinical Medicines Procurement “Getting Value for Money” The Results: – 2005/2006 = £4,721,238 – 2006/2007 = £8,953,191 – 2007/2008 = £5,873,646 – 2008/2009 = £5,128,995 – 2009/2010 = £5,713,346 Total Savings To Date = £ 30,390,416

15. The Future… More complex therapy areas (Work In Progress): – Continued Therapeutic Substitution – Anti-fungals – Anti-TNF’s – Anti-thrombolytics Closer collaborative working with Scottish Medicines Consortium (SMC) Closer collaborative working with National/Health Board Formularies Continued development of focused Clinical Advisory Panels

16. Summary No two procurement procedures are the same Clinical input at the centre of all procurement activity Savings are a key NHS agenda item Change management, whilst challenging, is always possible Future contracts will benefit from lessons learned Procurement and Clinical resource is essential Make a plan and stick to it!