Identify priorities for medicines and collaborate, don't reinvent the wheel
Sharing, collaborating and disseminating good practice in medicines use and procurement not only helps London's NHS manage limited resources more effectively, it also prevents trusts from individually reinventing the wheel – as a collaborative force, we do it once, do it well, and then do it again.
Medicines cost the NHS in London £2 billion a year, split equally between primary care trusts (mainly GP prescriptions) and acute and mental health trusts. Hospital medicine expenditure is rising by about 12 per cent a year, partly due to the introduction of new high cost medicines. The Pharmacy and Medicines Use workstream of the NHS London Procurement Partnership (LPP) works to deliver cost effective prices on medicines and related products; and it supports London-wide QIPP work on medicines use and procurement.
LPP is a professional collaborative organisation created and funded by its members, London's NHS organisations, with the objective of leveraging London's annual £6-7bn procurement budget to drive savings and improve patient care. The LPP Pharmacy and Medicines Use team's main objective is to drive the cost effective use of medicines in (and between) primary and secondary care by promoting efficient procurement, and getting clinical stakeholder involvement at all levels, including pharmacy staff, clinicians and commissioners.
Philip Aubrey, Pharmacy & Medicines Use and Procurement Lead for Secondary Care, comments, "Collaboration enables us to utilize economies of scale on a London level where appropriate, for example in managing tenders. In primary care, we're building on the work already done by Medicines Management teams in PCTs to focus on those areas with the greatest potential. For secondary care, our focus is on the use of therapeutic tendering to reduce the cost of hospital drugs and homecare costs for hospitals and PCTs.
"We look for collaboration opportunities across and between primary and secondary care, and focus on savings to be made through collaboration in areas such as Specials manufacturing and pharmacy stores. We work to encourage prescribing which is both clinically sound and cost effective by establishing clinical guidelines for high cost treatments. Where appropriate, we will encourage the use of non-branded medicines or changing from one type of medicine to another.
"We also make sure we keep trusts up-to-date about new medicines, medicines coming off patent, and any changes to the market, and we work with trusts on guidelines for the use of medicines."
Supporting QIPP initiatives
QIPP initiatives are many, and LPP works with trusts and CCGs to identify their top QIPP priorities. That identification work involves considering current work programmes in PCTs and acute trusts, national work programmes and recommendations from, for example, the National Pharmacy Council and the DH, and identifying “quick wins” that will be easy to implement.
QIPP is a national programme to improve the quality of care while making efficiency savings, and London's QIPP procurement work is jointly managed by the Commercial Support Unit and LPP. Jas Khambh, Pharmacy & Medicines Use and Procurement Lead for Primary Care, stresses that "When we're considering the potential for saving and improving efficiency as well as the quality of patient care, we always look at the clinical evidence. We use a scoring tool which takes into account all relevant factors, and decisions on where our work should focus are made by London's Primary Care QIPP sub-group, representing a range of London's NHS medicines and pharmaceutical professionals.
"LPP's support also includes a range of benchmarking tools and dashboards measuring primary and secondary care medicines procurement performance. We produce monthly benchmarking, savings and cost avoidance data, and other online resources including KPIs and Red Amber Green ratings which work at CCG level."
LPP will continue to support the medicines optimisation agenda for QIPP by:
• continuing to engage with CCGs and acute and mental health trust pharmacy and medicines management teams through QIPP working groups and Chief Pharmacist meetings, to ensure proper engagement and to align priorities with those of trusts
• providing detailed data analysis to identify lost opportunities and monitor progress with initiatives and targets
• hosting web-based information on the LPP website allowing access to detailed data for use by individual trusts and CCGs to address issues at a local level
• providing regular bulletins recommending initiatives that can be adopted at a local level
• encouraging collaboration and sharing of good practice across London to ensure
limited resources are used effectively.
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