1

Hospital Pharmacy and Medicines Optimisation Project

HOSPITAL PHARMACY TRANSFORMATION PLAN

March 2017

1. Executive Summary

1.1 The Birmingham and Solihull Transformation Plan (STP) made up of all health

providers including the three CCGs, two local authorities, seven hospitals, one

mental health trust and one community trust, sets out a five-year plan to

ensure local leaders work together to deliver better health and care for local

people. There are three strategic objectives including creating efficient

organisations and infrastructure, transformed primary, social and community

care (Community Care First) and Fit for Future secondary and tertiary

services. There isn’t a designated pharmacy/medicines management work

stream within the STP but work to generate savings is underway within the

CCGs.

1.2 It is likely that any service redesign across the STP and which involves

medicines management will require the engagement of the secondary care

pharmacy teams.

1.3 There is a proposed merger by acquisition of Heart of England NHS

Foundation Trust by University Hospitals of Birmingham. The clinical case of

change is being finalised and subject to satisfactory approval by various

organisations including the Competition and Marketing Authority and NHS

Improvement the Trusts could become one organisation as early as October

2017. This provides opportunities for the two acute Trust pharmacy

departments to work together to scope further ideas for improved efficiency

and productivity. The Trusts are already working together on digital systems

which includes electronic prescribing and administration.

1.4 The West Midlands Chief Pharmacists and East Midlands Chief Pharmacists

have been working collaboratively over the wider STP footprints on two

specific projects reviewing provision of aseptics services and medicines

information. Other projects may come to light as each service is scoped.

1.5 The Hospital Pharmacy Transformation Plan (HPTP) has been developed

through various discussions in the pharmacy and general management

teams. A project board has been established will develop, review and update

the detailed work plan and on an on-going basis scope potential productivity

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and efficiency opportunities. This will be undertaken in collaboration with other

Trusts in the STP footprint where appropriate. The plan includes reference to

efficiencies already in place, work already underway and further opportunities.

2. Carter Metrics and Model Hospital Benchmarks

2.1 Currently, Heart of England NHS Foundation Trust (HEFT) has a main

pharmacy department in each of the three hospital sites which provides a

comprehensive service including:

Clinical pharmacy/patient safety services

Dispensing services for in-patients, discharge and outpatients

Medicines procurement*

Ward stock distribution

Aseptic compounding (chemotherapy)*

Financial management of medicines spend

Medicines Information*

A number of these services* have been centralised to one site since the

three hospitals merged in 2007.

The outpatient dispensing service is outsourced on the Birmingham

Heartlands Hospital site although a different model is being developed and

will take into consideration plans for Good Hope and Solihull Hospitals.

2.2 Comparing the Trust data with national and peer benchmarks the key areas

for improvement include:-

Increasing the uptake of biosimilars

Increasing the number of active non-medical pharmacist prescribers

Implementing EPMA across the Trust including outpatients and

specialist areas including chemotherapy

Improving medicines reconciliation metrics

Reducing stock holding in pharmacy stores

Improving access to clinical pharmacy and medicines management

service at weekends

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3. Opportunities for transformational change (HPTP Plan Summary)

The Model Hospital and national benchmarking data had identified areas of further improvement and form the basis of the

identified work streams. Work streams will be established to review each element of the pharmacy service. A detailed project

plan will be developed by April 2017. This table highlights our current position to demonstrate that a number of the Carter

recommendations have already been implemented and new initiatives identified that requiring scoping.

Element of

Pharmacy Service

Current Position Actions underway/proposed for HPTP Timescales

SUPPLY CHAIN

A review of procurement processes is

being undertaken by Interim Head of

Procurement

Reviewing with view to implementing

rationalisation opportunities and efficiencies

across Birmingham and Birmingham and Solihull

STP and pending Trust merger

Q4 2018/19

Procurement of

Medicines

The pharmacy directorate is responsible

for the procurement of all medicines in the

Trust (or other departments under Chief

Pharmacist delegation)

Outsourced partner for outpatient

dispensing purchases own medicines in

accordance with Trust contracts.

Centralised procurement on behalf of all 3

sites.

CMU contracts are applied and contract

Implementation of e-invoicing is currently being

implemented. There is work underway to

improve our current position to >90%.

Medicines usage and expenditure software and

reporting tools are being purchased and will be

utilised to facilitate analysis of medicines

expenditure

To scope collaborative opportunity post-merger

with a view to applying larger volumes discounts

Q3 2017/18

Q2 2017/18

Q2 2018/19

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information applied to local ordering

systems.

CMU/Regional Medicines Optimisation

Pharmacist – this post was established on

a fixed term contract hosted by the

WMAHSN following a paper presented to

Trust Directors of Finance – Trust will

continue to contribute to salary to continue

to obtain benefits from appointment.

To continue to work with HTE who aim to

maximise value from regional procurement

frameworks.

A significant review was undertaken of

coding of medicines, especially high cost

drugs. A new pathway has been recently

developed to ensure all the key

stakeholders are informed of new

commissioning policies involving high cost

drugs. This work is undertaken in

conjunction with the finance and income

teams.

There is an established pharmacy cost

improvement group which reviews ideas

and proposals of future schemes.

for medicines.

To review information & recommendations from

Medicines Optimisation lead pharmacist

following their collaboration with other

procurement hubs and procurement leads and

implement local actions as required.

Local dashboard under development – to

provide data as requested to benchmark and

monitor uptake of initiatives.

The NHSI list will be reviewed by the pharmacy

CIP group and develop a plan for quick

On-going

Q2 2017/18

On-going

5

Blueteq is available for NHSE

commissioner approval for CDF drugs and

other specialities.

Operational indicators/KPIs are in place

and monitored monthly including stock

turnover, waste and outstanding invoices

implementation

Stores/

Distribution

Automation already in place at Heartlands

and Solihull Hospitals. Used for most stock

supplies and dispensing. Business case

for robot at Good Hope has been

unsuccessful for several years as unable

to demonstrate financial benefits.

Current stock holding (quantity) is 17.4

days (over 5 days).

Rationale to review stock holding – critical

medicines need to be in excess of 15 days

due to supply chain issues; need to look at

high cost drugs and number of days stock

holding as cash becomes a key issue.

Deliveries per day – in excess of 5 per day

To review literature for documented benefits of

ward based automation with a view to

developing a business case and options

appraisals document. To work collaboratively

with other Trusts which have implemented

similar schemes to identify lessons learnt.

To scope feasibility of reducing stock holding of

medicines supplied by wholesaler from 14 to 7

days.

To scope feasibility of reducing stock holding of

medicines supplied by manufacturer from 42 to

28 days (or less without introducing risks)

Deliveries will be a significant challenge since as

a minimum there are 4 wholesalers delivering

twice a day plus other ad hoc deliveries from

manufacturers. Unlikely to be achieved unless a

Q4 2017/18

Q2 2017/18

Q2 2017/18

Q4 2018/19

6

Internal project completed to move specific

large volume lines to internal direct to ward

delivery to reduce stockholding – findings

did not support implementation at this time

central Regional store in place. To scope

opportunities following merger by acquisition.

To scope opportunities for packing and

distribution of boxes from site/s with pharmacy

automation. May include supplies from central

store if established

To undertake critical review of ward stock lists

When the commercial market is more mature a

managed service for the end to end supply chain

may be available. To review literature and other

resources as these services become available

Q3 2017/18

Q3 2017/18

Q4 2019/20

Dispensing An outsourced dispensing service for

outpatients has been in existence at BHH

since 2007. A recent tender was awarded

to the current provider (Boots) for a further

5+ 5years and includes a similar service to

GHH but subsequently rejected. Both

parties are working together to develop

exit strategy and alternative model sought.

Outpatient drug treatment referral letters

used for non-urgent treatment.

Blister packs prepared by outsourced

To identify alternative model for outsourced

dispensing service following final decision of

tender. Model will need to take account of

opportunities for the repatriation of FP10s,

improved formulary management, homecare &

logistics and provision of blister packs for each

site.

To scope opportunities for outsourced model for

GHH and SH.

To scope opportunities for extending medicines

delivered through homecare/outsourced

provision with a view to maximising savings for

Q4 2017/18

Q3 2018/19

Q3 2018/19

7

partner for two of the hospital sites Trust, local CCGs and NHSE. Subject to

outsourced model in situ.

To scope opportunities for dispensing discharge

medicines with potential to create capacity for

extending clinical service and new savings

Q4 2017/18

Aseptics /

Chemotherapy

Aseptics dispensing services have been

centralised to one site three years ago.

The unit is unlicensed and medicines are

prepared under section 10 Medicines Act.

This means a product has to be prepared

for a specific patient against a prescription.

An external review was undertaken in

2013 and the recommendation was not to

license the unit at that time. Before this is

revisited again, the results of the EM/WM

aseptics review will be taken into

consideration.

A local Trust provides contingency in

emergency. At weekends urgent treatment

is obtained from a licensed manufacturer

under an SLA.

Procurement of high volume, lower cost

prefilled syringes to ensure effective use of

workforce for higher cost, lower volume

East and West Midlands HPTP Aseptic

Collaborative in place. Phase 1 is an initial

scoping exercise to look at the services provided

currently, the facilities and variation. This will in

turn support phase 2 which is looking at project

team to look at case for change – each Trust will

contribute to the project costs for phase 2

To implement NHSE dose banding schedules as

per CQUIN 17/18

To scope requirement to implement ‘campaign’

production with a view to improving cost

efficiency via vial sharing

Q4 2017/18

Q4 2017/18

Q3 2017/18

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items and trials. Prefilled products allow

service to be more responsive as these

are quicker to deliver.

Homecare Significant growth has been seen in the

use of home care for medicines supply.

Business case has been written identifying

need for additional resources.

Trust is compliant with Hackett Report

(2010) recommendations.

Home care framework is in place to ensure

cost effective service is available.

Working collaboratively with other Trusts in

West and East Midlands by sharing SOPs

to introduce more efficient processes

where appropriate

To scope further opportunities for provision of

homecare of high cost medicines with a view to

realise further savings.

To work with income team with regards to

shared savings benefits being agreed with

commissioners.

To assess current resource to deliver current

homecare service (review business case) and in

light of home care funding framework being

prepared by NHSE.

To scope opportunities to share workload with

homecare hubs across Birmingham and Solihull

STP

On-going

Q2 2017/18

Q2 2017/18

Q2 2017/18

Quality

Management

Systems

The QC of piped medical gases is

undertaken by an external provider with

contract managed through estates.

QA support for Farwell Audit for aseptics

services and ad hoc advice is available

from Bristol Hospital via an SLA.

To scope potential collaborative opportunities

with other WM (and EM) Trusts to establish local

QA service across the STPs within the patch

(Birmingham and Solihull) and in neighbouring

STPs (Staffordshire, Shropshire, Telford and

Wrekin, Derbyshire, Nottinghamshire,

Leicestershire and Rutland, Black Country,

Coventry and Warwickshire and Herefordshire

Q4 2018/19

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and Worcestershire).

ADVISORY

SERVICES

Medicines

Information

The Trust Medicines Information service

has been centralised to one site for

several years.

The West Midlands Regional Medicines

Information Service is based at Good

Hope Hospital.

Trust MI service provides education &

training for pre-registration pharmacists for

another hospital in the W Midlands

All clinical pharmacists can access MI

Databank on both sites.

Trust MI service supports a patient

helpline for medicines queries post

discharge

MI pharmacists support the formulary

management processes and management

of new drugs with support from the

Interface Prescribing Manager (a post

shared with the CCGs).

Collaboration has already started with the

Regional Medicines Information Service and a

temporary shared pharmacist post will

commence in November 2016.

Until the SPS review has clearly defined the

roles of Regional Medicines Information and the

resources available, further collaboration is

limited. Single site may be an option but

investment to estate will be required.

WM/EM Chief Pharmacist review of local

provision of Medicines Information Services

across STPs (Birmingham and Solihull,

Staffordshire, Shropshire, Telford and Wrekin,

Derbyshire, Nottinghamshire, Leicestershire and

Rutland, Black Country, Coventry and

Warwickshire and Herefordshire and

Worcestershire). To review collaborative

opportunities once report is available

Complete

Q4 2018/19

Q4 2017/18

10

Formulary A Trust interface formulary has been

available for many years but following the

creation of a new Area Prescribing

Committee for pan Birmingham and

Solihull and environs, this has been

updated following harmonisation of all the

formularies in pan Birmingham.

Additionally hospital only medicines are

included in the Trust netformulary.

There is a robust process in place for the

management of high cost drugs and other

new medicines. NHSE and CCG

commissioned policies are also managed

effectively to ensure quick access to new

medicines and appropriate systems are in

place to ensure the correct coding of

medicines including high cost medicines.

EPMA system helps control the prescribing of

new medicines which are not formulary. This is

monitored by the Medicines Assessment and

Advisory Group by reviewing new medicines

added to the system.

Looking at using warnings/decision support tools

on EP to help manage medicines choice.

To review stock control system and supporting

processes to address key challenge where a

high cost medicine is used for different

indications and it is commissioned for only one

indication.

To review local processes for managing the

introduction of new medicines following

implementation of Regional Medicines

Optimisation Committees (Apr/May 2017)

On-going

On-going

Q4 2017/18

Q2 2017/18

EDUCATION &

TRAINING

Training provided

to pre-registration

technicians and

pharmacists

Pre- registration technicians are fully

outsourced (including all assessing) to an

external provider

Participated in centralised recruitment of

pre-registration pharmacists (Oriel)

Due to changes in regional funding a review of

the current pre-registration technicians training

pathway to be reviewed & apprenticeship

scheme scoped – lead by HEE.

Q4 2017/18

11

NVQ assistant

staff

All training for NVQ qualification is

outsourced

Complete

Post registration

Pharmacy staff

Pharmacists undergo formal post grad

training from external sources e.g. diploma

in clinical pharmacy, lab final product

release, specialist training, independent

prescribing, PTQA

To scope opportunities of sharing expertise of

specialist pharmacists across local STP footprint

or within West Midlands with a view to

minimising costs associated with staff attending

courses off site.

Q4 2017/18

Undergraduate

training

Support is currently provided for Aston

University pharmacy undergraduates lead

by Teacher-Practitioner funded by Aston

University

To scope opportunities for reviewing & extending

support to universities e.g. Aston, Birmingham,

Keele and Wolverhampton across STPs

(Birmingham and Solihull, Staffordshire and

Black Country)

To consider developing shared posts with

universities in local STP (Birmingham and

Solihull)

Q2 2018/19

Q4 2017/18

SERVICES TO

EXTERNAL

ORGANISATIONS

Community

Services

Trust staff provide a medicines

management and clinical pharmacy

service to Solihull community as directed

by the CCG. Clinical service and

governance processes support local care

To scope further opportunities to work with community service leads to prevent admissions e.g. Solihull Together, GP confederations/CCGs To scope opportunities for collaborative working with Birmingham Community Health Trust with a view to introducing efficiencies across

Q3 2018/19

Q4 2017/18

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homes and residential accommodation

Challenge: Changing environment within hospital, CCGs, Solihull connect and formation of GP federations

community teams

To explore joint working with the community

services care home pharmacists/ practice

support pharmacists/rapid response pharmacist

To explore collaborative working across all the

sectors including care homes, community

pharmacies, CQC and the HEFT community

services team including medical team

To scope requirements of patients in other

intermediate care facilities e.g. St. Giles

To scope opportunities to review new

admissions to care homes e.g. to target elderly

patients being discharged home from HEFT

To review all activities undertaken by the current

community pharmacy services team and assess

if it requires pharmacist/technician involvement

CLINICAL

SERVICES

Clinical service

provision by

Patient facing activities by pharmacists

assessed as 82% following time and

motion audit undertaken using

Quality Improvement projects are being used to

help pharmacists prioritise patients requiring

review of high risk medicines, missed doses,

On-going

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pharmacists documentation agreed within WM.

Band 6 pharmacist rotation (4 months) has

been in place for three years following an

internal staffing transformation. Clarity

regarding line management and rotational

management has been developed.

Training packs in place with pharmacists

encouraged to work towards the Royal

Pharmaceutical Society General Level

Framework.

Band 7 pharmacists undergo an annual

rotation.

Prescribing pharmacists – 14% (of all

pharmacists in establishment). Most are

delivering service in specialist areas

Clinical teams focused on improving

patient flow and working with Trust

transformation teams

Summary Care Records and Your Care

Connected used routinely to support

medicines reconciliation by medicines

management ward based teams

clinical verification and to help with prioritisation

of workflow. Dashboard is in development and

will be used to monitor performance and

efficiencies.

A critical review of the rotations is underway to

inform a recruitment and retention strategy

which is in development.

NMP pharmacy strategy has been developed.

Implementation plan in place. To identify roles

and responsibilities in conjunction with Trust

Advanced Practice strategy.

To scope opportunities to collaborate with

primary care medicines management leads to

appoint shared posts which should help with

recruitment and retention.

To scope benefits of appointing/sharing posts

with commissioners (already working on

antifungals post with NHSE).

To scope opportunities for specialist pharmacists

taking the lead for their speciality across

Birmingham and Solihull & pending Trust merger

to ensure consistency and reduce variation.

Q2 2017/18

Q4 2017/18

Complete –

on hold

Q4 2018/19

Q3 2018/19

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Development of

ward based

pharmacy

technicians

Registered technicians support

pharmacists by undertaking medicines

reconciliation, medication history taking

and ward based dispensing

Ward based services are under review to ensure

technicians are provided service on the most

appropriate wards e.g. complex patients, high

turnover.

To review extended roles and responsibilities of

technicians e.g. medicines ordering with aim to

free up time for pharmacists to focus on

medicines optimisation at ward level.

E-ordering processes being reviewed on EP for

nurses

To scope opportunities in collaboration with

nursing managers for technicians to be involved

in ward based administration to release time for

nurses leading to improvement in patient safety

and patient care.

Q3 2017/18

Q3 2017/18

Q2 2017/18

Q4 2017/18

Embedding the

principles of

Medicines

Optimisation

Traditional clinical verification reviews

undertaken by pharmacists

To scope opportunities for increasing utilisation

of medicines optimisation resources and toolkits

with a view to implementing new critical review

of prescribed medicines and their place in

therapy e.g. in accordance with NICE, de-

prescribing, horizon scanning

Q4 2017/18

SEVEN DAY

SERVICES

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Pharmacy Seven

Day Services

Business case approved in 2014-15 to

support the delivery of a targeted clinical

pharmacy service on a Saturday and

Sunday in the mornings of Saturday and

Sunday on two sites.

Single On-call pharmacy service provided

across all sites. New rotas have been

implemented in Feb 17 after consultation

with pharmacists to provide equity in

delivery of the service and ensure senior

support is available for the junior

pharmacists.

To scope further opportunities for extending

service at weekend with reference to 7 day

service report issued recently and Keogh

recommendations

To scope further opportunities for providing on-

call support across wider organisation pending

merger.

Q4 2017/18

Q4 2019/20

(subject to final

acquisition)

NHS DIGITAL

HEALTHCARE

Pharmacy

Computer System

JAC is used for stock management and

procurement processes

JAC worksheets are utilised in the aseptics

dispensing unit

EPTTOs and eTTOs available – TTOs

available electronically to GPs (although

work is on-going regarding future content

and shared information and formatting)

JAC v 2016 – capital bid approved but on

NHS digital roadmap to be developed in

conjunction with interim IT management director.

To scope rationalisation of back office functions

across merged organisation e.g. informatics,

pharmacy systems with view to improving

productivity and efficiency

Q4 2017/18

Q3 2018/19

16

hold pending implementation of alternative

system post-merger. Timescales to be

agreed which affect whether upgrade

occurs.

EPMA JAC EPMA system - Implemented across

all sites in all areas except cancer

services, critical care, paediatrics,

maternity and some outpatient areas.

External review of IT infrastructure has put

a hold on EP chemo implementation

although funding and resources available

in original business case. Project initiation

meetings had restarted but now on hold

pending review of concerns raised locally

about system.

Implementation of new EP system to be agreed/

timescales unknown. Dependent on potential

merger timescales.

To standardise electronic prescribing systems

across merged organisations

To implement EPMA in general and specialist

areas including chemotherapy pending outcome

of proposed merger by acquisition Trusts.

Q4 2019/20

dm+d

Falsified

Medicines

Directive

An upgrade of the pharmacy stock

management system to deliver essential

standards is awaited from JAC. See

above – re JAC v2016

To ensure reporting is dm+d compliant Q2 2017/18

MEDICINES

OPTIMISATION

CQUIN – The proposed Medicines Optimisation

CQUIN for 17/18 and 18/19 supports the

To adopt the MO CQUIN in April 2017 to drive

the HPTP workstreams around outpatient

Q1 2017/18

17

MO reporting swift introduction of biosimilar agents,

improving data quality of use and

outcomes of high cost medicines, use of

lowest cost dispensing channels and

compliance with approved guidelines

(reviewing and switching).

dispensing, homecare, medicines optimisation,

digital transformation and medicines cost

reporting.

To consider development of business case for

additional resource to support implementation of

MO CQUIN.

Q1 2017/18

Biosimilar switch All new patients are initiated on infliximab

from April 2016. A plan for implementation

of other products was prepared but uptake

has been slow (as per metric)

To work with directorates to increase uptake of

biosimilars

To work with commissioners regarding shared

benefits savings schemes which would

encourage a quicker uptake

Implementation plans prepared for Infliximab,

rituximab, etanercept

On-going

On-going

Q3 2017/18

Generic contracts E.g. Implement generic voriconazole Complete

Top 10 drugs

savings – NHSI

There is a pharmacy group comprising

senior pharmacists, finance and general

management who meet to identify and

agree CIP plans. CIP over achieved year

to date. This group will review the

proposed top 10 list and agree how to

implement if relevant.

To review Regional Procurement Update

To participate in national audit to measure local

procurement services when audit tool is

available

To utilise specific tools being developed within

the procurement network to support the

collection of the metrics in a standardised way

and to facilitate benchmarking

To undertake review of over-labelled products

Q1 2018/19

Q1 2018/19

18

newsletters and implement proposed

savings opportunities.

and pre-packs to ensure a more efficient and

cost-effective supply & aligning with work due to

be undertaken by NPPSC.

To scope collaborative opportunities to

rationalise unlicensed medicines across the local

STP (Birmingham and Solihull) in conjunction

with procurement hubs & aligning with work due

to be undertaken by NPPSC.

Q1 2018/19

Q1 2018/19

IVIG outcomes Dispensing information is provided to

NHSE.

Local database in place for recording

required information

To scope what resources are required with a

view to ensuring outcome data is added to

national database for supply and demand

Q1 2017/18

CLINICAL TRIALS

Pharmacy support Trustwide medication

research trials.

To scope opportunities of utilising clinical

pharmacists in specialist clinics e.g. cancer with

a view to increasing uptake of investigational

medicinal products rather than licensed

medicines – research project in planning stages

Q3 2017/18

19

4. RISKS AND MITIGATIONS (might happen)

Risk identified Mitigation Plans Risk Remaining

Loss of WM Regional MO post at the end of

March 2017 would result in lack of coordination

across the WM Region, links to National

Procurement Committee / other Regional

Procurement posts and national agenda.

Future funding model is under

consideration with likely interim

contribution from each Trust in the

West Midlands.

Hospitals benchmark their own

medicines use and expenditure and

utilise CMU data to benchmark prices

paid or non-compliance with contracts.

Slower uptake of new medicines – peer

pressure

Automation: capital monies not available to

replace current robots at BHH and SH

pharmacies

Risk register – impact on work flow,

stock holding and staffing

Requirement for additional staffing

Slower dispensing/supplies

Regular breakdowns affecting work flow

Single supply chain – requires 100% medicines

lines to be provided by one

supplier/wholesaler. Links to Pharma and

opening up supply chains re: specific drug

lines.

To review medicine lines and see

whether suppliers can be rationalised

allowing for sufficient contingency

should a supplier not be available to

supply

5 deliveries per day

Capacity of manufacturing units is limited.

NHSE working with industry to ensure dose

banded doses are available.

To outsource prefilled products where

strengths available to reduce in-house

dispensing

Maximum efficiency not realised

Homecare –additional resources business

case is not funded – will limit future savings

Review procurement process to identify

other efficiencies e.g e-invoicing to free

Maximum benefits not realised

20

opportunities. Invest to save business case. up capacity

SPS review – final decision outstanding

regarding roles and responsibilities of regional

service & associated funding. What will hub

and spoke look like?

Local MI and regional MI service work

independently

Some resources shared

Some resources used and purchased

independently

Estate not shared

EPMA implementation – utilisation of system

from neighbouring Trust (potential merger)

Current system in place – request

upgrade in interim

High risk areas remain without

electronic prescribing system

Non-medical prescribing – funding and

capacity on courses for prescribing may not be

sufficient

Prioritise senior pharmacists, 8a and

above and then band 7 to undertake

training.

May take several years before band 6

and 7 pharmacists offered prescribing

training opportunities.

Outpatient pharmacy – financial sustainability

dependent on there being no changes to VAT

legislation and a viable profit net distribution

with NHSE

Local agreement with NHSE

commissioning to ensure outsourcing

provision is viable.

FP10s (loss of formulary control)

Outsourcing service is withdrawn,

reduced VAT savings opportunities

Ward based automation – costs of purchasing

cabinets may not be feasible from a financial or

operational perspective

Cabinets or automation phased in over

several years. Return on investment

quoted as 4 years

Traditional storage for

ward/departments remains in place

Rationalisation of aseptics services Loss of resilience, loss of income from

NHSE for aseptic services on site,

increased level of waste

Investment required to maintain quality

of aseptic dispensing units

21

5. ISSUES AND MITIGATIONS (will happen)

The following issues have been identified to happen during the course of the project:

Issues identified Mitigation Plans Risk Remaining

HEE funding and training course loss for 7 pre-

reg pharmacist posts may cease from July 18

due to changes

Uncertainty remains for training provision,

course changes and effects on service

capacity

Preparation of business to recruit

pharmacy technician (band 4) posts

prevent reduction from service provision

and capacity.

Business case may not be funded or

partial funding.

Unable to contribute to service provision

as currently part of workforce

HEE (HEWM) central funding and training

course loss for 6 pre-reg technician posts –

cease from Sept 2017

Preparation of business to secure

funding apprentices (student technician

posts and training course funds form

Trust.

Business case may not be funded or

partial funding. Negative impact on

pharmacy technician succession

planning.

Written by:

Tania Carruthers Clinical Director of Pharmacy

Divisional lead sign off: Dr Alan Jones, Divisional Director (Div 1)

Executive lead sign off: Julian Miller, Interim Finance Director

31.3.17