What are the challenges of successfully implementing homecare?

Phil Deady, Pharmacy Procurement ManagerLeeds Teaching Hospitals NHS Trust &

Yorkshire and Humber NHS Pharmaceuticals Purchasing Consortia

Plan of session

Leeds Teaching Hospitals’ homecare medicines management services

Homecare service development: tasks and challenges

The Leeds team approach to homecare

LTH homecare medicinesmanagement services

First homecare patient early 1980’s All homecare medicines handled

through Pharmacy except medicinal blood products

3,300 active patients 07/08 Total spend 07/08 £12.6M (21% of

total medicine spend £59.1M) 23 different homecare therapies Five homecare companies

LTH homecare Top 10 by spend 07/08

1. Etanercept

2. Medicines for HIV/AIDS

3. Medicines for Multiple Sclerosis

4. Intravenous antibiotics for Cystic Fibrosis

5. Parenteral Nutrition

6. Adalimumab

7. Immunoglobulins

8. Imatanib

9. Erythropoietins

10. Liver transplant medicines

Homecare service development: suggested model

PATIENT/CARER

Homecareservice proposal

Liaise withCommissioners

Servicespecification

Horizon scanning

MultidisciplinaryTeamwork

Tenderprocess

Change Management

HOMECAREMEDICINESSTRATEGY

PerformanceManagement

Homecare Medicines Management Strategy

Define homecare medicines management services Proposed direction and scope for homecare Reference national policy and guidance Propose systems and processes for developing homecare

services Define key stakeholders Summarise benefits and risks Propose methods to identify homecare opportunities Propose methods of tendering and ongoing management

of homecare services

Horizon scanning

Specialist pharmacists routinely do horizon scanning for medicines due for launch to the UK market

Need to horizon scan for new medicines that will be launched with homecare services included

Need to horizon scan for new medicines with the potential for homecare services

Start discussions with commissioners on new medicines homecare services at this point?

Homecare service proposals

Ideas can come from specialist pharmacists, nurses, clinicians, patients/carers (reactive)

Proposals also come from homecare companies LTH procurement homecare team do an annual

review to identify potentially advantageous homecare services (pro-active)

LTH procurement staff use a “Homecare Medicines Submission Form” to gather and analyse information on homecare service proposals

Homecare service proposals

“Homecare Medicines Submission Form” Product information

Drug(s) for consideration Which disease(s)? What is the patient population? How does the patient currently receive treatment? How is the treatment prescribed? What monitoring is needed? Is the medicine self administered or not? Are there any training needs? Are any ancillary items needed? Is aseptic compounding required?

Homecare service proposals

“Homecare Medicines Submission Form” Financial

Which clinical management team? Which Consultant(s)? Current annual spend? Current VAT status on medicine(s) Is treatment Tariff or excluded from Tariff? Is there potential loss of Trust income?

Homecare service proposals

“Homecare Medicines Submission Form” Option assessment

Advantages Disadvantages Risks/Governance issues

Should homecare services be submitted to the Trust Drug and Therapeutics Committee?

Multidisciplinary teamwork

Ensure thorough involvement with Pharmacy procurement team Consultant Specialist Nurse Specialist Pharmacist Patient/Carer representative Business Manager/Finance Manager Other health professionals depending on service

Commissioners

When to engage in process? Depends on your relationship with your local

commissioners Depends on Tariff status of the medicine May be as early as horizon scanning May be at tender specification or later Potential to include Trust administrative costs

and resource requirements into a business case

Service specification

Work with multidisciplinary team to agree service specification

Use templates from the National Homecare Medicines Committee/PASA website

Consider all aspects of the homecare service as per NHMC/PASA guidance

Consider developing service specifications for non Trust- contracted homecare services (usually pharma-contracted)

Tender process

Define the financial aspects of your homecare service Current costs of medicines Assessment of current non-medicine costs

Assess the method required for tendering according to your Trust Standard Financial Instructions (SFIs) and EU Regulations Competitive quote Trust tender EU tender

Tender process

Ensure a multidisciplinary clinical project group is involved all the way along, including adjudication

Patient and carer involvement Presentations from homecare companies Be mindful of need for change management

plans

Change management

Change management planning needed for Change in supply from hospital to homecare Change from one homecare provider to another Multi-Trust homecare services

Points to consider Agreed start dates (may be phased) and project plan Be mindful of Data Protection Act Agree Trust staff roles and responsibilities Agree Homecare staff roles and responsibilities

Further information on the NHMC/PASA website

Performance management

Essential part of the homecare service Ensures your patients are getting the service you

require from the homecare provider Ensure tender specification includes information

on performance management and key performance indicators

Consider performance management of non Trust-contracted homecare services

More information in Jane Kelly’s session this afternoon and the NHMC/PASA website

The Leeds approach to homecare:The procurement homecare team

Phil DeadyPharmacy Procurement

Manager

JanePharmacy Procurement

Project Manager0.75wte Band 8B

MichaelSpecialist TechnicianHomecare Medicines

Management1.0wte Band 6

AmandaPharmacy Contracts

Manager1.0wte Band 7

AnnePharmacy Procurement

Business Manager1.0wte Band 6

SueHomecare Invoice

Administrator1.0wte Band 2

LindaHomecare Invoice

Administrator1.0wte Band 2

Summary of roles and responsibilities

Pharmacy Procurement Project Manager

• Manages the Trust’s strategy for homecare medicines management

• Identifies new opportunities for homecare provision

• Assessment of proposed homecare services for patient focus and cost effectiveness

• Manages risk management issues

• Pharmacist expertise for homecare service development

Specialist Technician Homecare Medicines Management

• Manages the operational aspects of homecare medicines services

• Implements new homecare services

• Change management of contracts for homecare services

• Performance management• Patient involvement• Error and incident reporting

Summary of roles and responsibilities

Pharmacy Contracts Manager

• CIPS qualified

• Equivalent of PASA Category Manager

• Has LTH and regional contracting roles

• Manages the tendering process for homecare medicines services

• Contractual reference for supplier performance management

• Ensures processes meet EU and LTH guidance

Pharmacy Procurement Business Manager

• Manages the order/invoice process for homecare medicines services

• Manages a team of administrative staff responsible for the certification and payment of homecare invoices

• Provides expert Pharmacy IT system (JAC) coding/costing advice on homecare services

• Acts at interface of homecare contractors’ finance departments and LTH

• Manages data for non-tariff medicines charging to PCOs

Key focus areas for LTH procurement homecare team

Operations

Finance and Data

Strategy

LTH Homecare funding

Current staff costs in procurement team and clinical pharmacy teams for homecare roles ~£164k pa

~£50 per homecare patient pa Resource bids from LTH or PCO contract savings Resource bid from regional drug contract management

SLA Contractual funding as value-added services in homecare

contracts Re-engineering of existing posts

Summary: What are the challenges for successfully implementing homecare?

Be patient centred at all times Have a strategy for homecare medicines services Keep an eye on new developments Analyse requests for homecare services Be pro-active where possible Work with stakeholders in your own and other

organisations, including all sectors of the NHS, homecare and pharmaceutical companies

Bid or contract for resource to administer homecare services

Make use of the National Homecare Medicines Committee/PASA website