LPP: How to work in partnership with the LPPJasbinder Khambh, Pharmacy & Medicines Use & Procurement Lead for Primary Care | NHS London Procurement Partnership

Managing Medicines in the NHS – London

Perspective

Jas Khambh

Pharmacy & Medicines Use & Procurement Operational Lead & Lead for Primary Care, LPP

Tim RootStrategic Pharmaceutical Lead, LPP

Today’s Objectives

•An overview of how medicines are managed in the NHS (in London)

•An overview of the Medicines Use and Procurement QIPP Workstreams in London

The New Landscape

•Abolition of PCTs & SHAs•Commissioning power shared between NHS England (was NHS Commissioning Board) and GPs•So we have:

NHS England – direct commissioning & oversight of CCG commissioning

Clinical commissioning groups – direct commissioning

Local authorities: social services, public health services

Managing medicines

•National guidance and priorities• NHS Constitution• Innovation health and wealth• NICE – good practice guidance on developing

and updating local formularies (Dec 2012)•Local guidance & priorities

• Formularies•Variance across the country

• Decision making groups: stakeholder engagement, processes

• Criteria for decision making• Decision outputs

Managing the introduction of new medicines – factors considered

•Patient safety•Budget impact•Strength of evidence

• Place in therapy• Clinical effectiveness• Cost effectiveness

•Equity of access•Stakeholder views

On the horizon?

• Continuing fiscal constraint• Value-based pricing• NHS England contracting for medicines• Greater consistency about commissioning for high-cost

PbRX medicines

Pan-London Management of Medicines through the QIPP agenda

•LPP •Built on

• 30 years medicines management & medicines procurement expertise in acute trusts

• Pharmacy & Medicines Management work of the LPP.

•There are 3 workstreams:Primary Care Acute & MH Trusts (Secondary Care)Cross-sector

9

Pharmacy & Medicines Use & Procurement Governance Model for London

LPP & Medicines Use and Procurement Productivity

Steering Group

Ad hoc projects / Task & finish group

LPP Pharmacy Medicines

Management Group/ Secondary care QIPP Sub-Group

LPP Steering BoardCommercial Board / Productivity PLG at

NHSL

NHS England Trusts and PCTs

QIPP guidance

Monthly QIPP

reportingSubscriptions

Monthly QIPP workstream reporting

High level comment

on workstream

Monthly project reporting against plan

Monthly project reporting against plan

Primary Care QIPP Sub-Group

Project initiation,

milestone and results

reporting

Combined and co-ordinated LPP

and productivity reporting

NHS London Procurement Partnership – Pharmacy, Medicines Use & Procurement Workstream

Key Objectives and Priorities for 2013 - 2015

32 CCGS and

3 CSUs

QIPP Promotes & supports

across the NHS in London:

Evidence based choice of medicines Safe , cost-

effective use of medicines (£)

Reduced medicines waste (£)

Recommendations and advice to prescribers and medicines management

teams Specialist analytics &

informatics support, key performance indicators

and dashboards

Management of primary care rebate

schemes (£)

Medicines Optimisation

Safe use of medicines and improved quality of

patient care: optimised patient

experience & treatment outcomes

Medicines optimisation as part of routine

practiceContinuity & quality of care involving medicines

use, across the

primary/secondary/tertiary/social care interfaces

Specialist pharmaceutical support

for optimisation of prescribing for complex therapeutic areas such as

mental health, cancer

chemotherapy , nutrition and dietetics (£)

Collaboration and sharing of best

practice London-wide

stakeholder engagement and working groups

Pan-London solutions Do once and share : efficient use of limited

resources (£) Facilitated access to

key advice & information at www.lpp.nhs.uk (£)

Training and education Collaborative working

with external stakeholders e.g.

pharmaceutical industry

Procurement of the most cost-

effective medicines for

acute & mental health trusts

Expert knowledge and specialist expertise from

medicines procurement specialists Pan-London contracts to secure best value-for-

money (£) Strategic clinical

medicines procurement (£)

Support for management of expenditure on:

high cost PBR excluded drugs (£)

supply of medicine through Homecare (£) Patient Access

Schemes (£)

Acute and Mental

Health Trusts

Note: All of these objectives aim to improve productivity and quality of patient care. Objectives marked (£) can provide significant financial savings to the local health economy in London. These savings may be quantified in terms of return in investment and against key performance indicators.

Primary Care QIPP Workstream

• Engagement with CCGs/CSUs

• Collaborative approach

• Primary Care QIPP sub-group

• Priority setting

• Medicines Information & Specialist Pharmacy Services support

• Data collection, analysis & reporting

• Dashboards

• Rebate schemes

2013/14 priorities

• Engagement with new stakeholder groups• CCGs, CSUs, NHS England

• Quality & Safety• Cross-sector• Extend & Refine data presentation• Split dashboards• Acute & MH Trusts

• Define® benchmarking tool• Primary Care

• Financial• Quality & safety• Mental Health• Nutrition

Primary Care Clinical Priorities for 2012/13

Cardiovascular

•Renin-angiotensin system drugs•Statins•Ezetimibe

Endocrine

•Diabetes•Osteoporosis

Central Nervous System

•Prescribing in mental health•Low dose antipsychotics•Hypnotics•Venlafaxine•Pain control

Other Therapeutic areas

•Glucosamine•Prednisolone•Wound care•Specials•Vitamin D•Oral nutritional supplements•Antimicrobials

Tools and resourceswww.lpp.nhs.uk

• Dashboards• KPIs and Red Amber Green ratings • CCG and CSU level (not practice level)• Benchmarked data including savings / lost

opportunity• Key messages bulletins with MI• Supporting information for procurement• Newsletters for chief executives• Working groups• Specialist pharmacist advice & tools to support

implementation• Events

LPP website

LPP website

Trend graphs for PCTs/Clusters

Dashboard Benchmarking Graphs

Secondary care dashboard

Final points

• Engagement with the clinical commissioning groups• Understand new stakeholders & their priorities

• Support CCGs and Trusts to improve performance• Support local QIPP plans

• Share good practice• Pan-London approach• Collaborative working between primary & secondary

care• Enhance Dashboards• Collaborative working with community pharmacists• Collaborative working with the pharmaceutical industry

www.lpp.nhs.uk

Jasbinder.khambh@lpp.nhs.ukTim.root@chelwest.nhs.uk