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NOEL J STAUNTON BSc, MRPharmS, MBA, Dip H.Econ

2. TODAY. NHS reorganisation

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NOEL J STAUNTON BSc, MRPharmS, MBA, Dip H.Econ

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    1. 1 NOEL J STAUNTON (BSc, MRPharmS, MBA, Dip H.Econ) Pharmaceutical Consultant-3i consultancy ltd Work with Pharma companies (Pfizer, GSK, Lilly, BI, Novartis, Shire, Galderma, Stiefel, Takeda, Lundbeck etc, etc) Mob 07980 148711. E mail noel@3iconsultancy.com

    2. 2 TODAY NHS reorganisation – why? Payment By Results (PBR) – how this encourages prescribing National and local initiatives to contain prescribing The future

    3. 3 NHS investment hasn’t delivered (Ref. P Hewitt, 20th Sept ’06) Why reorganise the NHS?

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    8. 8 MOST (ALL?) NHS CHANGES REVOLVE AROUND SPENDING MORE IN PRIMARY CARE AND LESS IN SECONDARY CARE PBR PBC GP contract, Community Pharmacy contract, Consultants contract Nurse and Pharmacist Prescribing White Paper Managing long term conditions Etc, Etc, Etc

    9. 9 UK is still a slow adopter of new medicines and appliances and still spends less than most other developed countries. What about NHS spend on pharmaceuticals?

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    12. 12 PBR Copy of US system which DOES reduce hospital stay (Ref HSJ, 9th Dec 04, P 16) Old system - block contracts PAY FOR WHOLE POPLUATION Can’t disinvest from secondary care New system - PBR PAY FOR EACH INDIVIDUAL PATIENT CAN DISINVEST FROM HOSPITALS

    13. 13 PBR International phenomenon DRGs first in the USA -Medicare France uses US DRGs Italy uses modified version of US DRG system Germany & Netherlands from 2003 England, Australia, Norway, Austria, Finland, Sweden, Japan and Canada have own case mix tools

    14. 14 The tariff covers EVERYTHING that happens to the patient whilst in hospital (drugs, tests etc) Overseas PBR has stimulated primary care prescribing (in order to prevent expensive hospital tariffs) Overseas PBR has threatened secondary care prescribing (the hospital earns the same amount regardless of which drug they use) UNLESS the drug reduces length of stay Birth of real pharmaco economics in UK? PBR

    15. 15 National and local incentives to contain prescribing Local schemes include: PCT prescribing incentive schemes. Grey lists/drugs less desirable/red lists National schemes include: NHS Institute for Innovation – targets to prescribe patent expired drugs. Clinical reviews e.g. NICE, SMC, NPC, UKMI, MTRAC etc). GMS contract appendix 8, excessive or inappropriate prescribing and medicines management points. PBC savings

    16. 16 What action can a PCT actually take against a high prescribing GP? PCTs interpret things differently. In July 2002 the WHO asked the UN: “What, in your honest opinion, can we do to solve the problem of the shortage of food in the rest of the world?”

    17. 17 Didn’t work because: East Europeans didn’t understand the word “honest” Chinese didn’t understand – “opinion” Middle Easterners didn’t understand – “solve” South Americans didn’t understand – “problem” Western Europeans didn’t understand – “shortage” Africans didn’t understand – “food” Americans didn’t understand – “rest of the world”

    18. 18 What action can a PCT actually take against a high prescribing GP? Clause 304 of the GP contract legislation states: “The Contractor shall not prescribe drugs, medicines or appliances whose cost and quantity, in relation to any patient, is, by reason of the character of the drug, medicine or appliance in question, in excess of that which was reasonably necessary for the proper treatment of that patient”. (http://www.dh.gov.uk/assetRoot/04/12/67/07/04126707.pdf) A PCO would therefore have to identify excessive prescribing for an individual patient

    19. 19 Short term Continued emphasis on cost minimisation of prescribing Medium term PBR kicks in and the UK starts to see prescribing as an investment Long term UK has similar prescribing rates to rest of Europe and N America The Future?

    20. 20 NOEL J STAUNTON (BSc, MRPharmS, MBA, Dip H.Econ) Pharmaceutical Consultant-3i consultancy ltd Work with Pharma companies (Pfizer, GSK, Lilly, BI, Novartis, Shire, Galderma, Stiefel, Takeda, Lundbeck etc, etc) Mob 07980 148711. E mail noel@3iconsultancy.com

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