This event has been accredited by the College of Pharmacy Practice against the Royal Pharmaceutical Society's CPD compet

1. This event has been accredited by the College of Pharmacy Practice against the Royal Pharmaceutical Society's CPD competency framework.

2. Update “What is happening in the medicines homecare market?” Allan Karr, MRPharmS, DipM, MBA. Chairman, National Homecare Medicines Committee Allan Karr, MRPharmS, DipM, MBA. Chairman, National Homecare Medicines Committee

3. Medicine Homecare Services Aim is to : “Support patients with chronic and acute illnesses in the community.”

4. Medicines Supply Chain Homecare delivery service R&D Manufacturer Original patent holder EMEA MHRA Production unit Ward Production unit Specials Manufacturer Hospital pharmacy Distributor & Wholesaler Patient MEDICINES MANAGEMENT Generic Supplier Community pharmacy EMEA MHRA Production unit Dispensing doctor PI Supplier

5. Homecare Service Process  Consider product and type of service – obtain approval e.g. DTC, PCT’s • Methodology for recruiting/registering patients • Prescription process e.g. clinical check, chasing Rx • Agree performance standards with provider Contract with Homecare services provider Communication process between all parties Invoice and Payment Monitor and audit performance      Home care company can then provide the service e.g. purchase, dispense, deliver and administer medicines. General/Value added e.g. Collection of waste, education and support. Data management, Training, Clinical Governance & Audit   

6. Risk Management Potential Increasing Risk & Increasing Cost & Increasing Complexity Preparation Aseptic Nurse Administration Nurse Administration Dispensing Process Dispensing Process Dispensing Process Delivery Process Delivery Process Delivery Process Delivery Process Increasing value added service

7. Existing Therapeutic Areas • Cardiology • Oncology • Cystic fibrosis • Dermatology • Gastroenterology • Haematology • Haemophilia • HIV • Hypopituitarism • Lyposomal storage disorders • Multiple Sclerosis • Post-menopausal Osteoporosis • Primary Immunodeficiency Disease • Renal dialysis and transplant • Schizophrenia • Respiratory disease • Rheumatoid arthritis • Rheumatology • Thalassaemia

8. Current medicinal products that have been supplied via Homecare Services • Home parental nutrition • IVF Treatments • Adult growth hormone • Milrinone • Trastuzumab • Epoetin • Anitbiotics • Etanercept • Efalizumam • Methotrexate • Adalimumab • Imiglucerase • Epoetin • Blood coagulation factor VIII & IX • Anti-retrovirals • Somatropin (human growth hormone) • Desferrioxamine • Interferon • Beta-interferon • Topotecan  • Teraparatide • IV/SC immunoglobulin • Darbepoetin  • Immunosuppressants for renal transplant • Clozapine  • Terbutaline • Adalimumab • Infliximab • Teraparatide • Methotrexate  • Desferrioxamine • Herceptin

9. Market Size & Growth

10. Current List of Homecare Providers Air products Calea Uk Careology Central Home Care (Alliance Unichem) Flexible Home Care Health Care at Home/ADS Evolution (AAH/Celesio) Intecare Nutricia Clinical Care Bupa/Clinovia Polarspeed Mawdsley Brooks Baxter/Willow Medco DHL

11. What are the benefits of Medicines Homecare Discharge patients sooner Reduce non-essential OPD appointments & admissions Moves workload from dispensary to administration Reduced waiting times Financial?  Organisation Increased choice Time saving - no waiting in OPD Reduced travel Convenience Quality of life – less hassle Less risk of HCAI  Patient Capacity gains Reduces stress in the dispensary Refocuses skill mix and clinical priorities Reduced waiting times for non-home care patients.  Pharmacy Policy Capacity Efficiency Control Patient choice Financial  Primary care

12. Benefits/Drivers Pharma Industry Perspective Company is closer to the patient. Increase opportunity for DTC marketing? Fewer control systems? Ability to offer reduced prices to customers without loss of profit e.g. part of NICE “patient access scheme” process. More control over the supply chain   

13. The Procurement Framework and Contracting Models 1. Host Trust Tender Model • Trust selects the service • Specification developed and tendered • Trusts selects a preferred provider 2. Pharma CompanyModel • Pharma tender or selection • New distribution route • No NHS involvement      

14. Models of Distribution Hospitals/ PCT’s/CPH’s Hospitals/ PCT’s/CPH’s Homecare Supplies Homecare Supplies Pharmaceutical Manufacturers Pharmaceutical Manufacturers Relationship? No Tendering Tendering Relationship? No Tendering Tendering

15. The Governance and Quality Issues - with outsourcing comes risk Services are not the same as products e.g.  Absence of inventory from trust perspective People as part of the service Greater involvement of customers Greater difficulties in maintaining quality standards Importance of time factor    

16. The Governance and Quality Issues - with outsourcing comes risk  Prescription checking and validation Aseptic preparation and administration Technical and clinical advice Responsibilities and liabilities of each party Performance standards Error and complaint monitoring     

17. The Clinical Governance Framework Risk management e.g. assessment and risk reduction techniques Establishment of quality systems and performance standards Inclusion in Trust Clinical Governance procedures    Must have a clear contractual relationship between purchaser & provider

18. What are the Outstanding Issues?  NHS strategy e.g. private sector, do-it- yourself (OPAT), FP10(HP)? Confirmation/clarity on VAT position Agreed product list for home care Ensure adherence to professional practice & Clinical Governance. Operational systems need improving e.g. employing home care co-ordinators, electronic links with home care suppliers. Data management     

19. What are the Outstanding Issues?        Clarification of PCT/GP/Commissioners role Fit in new financial structure e.g.Tariffs, Financial resources Relationship between manufacturer, home care service provider and Trusts Managing a contracted service effectively Development and use of common contracts Development of performance standards & audit arrangements? Unbundling of costs from products

20. What are the Outstanding Issues? • What will be the impact of new home care services suppliers Recognition that the home care market exists and is becoming more important  

21. Role of the National medicines Homecare Committee Hospitals/PCTs/CPH’s NHMC role Effective Working Relationships Pharmaceutical Manufacturers Home Care Supplies