What are the challenges of successfully implementing homecare?

1. What are the challenges of successfully implementing homecare? Phil Deady, Pharmacy Procurement Manager Leeds Teaching Hospitals NHS Trust & Yorkshire and Humber NHS Pharmaceuticals Purchasing Consortia

2. Plan of session • Leeds Teaching Hospitals’ homecare medicines management services • Homecare service development: tasks and challenges • The Leeds team approach to homecare

3. 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

4. LTH homecare Top 10 by spend 07/08

6. Homecare service development: suggested model PATIENT/CARER

7. 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

8. 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?

9. 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

10. 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?

11. 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?

12. 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?

13. 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

14. 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

15. 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)

16. 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

17. 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

18. 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

19. 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

20. The Leeds approach to homecare:The procurement homecare team

21. 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

22. 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 Summary of roles and responsibilities

23. Key focus areas for LTH procurement homecare team

24. 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

25. 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