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QIPP – viewed from a Foundation Trust

The presentation by Tony West, Chief Pharmacist at Guy’s and St. Thomas’ NHS Foundation Trust, highlights critical financial challenges faced by NHS trusts, including a stagnant growth rate and significant savings targets. With a turnover of £1bn, the trust must adapt to a new landscape marked by reduced funding, tariff limitations, and quality metrics. West emphasizes the need for efficiency, waste reduction, and driving value for money while maintaining quality care. He explores the implications of structural changes, supply chain inefficiencies, and the potential for innovative partnerships to enhance service delivery.

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QIPP – viewed from a Foundation Trust

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  1. QIPP – viewed from a Foundation Trust Tony West PDIG Committee Member Chief Pharmacist, Guy’s & St Thomas’ NHS Foundation Trust

  2. The Background • GSTFT - < £1 bn turnover • Part of King’s Health Partners • KCH, SLaM & KCL... . £2 bn turnover • 2/3 activity is ‘specialist’ care • 1 million patient contacts per year • No PFI build • Viewed as ‘successful’... up until now!!!

  3. London SHA – the perfect storm ? Shift to ‘lower cost’ setting

  4. London SHA – the perfect storm ? Decommissioning

  5. Add in the national picture... • ‘Growth’ at 0.1 % above GDP deflator • Tariff • Zero growth in PbR tariff... so any growth funding for NHS will barely cover volume increase • Non-elective capped at 2008/09 activity, over activity only paid at 30 % • Looking to not pay anything for re-admissions • %age of tariff ‘withheld’ for quality... CQUINs

  6. What does that mean ? • CIP target for: • 2010 / 11 – 10% • 2011 / 12 – 5 - 10% • 2012 / 13 – 5 - 10% = • Much more for the same or • Same for much less or • Less for an awful lot less

  7. Which brings me nicely to medicines.. • London SHA planning assumptions • ‘core’... £286 m savings by 2016/17 • ‘aggressive’.... £455 m savings • GSTFT • £ 75 m.... > 10% of ‘clinical’ spend • 2/3 of which is PbR excluded... pass thru • Local PCTs looking for savings on above • PbR excluded medicines charged at acquisition cost... i.e. we add NO overhead • 2.5 % rise in VAT adds £1m extra cost

  8. QIPP - KHP • Quality • Safety • Outcome • Patient experience • Innovation • Prevention • Performance • Excellence in • Clinical care • Education & training • Research ( + application of research) • Partners, whether NHS or Academia have to address financials

  9. So... what can you do to help us ? • Understand our, i.e. NHS, environment • Cash will be tight... must recognise that • we cannot afford waste • we have to drive efficiency • we must get value for money • NHS, patients and tax payers generally • we must not compromise quality • Revolution rather than evolution ?

  10. What doesn’t work for us ? • Supply chain inefficiency • Out of stock • Short orders • Exceeding ‘quota’ • Packaging incompatible with our automation • Multiple coding • Lack of integration

  11. What doesn’t work for us ? • For the introduction of new medicines (which we DO want to see) • Duplication of effort... • Patient Access schemes • ‘Phoney’ orphan medicines • Blatant attempts to extend patent life while offering little or no value

  12. What doesn’t work for us ? • Lack of transparency • Homecare • Valuable, but if don’t know what it actually costs how can we determine real ‘value for money’ ? • Where a tied deal is with one provider.. what room for innovation and the use of ‘small businesses’ such as community pharmacists ? • VAT • UK position unique in EU... it will get challenged • Tax avoidance not a sound base for any business • Do current initiatives offer the UK tax payer true value for money ?

  13. The sad facts... UK has one of poorest access to new medicines for its citizens Patients still don’t get benefit from medicines they are prescribed... the adherence / concordance agenda Transfer of care still a major problem

  14. The opportunities... • NHS structural changes... high risk but right direction • ‘Value based pricing’... the end of the UK being the ‘reference price’ ? • Supply chain is inefficient.. there must be savings for all? • Collaboration... possibly partnerships given the ‘any willing provider’ thrust of White Paper

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