how to work in partnership with the lpp
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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
[email protected]@chelwest.nhs.uk