this event has been accredited by the college of pharmacy practice against the royal pharmaceutical...
TRANSCRIPT
This event has been accredited by the College of Pharmacy Practice against the Royal Pharmaceutical Society's CPD competency framework.
Allan Karr, MRPharmS, DipM, MBA.Chairman, National Homecare Medicines Committee
Update
“What is happening in the medicines homecare market?”
Allan Karr, MRPharmS, DipM, MBA.Chairman, National Homecare Medicines Committee
Medicine Homecare Services
“Support patients with chronic and acute illnesses
in the community.”
Aim is to :
Medicines Supply Chain
Hospital pharmacy
Production unit
R&DManufacturer
Original patent holder
Specials Manufacturer
Generic Supplier
PI Supplier
Patient
Production
unit
Community pharmacy
Dispensing doctor
Ward
ME
DIC
INE
S M
AN
AG
EM
EN
T
EMEA
MHRA
EMEA
MHRA
Distributor & Wholesaler
Homecare delivery service
Production unit
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
Risk Management Potential
Increasing value added service
Delivery Process
Nurse Administration
Increasing Risk
& Increasing Cost
& Increasing Complexity
Dispensing Process
Delivery Process
Dispensing Process
Delivery Process Delivery Process
Dispensing Process
Nurse Administration
Preparation Aseptic
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
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
Market Size & Growth • Market Size £960m
• Market Growth +18% pa
£200m
Med Consumables
Fluids
Nutrician
Other
Pharma
£180m
£241m £300m
£39m
Continence£45m
Urology£85m
Stoma£150m
Insulin Pumps£20m
Diabetes£59m
MS£31m
Growth H.£68m
Cystic Fibrosis
£30m
Haemophilia.£53m Med
Consumables
Fluids
Nutrician
Other
Pharma
£180m
£241m £300m
£39m
Continence£45m
Urology£85m
Stoma£150m
Insulin Pumps£20m
Diabetes£59m
MS£31m
Growth H.£68m
Cystic Fibrosis
£30m
Haemophilia.£53m
£180m
£241m £300m
£39m
Continence£45m
Urology£85m
Stoma£150m
Insulin Pumps£20m
Diabetes£59m
MS£31m
Growth H.£68m
Cystic Fibrosis
£30m
Haemophilia.£53m
Source: Overall Market & Growth: AT Kerney Market Data, Provider Revenue & Growth Estimates, DHL commissioned
Therapy Split: DHL Commissioned Primary Research, Provider & Pharmaco Revenue Data
Current List of Homecare Providers
DHL
Medco
Baxter/Willow
Mawdsley BrooksPolarspeedBupa/Clinovia
Nutricia Clinical CareIntecareEvolution
(AAH/Celesio)
Health Care at Home/ADS
Flexible Home CareCentral Home Care
(Alliance Unichem)
CareologyCalea UkAir products
What are the benefits of Medicines Homecare
Policy Capacity Efficiency Control Patient choice Financial
Primary care
Capacity gains Reduces stress in the dispensary Refocuses skill mix and clinical priorities Reduced waiting times for non-home care patients.
Pharmacy
Increased choice Time saving - no waiting in OPD Reduced travel Convenience Quality of life – less hassle Less risk of HCAI
Patient
Discharge patients sooner Reduce non-essential OPD appointments & admissions Moves workload from dispensary to administration Reduced waiting times Financial?
Organisation
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
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 Company Model
Pharma tender or selection
New distribution route
No NHS involvement
Models of Distribution
TenderingRelationship? No Tendering
TenderingRelationship? No Tendering
Hospitals/PCT’s/CPH’s
Homecare Supplies
Pharmaceutical Manufacturers
Hospitals/PCT’s/CPH’s
Homecare Supplies
Pharmaceutical Manufacturers
The Governance and Quality Issues - with outsourcing comes risk
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
Services are not the same as products e.g.
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
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
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
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
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
Role of the National medicines Homecare Committee
Hospitals/PCTs/CPH’s
Pharmaceutical Manufacturers
Home CareSupplies
NHMC role
Effective Working
Relationships