A Hospital without a Pharmacy - building a first

class pharmacy service

Anne Cope Associate Director of PharmacyUniversity Hospital Birmingham

NHS Foundation Trust

Introduction• Strategic context

• Medicines Management

• Workforce redesign

• New Hospital

• Decentralised pharmacy service

• Challenges ahead

• Summary

Strategic context

• Commissioning a patient led NHS

• Choice, access and responsiveness

• National programme for IT – Connecting for

Health• Our Health, Our Care, Our Say

• Shifting the balance of power

• Foundation Trusts

• Payment by Results

• Cost Improvement Programmes

Strategic context – medicines management

• Medicines Management Framework

• A Vision for Pharmacy

• Building a Safer NHS for Patients

• Standards for Better Health

• Choosing Health through Pharmacy

• The Best Medicine

Medicines Management• Healthcare Commission

• Acute Hospital Portfolio – The Best Medicine• Mental Health

• Linked to Annual Health Check

• Patient focus• Clinical focus• Efficiency and capability

• Benchmarking

Changes to Pharmacy Workforce

• Prescribing roles

• Consultant Pharmacists

• Skill-mix changes

• Pharmacists with a Special Interest

What do patients want

• The best from their medicines

• Safe passage

• Information

• Flexibility

• And FAST !

About UHB

• Currently two sites– Queen Elizabeth (1938) and Selly Oak

(1897)• £357m annual income• ~1200 beds• 500,000 patient contacts per year• 6,700 employees• Foundation Trust since June 2004• Broad range of specialties • Royal Centre for Defence Medicine• R&D centre

Pharmacy and medicines at UHB

• 135 staff

• £35M pa on medicines

• UHB Medicines “lead manufacturing unit”

• Some “ward based pharmacy” services

• Electronic prescribing (PICS)

• Strong support within Trust for leadership and modernisation

• Rating of “Fair” for Medicines Management in Acute Hospital Portfolio

Why have a hospital without a pharmacy

• Deliver a high quality, patient focused service, through safe, clinical and cost effective use of medicines

• Make the best use of the skills of the pharmacy team, within a multidisciplinary environment

• Develop and utilise innovative technology to gain efficiencies and free up staff

• Work collaboratively with patients and all partners, including the local health community and the private sector

New Hospital Overview

How do we plan to deliver an effective medicines supply chain?

• Decentralised automation and pharmacy service

• Linked with e-prescribing and administration

• Supplier delivery direct to automation?

• Joint venture with private sector

• Contingency Plan

Working with commercial partners

The 4 tests:

• Is it in the interest of patients?

• Is it consistent with local/national strategies?

• Is it VFM?

• Is it consistent with public sector values?

Current Patient Journey

In-Patient Supply New Hospital

Medication prescribed electronically

Professionally checked by pharmacist and supply authorised

if needed

Medication collected from

automation module

Out-Patient Supply New Hospital

Options:

• Automated “in house” pharmacy in New Hospital

• Private sector run pharmacy

• Electronic transmission of prescriptions (ETP) to private sector supplier

• Homecare services

Pharmacy Stores

Options:

• Some retained stores function

• Direct delivery by supply partner to clinical area or automation units

• UHB Warehouse -WDL

Challenges: decentralised pharmacy service

• Selling the vision

• Ward based pharmacy/medicines management team

• Patients own medication/ self administration/

dispensing for discharge

• Role of clinical specialists

• Corporate/Clinical Governance

• Short timescale

• Supply chain issues

Challenges: Supply chain issues

• Availability of products through a single supplier

• Ensuring Value for Money

• Prescribers and key stakeholders as integral part of decision making

• Response to emergencies

• Non robot inventory

• Medicines governance arrangements:

- JIT - notification of shortages- interchangeability of products- potential for medication errors- critical medicines – stock holding - cold chain maintenance

Where are we now?

• Competitive Dialogue Procurement Process

• OEJU issued Jan 2007 followed by PPQ and Information Memo in Feb 2007

• Divided into Lots 1 and 2

• ITD1 bidders responses received and currently under evaluation

• ITD2 documentation being prepared

Next Steps

• Notify bidders of outcome of ITD1

• Issue ITD2 (probably end of July)

• Evaluate ITD2 bidder responses    

• Undertake face to face dialogue with bidders

• Issue ITT documentation

• Plan SOH pilot

• Contingency plan

Summary

• NHS continues to undergo significant transition.

• Changing the existing pharmacy delivery model will be challenging.

• This will require a resilient corporate and clinical governance framework to ensure delivery of optimal organisational and patient benefits.