Paper 7

Reporting to: Trust Board - 24th September 2015

Title NHS eProcurement Strategy

Sponsoring Director Neil Nisbet, Finance Director

Author(s) Neil Nisbet, Finance Director

Previously considered by

Executive Summary

The Department of Health have placed a requirement upon Acute Trusts to improve their procurement processes through the implementation of information technology solutions. In particular a recommendation has been made that Acute Trusts construct local adoption plans in respect of two key standards GS1 and PEPPOL (Pan European Pubic Procurement On-line). As reported to Trust Board in June 2015, the Trust commissioned a framework supplier to assist the Trust produce an Adoption Plan, which was submitted to the Department of Health in June 2015. A review of the impact of the NHS eProcurement Strategy and the implementation of GS1 and PEPPOL standards at SaTH has also been undertaken and the findings of this are outlined in the attached extract from the Compliance Report and the GS1 and PEPPOL Adoption Plan. The full report is included in the Board Information Pack.

Strategic Priorities 1. Quality and Safety Reduce harm, deliver best clinical outcomes and improve patient experience.

Address the existing capacity shortfall and process issues to consistently deliver national healthcare standards

Develop a clinical strategy that ensures the safety and short term sustainability of our clinical services pending the outcome of the Future Fit Programme

To undertake a review of all current services at specialty level to inform future service and business decisions

Develop a sustainable long term clinical services strategy for the Trust to deliver our vision of future healthcare services through our Future Fit Programme

2. People Through our People Strategy develop, support and engage with our workforce to make our organisation a great place to work

3. Innovation Support service transformation and increased productivity through technology and continuous improvement strategies

4 Community and Partnership

Develop the principle of ‘agency’ in our community to support a prevention agenda and improve the health and well-being of the population

Embed a customer focussed approach and improve relationships through our stakeholder engagement strategies

5 Financial Strength: Sustainable Future

Develop a transition plan that ensures financial sustainability and addresses liquidity issues pending the outcome of the Future Fit Programme

Board Assurance Framework (BAF) Risks

If we do not deliver safe care then patients may suffer avoidable harm and poor clinical outcomes and experience If we do not implement our falls prevention strategy then patients may suffer serious injury If the local health and social care economy does not reduce the Fit To Transfer (FTT) waiting list from its current unacceptable levels then patients may suffer serious harm

Risk to sustainability of clinical services due to potential shortages of key clinical staff

If we do not achieve safe and efficient patient flow and improve our processes and capacity and demand planning then we will fail the national quality and performance standards If we do not get good levels of staff engagement to get a culture of continuous improvement then staff morale and patient outcomes may not improve If we do not have a clear clinical service vision then we may not deliver the best services to patients If we are unable to resolve our (historic) shortfall in liquidity and the structural imbalance in the Trust's Income & Expenditure position then we will not be able to fulfil our financial duties and address the modernisation of our ageing estate and equipment

Care Quality Commission (CQC) Domains

Safe

Effective

Caring

Responsive

Well led

Receive

Note

Review Approve

Recommendation The Board is asked to consider the recommendations and approve, in principle, the Adoption Plan to enable the Trust to proceed to the next stage.

Document Author: Kevin Sample

Document Owner: Geoff Warrington

Created Date: 26/06/15

Current Issue Date: 01/09/15

Version Number: 0.2

Document ID: RXW/0.2/DHeProcBR

The Shrewsbury and Telford Hospital NHS Trust

NHS eProcurement Strategy

GS1 and PEPPOL Compliance Board Report

Document Control

Document History

Issue No. Date Author Change (s)

0.1 26/06/15 Kevin Sample First Draft

0.2 01/09/15 Kevin Sample Additional use case detail added

Authorisations

Role Name Contact details Date Authorised

CFO Neil Nisbet Neil.nisbet@sath.nhs.uk 24/06/15

Distribution for information

Role Name

Non-Executive Director Brian Newman

Via e-mail to: Neil Nisbet, Paula Davies, Amanda Young

Contents

Document Control 2

Document History 2

Authorisations 2

Distribution for information 2

Contents 3

1. Background 5

1.1 Introduction 5

1.2 What the Trust is required to do 6

1.3 Document Purpose – GS1 and PEPPOL adoption 7

1.4 Board Endorsement 8

2. Executive Summary 9

2.1 Overview 9

2.2 Background 9

2.3 Approach 10

2.4 Key Findings, Recommendations and Conclusions 11

2.5 Executive Board sign off 22

3. NHS eProcurement Strategy 23

3.1 Overview 23

3.2 Technology Infrastructure 23

4. GS1 25

4.1 What is GS1 25

4.2 Why are the standards being implemented? 25

4.3 GS1 and PEPPOL adoption guidance 26

4.4 GS1 Use Cases 26

4.5 Global Location Number (GLN) 28

4.6 Global Trade Item Number (GTIN) 31

4.7 Global Document Type Identifier (GDTI) 32

4.8 Global Product Classification (GPC) 33

5. Pan European Public Procurement On Line (PEPPOL) 35

5.1 What is PEPPOL? 35

5.2 Implementing PEPPOL at the Trust 35

6. Findings and recommendations 37

6.1 Overview 37

6.2 Governance 37

6.3 GS1 Adoption 39

6.4 Capacity and GS1 Capability 44

6.5 PEPPOL Adoption 44

6.6 Communications 46

6.7 Reporting 47

7. Adoption Plan 48

Appendix A Glossary 49

Appendix B Staff Interviews and Meetings 51

B.1 Staff interviews and meetings 51

B.2 Key Stakeholders identified but not interviewed 51

Appendix C Department of Health e-Procurement Strategy 52

C.1 Department of Health e-Procurement 52

Appendix D GS1 and PEPPOL adoption plans guidance 53

D.1 Department of Health GS1 and PEPPOL implementation guidance 53

Appendix E The Shrewsbury and Telford Hospital NHS Trust GS1 and PEPPOL Adoption Plan 54

E.1 GS1 and PEPPOL Adoption Plan 54

Appendix F The Shrewsbury and Telford Hospital NHS Trust GS1 and PEPPOL Benefits Calculator68

F.1 Cost and Benefit Calculator 68

Appendix G The Shrewsbury and Telford Hospital NHS Trust GS1 and PEPPOL Definition Factors70

1. Background

1.1 Introduction

Procurement in the NHS has been debated and discussed over a number of years. There have been several Department of Health (DH) publications and press articles identifying that the NHS lags behind other industries in terms of how goods and services are procured. Procurement in the NHS is fragmented resulting in huge variations in technology adoption, process optimisation, prices paid for products and adoption of standards to trace products consumed in clinical activity.

The adoption of data standards, technology and best practice processes will deliver significant, sustainable savings for the NHS and ultimately improve the care provided to patients.

The Department of Health “NHS eProcurement Strategy” (May 2014) is a major strategic initiative aimed at transforming supply chain and procurement processes across the NHS and covers technology, processes and standards. The NHS Standard Contract requires that all providers who deliver services commissioned by the NHS must adopt this strategy.

The strategy requires all NHS acute providers (and Non NHS providers) to comply with a comprehensive list of data, process and technology requirements in order to deliver sustainable savings to the NHS for years to come.

The model mandated by (via the terms and conditions of the Standard Contract) the Department of Health (DH) is deployed across other sectors (retail and manufacturing) and certain elements are being deployed in the health sectors in other countries (Australia, Canada and the USA).

The publication of the strategy presents a number of challenges to NHS acute providers to comply with the requirements of the strategy and rapidly deliver the benefits identified by the DH.

The main area of initial focus for the DH is on the acute provider sector, however all NHS organisations are asked to consider implementing the strategy recommendations.

1.2 What the Trust is required to do

The transformation is expected to take several years to be implemented in full across the NHS, however all Trusts are required to undertake the steps to begin the adoption of mandated global data standards (using GS1) and messaging standards (PEPPOL) for transmission of business messages between the Trust and its suppliers.

Areas of initial focus for the Trust are:

1. GS1 and PEPPOL standards are mandated by the DH as part of the NHS eProcurement Strategy.

2. All Trusts are required to develop a GS1 and PEPPOL adoption plan. The plan needs to be endorsed by the Trust Board by the end of June 2015.

3. Each Trust is required to appoint an Executive Director and a Non-Executive Director to champion and oversee the implementation of the strategy on behalf of their Trust.

4. To appoint a senior manager as a GS1 Lead.

5. All organisations will be expected to follow EU directives to implement a unique device identification system (UDI) for medical devices.

6. The Trusts are required to provide procurement and accounts payable data for the national comparison of a basket of goods.

The use of GS1 standards across the NHS will provide the opportunities for transparency, efficiency and significant savings across the NHS (see appendix F for Benefits Calculator). GS1 in itself is simply a coding standard, implementing coding standards in isolation will not generate significant savings without focus on technology, business process and change management. The plan that the Trust creates therefore needs to incorporate all these aspects.

The NHS eProcurement strategy and this document reference a number of acronyms and use technical terminology. To assist the reader, a glossary of terms and abbreviations used within this document is included in Appendix A.

The diagram above is taken directly from the NHS eProcurement strategy. It outlines the process, national technical infrastructure (to be established by the DH), local technical infrastructure (to be implemented by the Trust) and most importantly (for the purposes of this document) the adoption of GS1 and PEPPOL standards by both acute providers and their suppliers.

1.3 Document Purpose – GS1 and PEPPOL adoption

The primary purpose of this document is to provide the Trust with:

• An overview of the Trust’s current adoption of GS1 and PEPPOL compliant standards.

• A series of recommendations, which are outlined in section three, that the Trust should implement in order to successfully deliver the eProcurement Strategy.

• An Adoption Plan that supports the implementation of the strategy.

• A high level calculation of the benefits of implementing the strategy.

The Board report does not provide detailed financial data points. The high level financial model used has been provided by the DH with no modification. It is expected that a business case template is to be provided as guidance from the DH in due course for the Trust to populate. This will be completed during the start-up stage of the strategy implementation.

1.4 Board Endorsement

The Trust Board are requested to review and endorse the approach and the GS1 and PEPPOL adoption plan. They will approve the GS1 Lead to commence the next stage which is the generation of the business case based on each implementation area (as defined within the Adoption Plan in Appendix E).

The Trust, by having a Board endorsed GS1 and PEPPOL adoption plan in advance of the end of June 2015, meet the first required target of the strategy to maintain compliance.

2. Executive Summary

2.1 Overview

This section highlights the major findings and recommendations from our review, with further detail provided in the underlying sections in the report. This board report is formatted into sections covering;

• background (section 2.2);

• the approach (section 2.3);

• summary of the findings, recommendations and conclusions (section 2.4);

o Cost of implementation (section 2.4.1)

o benefits of implementation (section 2.4.2)

o risks (section 2.4.3)

• further information about what the DH eProcurement strategy is (section 3);

• what GS1 standards are (section 4);

• what PEPPOL is (section 5);

• detail of the findings, recommendations and conclusions (section 6);

• adoption plan (section 7 and appendix E); and

• Benefits Calculator (appendix F).

2.2 Background

The latest Operational Plan for The Shrewsbury and Telford Hospital NHS Trust (the Trust) notes that the Trust “recognises the need for whole system transformation and that the delivery of future healthcare requires ‘adaptive systems’”

The delivery of the operational plan is founded on 5 strategic objectives:

• Quality and Safety: Providing safe services, consistently delivering healthcare standards and improving the patient experience.

• People: Delivering a flexible workforce to meet the changing needs of our communities and the services that we deliver.

• Innovation: Striving for excellence through technology and innovation.

• Community and Partnership: Working with partners to improve the health and wellbeing of our community.

• Financial Strength: Building a sustainable future

The NHS eProcurement strategy supports the Trust’s vision to continue the development of the strategic plan. Through the application of GS1 standards across the supply chain the NHS eProcurement strategy enables the Trust to develop its processes and systems to deliver improved value whilst staff will feel valued by the elimination of non-value adding tasks. The NHS eProcurement strategy mandates the adoption of GS1 standards across the supply chain. An explanation of GS1 standards is in section 4. In essence the eProcurement strategy requires the Trust to adopt GS1 compliant unique identifiers relating to products, places and people.

The core GS1 standards that are required to be implemented in the adoption of the strategy are:

Global Location Number (GLN). Place

Global Trade Item Number (GTIN). Product

Global Service Relationship Number (GSRN). Person

Global Individual or Returnable Asset Identifier (GIAI/GRAI). Asset

Global Document Type Identifier (GDTI). Document

2.3 Approach

This document has been produced to review what the eProcurement strategy means for The Shrewsbury and Telford Hospital NHS Trust, what gaps exist in the current processes deployed at the Trust (in terms of process, technology and people) to successfully deploy, adopt and comply to GS1 and PEPPOL standards.

To develop the adoption plan and Benefits Calculator, a number of interviews have been carried out with the Trust’s stakeholders who are not only involved in the current supply chain processes at the Trust, but also those who are affected by the proposed changes, specifically the processes outlined by the DH’s ‘3 use cases’1. A list of staff interviewed is contained within Appendix B.

1 Covering inventory management, P2P processing, product recall.

Manufacturer Distributor Trust Legal entity

2.4 Key Findings, Recommendations and Conclusions

The Table below outlines the initial focus areas as defined in section 1.2. These are the minimum areas that require completion by the Trust to be compliant with the strategy.

The supplementary focus areas cover areas that should have been completed by the Trust prior as per other Depatment of Health published standards.

ID Initial Focus Area Finding Recommendation Strategic Area 1 Develop a GS1 and PEPPOL adoption plan.

The plan needs to be endorsed by the Trust by the end of June 2015.

Open - Currently under review The Trust Board are requested to consider and approve, in principle, the recommendations in this report and the enclosed adoption plan.

Patient Care Value Staff

2 Appoint a Non-Executive Director (NED). Complete – This is confirmed as Brian Newman N/A Staff 3 Appoint an Executive Director. Complete - This is confirmed as Neil Nisbet N/A (This is required if the GS1 Lead is not

an Executive Director) Staff

4 Appoint a senior manager as a GS1 Lead. Complete - This is confirmed as Neil Nisbet N/A Staff 5 Follow EU directives to implement a

unique device identification system (UDI) for medical devices.

Open - Current systems do not support the capture and storage of UDI data points such as serial number, batch/lot and expiration dates (where given).

The current IT systems (Oracle, Sema Helix) should be upgraded or new systems procured that support the capture and storage of GS1 standards as well as UDI data.

Preventative Care Patient Care

6 Provide procurement data for the national comparison of a basket of goods.

Open - The definition of the data set has not been issued by the Department of Health (as at publishing).

The Trust should keep up to date on publications on reporting and ensure that data can be extracted from any system holding financial information.

Value

ID Supplementary Focus Area Finding` Recommendation Strategic Area 1 All patient wristbands must have GS1

compliant machine readable content as well as human readable content as per the standard ISB1077 by September 2013.

Open – The Trust currently produce compliant patient wristbands. However, there has been no analysis done to ensure compliance in all areas and the machine readable aspect is not currently used

All IT systems must be able to capture and utilise GS1 compliant data to enable tracking and tracing of patient data.

Patient Care

2 The Trust must be registered with GS1 and be allocated a Global Company Prefix (GCP).

Complete – The GCP is 5053291 N/A N/A

All of the recommendations listed are included within the adoption plan in appendix E.

The table below represent the breakdown of the findings and recommendations that support the development of a GS1 and PEPPOL adoption plan. These findings, recommendation and final conclusion support the generation of the adoption plan and are included within the adoption plan as specific tasks. (See appendix E).

ID Finding Recommendation Strategic Area

1 The Trust has not created a governance framework for the implementation of GS1 standards.

The Trust should implement a robust governance framework to oversee the implementation of GS1 standards across the Trust.

Staff

2 The Trust currently does not have a GS1 Advisory Group to offer dedicated focus for the delivery of GS1 standards.

The formation of a GS1 Advisory Group is recommended that offers dedicated focus. Their function is to oversee the implementation and achievement of the associated benefits and should consist of a member from each affected function.

Staff

3 Global Trade Item Numbers (GTIN) are not used within the Trust

The Trust must ensure that all systems that identify products can capture and utilise GTINs

Value

4 The Trust has an IT development plan covering the current year. The plan does not stipulate the requirement for any new systems to comply with GS1/PEPPOL standards.

Any IT systems that are to be upgraded or procured must support the capture and storage of GS1/PEPPOL standards as well as UDI data where applicable. The current IT development plan needs to be reviewed in light of the eProcurement Strategy. This requirement should be mandated in any specification/tender issued

Patient Care

Value

Staff

5 The Trust’s current IT infrastructure does not communicate with any national procurement infrastructure elements.

All IT systems must integrate with national infrastructure elements – the key national infrastructure elements are the NHS DataPool, NHS Product Information Management (PIM), NHS GLN registry and the Spend Analytics solution. These systems are to be established by the DH at a later date and the Trust should ensure that they are aware of any publications from the DH.

Value

6 The eProcurement strategy is a significant undertaking that covers the management, tracking or tracing of people, product and places.

The Trust has not commenced the adoption of the eProcurement strategy, GS1 (except patient wristbands) and PEPPOL standards and has only commissioned the creation of the adoption plan.

The adoption of GS1 Standards should be managed in discreet steps. Each step being limited to a single standard. The initial three standards to implement are recommended to be:

Global Service Relationship Number (GSRN). The utilisation, for care receivers, is defined in ISB1077 and is partially in place. The Trust must allocate a Service Relationship Number to each of its employees as well as continuing its roll out to all patients.

Global Trade Item Number (GTIN). All products and services procured by the Trust should have a GTIN and will be mostly generated and allocated by suppliers. GTINs must be allocated by the Trust for all products and services it provides to outside entities.

Global Location Number (GLN). This is for all stock holding positions within the Trust as well as the Trust as a legal entity. All stock holding locations must be captured and allocated a GLN.

Patient Care

Value

Staff

7 The Trust does have a PEPPOL compliant access point (GHX Exchange) which is currently being rolled out.

The Trust must work with GHX to maximise the throughput of electronic transactions in order to meet the Department of Health’s target of 80% of eTransactions (POs, ASNs and eInvoices) via a PEPPOL Access Point by 2018.

Value

8 The Trust currently manually keys in invoices received into the Oracle Finance System

The Trust must liaise with their suppliers to ensure that all invoices are received via a PEPPOL compliant exchange in order to meet the Department of Health’s target of 80% of eTransactions (POs, ASNs and eInvoices) via a PEPPOL Access Point by 2018.

Value

9 The Trust does not currently receive Advance Shipment Notifications (ASNs) from its suppliers.

The Trust should work with its suppliers and its PEPPOL compliant exchange2 in ensuring that the suppliers issue and the Trust receives ASNs.

Value

10 The Trusts employees have a basic understanding of what GS1 is, however the knowledge is insufficient to deliver the full adoption plan.

The Trust should invest in GS1 training to bring key personnel up to speed with the standards.

The Trust should adopt a ‘Train the Trainer’ approach to training, particularly around those systems affected by the adoption of standards and quickly integrate systematic training into Business As Usual activities.

Staff

11 The Trust uses Discoverer and internal system reporting to provide business intelligence.

All reporting systems/outputs should be reviewed/redeveloped to ensure it can meet the additional reporting outputs created by GS1 adoption.

Value

12 The Trust does not currently have an Inventory System The Trust should review and procure an inventory system in order to maximise compliance and benefit realisation with the adoption of GS1 standards and associated efficiencies

Patient Care

Value

13 The Trust is currently developing an enhanced reporting suite utilising an in house Data Warehouse and QlikSense reporting

The data warehouse should be evaluated for use as a central data hub for GS1 identifiers and should continue to be developed to maximise the visibility of achieved efficiencies

Value

2 List of PEPPOL compliant exchanges are available at: http://www.peppol.eu/about_peppol/members

14 The Trust currently shares some payroll and procurement services with 2 other entities.

The data sharing relating to the shared services should be reviewed to ensure continuity of compliance

Value

15 The Trust is developing a new process for internal receipting The Trust should ensure that the new processe consider GS1 compliance and should maintain focus on this area to improve stock visibility in the absence of an Inventory system

Value

16 It has been identified that some areas have bespoke patient based systems

A thorough review of all IT solutions within the Trust should be conducted in order to reduce duplication of effot and to ensure data integrity is maximised

Patient Care

Value

17 The current Pharmacy System (EDS) does not link directly to the Finance System(Oracle)

A direct link for trandfer of data from EDS to Oracle should be investigated and if possible created in order to reduce the likelihood of data errors

Value

Radiology and Labs systems are not entirely integrated into other patient data management systems

The development of the data warehouse model currently being rolled out within the Trust should ensure data feeds from these areas. The systems used should also be reviewed for GS1 compliance.

Patient Care

Value

2.4.1 Costs of implementation

The NHS eProcurement strategy mandates the implementation of core local infrastructure systems. The implementation of the strategy will require further investments in hardware, software, consultancy / change management provision as well as incurring the ongoing costs of application. The costs are outlined within the Benefits Calculator as shown in appendix F.

The table below outlines the investment needed to ensure that the currently held infrastructure is compliant and rolled out throughout the Trust.

ID Area Infrastructure Currently Deployed

Investment Needed

1 Catalogue Management System

Nexus Work with GHX to ensure compliance or procure a compliant solution

2 Inventory Management System

None The Trust should look to procure an Inventory Management solution which is GS1 Compliant and can capture/record UDI data

3 P2P Solution Oracle Developer time will be required to add in the functionality to capture UDI and GS1 identifiers. Users will be required to test the solution

4 Exchange Service Solution

GHX Exchange A PEPPOL compliant system will need to be developed or procured

5 Spend Intelligence Solution

Discoverer / Data Warhouse feed to QlikSense

The Trust should define the reports to be written and data feeds that need creating.

6 eSourcing Solution None The Trust should investigate the possibility of procuring an eAuction/eTendering platform. It is noted that this platform should feed data into the national “Contracts Finder” database

7 Patient Administration System

Sema Helix The current PAS needs to be reviewed to analyse GS1 compliance.

8 Medical Records System

None – paper based(Trust has development plan)

The Trust must develop/upgrade the system in line with their upgrade plan. All paper records must be held electronically. All other patient data holding systems must update the electronic patient record

An initial high level assessment of the existing deployment and adoption of the GS1 and PEPPOL standards across the trust is illustrated in the table below with corresponding notes. This has been used as a guide to the population of the programme plan and the costs benefits summaries. Departments involved in adoption

Notes

Cate

ring

Clin

ics

Com

mun

ity

equi

pt

EBM

E

Esta

tes

Fina

nce

IT

Med

ical

re

cord

s

Path

olog

y

Phar

mac

y

Proc

urem

ent

Ster

ile

serv

ices

Thea

tres

War

ds

Core enablers

1 Location numbering Although some areas are identified for FM and IT purposes neither are GS1 compliant.

2 Catalogue management

The utilisation of GHX Nexus ensures that the Trust will be able to accept GTINs as and when suppliers release the data.

3 Patient identification Although the Trust uses compliant wristbands the capture of the data is not via automatic method.

Primary use cases

1 Inventory management

The Trust does not have an Inventory System. And should conduct a review/procurement to ensure that the Trust will be able to accept GS1 identifiers and UDI information as and when suppliers release the data.

2 Purchase-to-pay processing

GHX Exchange ensures that all POs and ASNs will be transmitted by a PEPPOL access point. However, the Trust’s instance of Oracle does not allow the capture of GS1 identifiers.

3 Product recall

The Trust currently does not, by automatic information and data capture, allocate product to patient. The Trust is currently investigating the ability to perform this and it is recommended to continue to do so.

Key: Green – full adoption, Amber – partial adoption, Red – minimal or no adoption, Blue – not considered relevant

2.4.2 Options Appraisal

This section sets out the key options considered in support of the recommendations of the NHS eProcurement strategy. Each option has its advantages and disadvantages which are outlined in the table.

ID Option Advantages Disadvantages

1 Do Nothing Existing cost base maintained No changes to existing working practices

Not compliant with NHS Standard Contract Difficulty of automatically tracking products to patients No change to existing cost base (No savings) Not compliant with Unique Device Identification (UDI), Falsified Medicine Directive (FMD) or EU electronic invoicing regulations (PEPPOL)

2 Departmental Approach

Leads to compliance with NHS Standard contract Compliance with EU regulations on UDI, FMD and electronic invoicing

Potential for different approaches to be adopted across the trust leading to greater overall cost Risk of duplication of effort both internally and from technology providers Competing priorities, overlap and disjoin between activities Lack of focus for (stretched) internal resources

3 Centralised Approach

Leads to compliance with NHS Standard contract and with EU regulations on UDI, FMD and electronic invoicing Consistent approach across all aspects of the trust Coordination of system developments and updates to minimise overall cost to trust

Level of overall investment required to effect changes Commitment required from individual lead to coordinate activities

A centralised approach to delivery of the GS1/PEPPOL activities is recommended. This approach will promote the efficient and planned use of scarce resources, will reduce the potential duplication of roles, training, and meetings, and will ensure that best practice can be adopted as quickly as possible through the implementation of lessons learnt. Additionally, centralisation will reduce potential silo working and departmental conflicts

2.4.3 Benefits of implementation

The use of standard codes and associated barcodes across the supply chain will allow providers to procure goods and services from suppliers in a far more efficient manner. The transparency will not only improve procure to pay processes at the Trust (allowing for significant savings to be realised) but also improve patient safety in the Trust. This will be through:

• The correct product being ordered and recognised by the supplier;

• Reduced risk from counterfeit products and drugs; and,

• Automated batch recall processes.

The financial benefits are outlined in the Department of Health’s benefit calculator as shown in appendix F. The DH Benefits Calculator suggests that the Trust could save £4.4m over the 4 year period with the project becoming self-funding by the 1st half of the 4th year.

2.4.4 Risks

The Trust should perform a full risk and impact analysis prior to the implementation of the adoption of GS1 and PEPPOL standards, however an outline set of risks are listed below:

- No overall governance of the project may result in a project that does not meet the expectations of the Trust and could potentially fail.

- New systems procured without full understanding of overall strategy and the possibility of new systems not being able to reference GS1 identifiers could significantly impact the implementation.

- Other pressures upon the Trust could remove the up-front funding required to commence the programme.

- The project may cost more than originally anticipated or benefits may be less than expected if timelines are extended or systems vary.

- ‘Maverick’ spend through non systemised routes such as ‘over-phone’ or PCard, which are non compliant, will impact the Trust’s compliance to the eProcurement strategy as well as reducing the Trust’s ability to monitor its spend and affecting procurement leverage.

- The Government may release other strategies that take precedence over the eProcurement strategy.

- If the Trust partially implements the strategy and uses a mix of standards (GS1 and Trust specific) there is a risk of ‘data clash’ where a number could relate to more than one item which would cause significant issues.

2.4.5 Conclusion

The Trust has commenced the adoption of the requirements as outlined by the DH by identifying a GS1 Lead, Executive Director and Non-Executive Director. To fulfil all of the initial requirements the Trust must confirm the plan for the implementation of GS1 and PEPPOL standards (appendix E) and achieve Trust endorsement of the plan.

The implementation of GS1 standards, ensuring systems can capture UDI information and guaranteeing that all business communications are via a PEPPOL compliant exchange is a significant undertaking that needs the full endorsement of the Trust and its Board.

The full implementation is expected to take up to 4 years (see plan - appendix E) and is dependent upon the availability of National Infrastructure (see table below for timelines) and the Trust’s procurement of core systems, such as a new/upgraded P2P System (Oracle)

To support the implementation of GS1 and UDI standards some system improvements will be required. PEPPOL compliance and the capture and utilisation of GS1 identifiers and UDI requirements within the Trust are crucial and therefore the Trust should continue to review and develop to ensure that the information from these systems is shared throughout the Trust’s entire system landscape.

To deliver this mandated requirement the adoption of the strategy should be performed by a centralised function (as per the options analysis).

The implementation of the strategy will significantly impact all aspects of the Trust and thus it is critical that the delivery of change does not negatively impact the delivery of care.

National Infrastructure Delivery

NHS GS1 DataPool Procurement to commence - Q4 2015/16

NHS PIM Solutions Procurement to commence - Q4 2015/16

NHS GLN Registry No Date Issued as at 26/06/2015

2.5 Executive Board sign off

The Trust Board are requested to consider the recommendations in this report and approve, in principle, the attached adoption plan to enable the Trust to proceed to the next stage and develop the individual business cases for the implementation of each section.

The Benefits Calculator (appendix F) is a high level document that outlines where the Trust could expect to incur costs and achieve savings. It does not provide sufficient data to create a full business case but does provide the Trust with indicative values that support the direction of travel. The Benefits Calculator and subsequent business cases will be generated and refined by the Trust to offer credible local values at each stage of the programme. The Board will not approve the commencement of the implementation of the adoption plan until the business case has been reviewed and approved by the Trust Board.

The Trust is asked to support GS1 and PEPPOL standards.

Top 5 Recommendations:

1) Ensure that patient wristbands are compliant in all areas of the Trust and can be captured via AIDC.

2) The Trust must transfer all active medical records to electronic format (roll out an EPR) and seek to ensure that the majority of medical records are computerised.

3) Implement a robust governance framework to oversee the implementation of GS1 and PEPPOL standards across the Trust.

4) Form a GS1 Advisory Group that offers dedicated focus to the project.

5) Ensure that all IT systems are able to utilise GS1 compliant data to support the tracking and tracing of patients through their hospital episode.

3. NHS eProcurement Strategy

3.1 Overview

The NHS published their eProcurement Strategy in May 2014. The strategy provides a holistic view of the technology, processes and data standards that need to be implemented nationally and locally in order for the NHS to transform its Procurement and Supply Chain processes.

The strategy itself proposes the implementation of solutions that are used in industries with more efficient and advanced supply chains than the NHS (e.g. retail and manufacturing), therefore the NHS will not be implementing untried technology.

The strategy is expected to take a number of years to implement fully, however progress is expected in a number of areas over a relatively short period of time.

3.2 Technology Infrastructure

The strategy primarily covers the procurement infrastructure, which, in itself has wider ramifications throughout the Trust. Although all systems that capture people, product or place will be affected the initial set of systems will need to be those that relate to the procurement of goods or services.

Within the Strategy, the Department of Health (DH) have proposed a technical architecture for the traditional Purchase to Pay (P2P) process that is outlined in the diagram below:

To provide some context, the key process steps are as follows:

1. Suppliers and Distributors load their data into a GS1 accredited data pool (database of items and services that meets GS1 standards). The DH will be procuring this data pool. This data pool will receive all item information that relates to the NHS from the other data pools.

2. The data pool will contain master data about the product or service identified by the unique Global Trade Item Number (GTIN) and the organisations that are to receive the data (e.g. NHS Trusts) through use of a Global Location Number (GLN). The supplier therefore only has to send the data to its customers once via the data pool rather than sending individual files or catalogues to multiple customers. The NHS data from the data pool is extracted for use by the NHS by a nationally sourced Product Information Management System (PIM). This system will in effect be the NHS National Catalogue of Products and Services.

3. The PIM will provide extracts of data relating to each individual NHS Trust through integration with each Trust’s local catalogue system. The data extract will contain the GTIN data and associated item attributes required to make informed procurement decisions.

4. The local catalogue system will be used by the Trust Procurement Team to populate the local point of demand systems (Inventory and Requisitioning systems). Therefore, the item number and attributes provided by the supplier will be used in all systems raising purchase orders in the Trust. Since all systems are mandated to use the GS1 identification system there will be less likelihood of product misidentification.

5. The Trust is required to issue Purchase Orders electronically via a PEPPOL access point (exchange). The access point will provide suppliers with purchase orders in a format that can integrate seamlessly with their sales processing systems. The process along with the GS1 standard GTIN and GLN will ensure that suppliers and hospitals are both using standard data and formats for transacting in a far more efficient manner.

6. The PEPPOL access point will also be able to receive and process other electronic notifications such as purchase order acceptance, advance shipping notifications and invoices from the suppliers. These invoices can then be automatically integrated to the Trusts Finance system for processing and payment (once receipt of goods and services has been acknowledged). The infrastructure will provide the NHS with the platform for genuine, efficient eCommerce technology and processes deployed across other sectors in industry (retail and manufacturing) and other Health Economies (e.g. Australia, USA and Canada).

7. Global Document Type Identifiers (GDTI) (which can be applied to physical or electronic documents) will be applied on multiple documents across each of the systems. The type identifier, as a method of controlling documents that infer title, obligation or status, could appear on invoices, bills of lading, letters of credit, insurance documents as well as HR records and, the strategy’s primary function, patient records.

4. GS1

4.1 What is GS1

GS1 is a not for profit standards organisation. GS1 control and promote standards for classification of entities, products, services and physical locations. The standards promoted by GS1 provide the enabler for the transformation of supply chain data, technology and associated processes referenced in the strategy.

The NHS eProcurement strategy mandates the adoption of GS1 standards across the supply chain. In terms of their use, GS1 codes can be used for the following:

• All goods and services procured by the Trust must use GS1 standard codes to uniquely identify each product or service. These items will carry a Global Trade Item Number (GTIN).

• All organisations (i.e. Trusts, Trust Sites and Suppliers) will be identified using a unique GS1 Global Location Number (GLN).

• All persons (employees as well as patients) will be identified using a Global Service Relationship Number (GSRN)

Each GS1 code standard (GTIN, GLN and GSRN) is called a “Key” as it is merely an identifier for the systems to interrogate data bases which contain information about the entities identified such as the NHS Datapool for products.

The GS1 system provides a globally consistent standard for the identification (through a numbering system), capture (through barcoding and RFID technologies) and sharing (through the Global Data Synchronisation Network of DataPools) of information about products, locations, people and services.

4.2 Why are the standards being implemented?

The use of standard codes and associated barcodes across the supply chain will allow providers to procure goods and services from suppliers in a far more efficient manner. The transparency will not only improve procure to pay processes at the Trust (allowing for significant savings to be realised) but also improve patient safety in the Trust. This will be through:

• The correct product being ordered and recognised by the supplier;

• Reduced risk from counterfeit products and drugs; and,

• Automated batch recall processes.

GS1 standards have been deployed for many years across various other industry sectors (e.g. retail and manufacturing). The adoption of the GS1 standards across the NHS will enable the same efficiencies to be realised across the health sector.

4.3 GS1 and PEPPOL adoption guidance

The Department of Health are planning to issue guidance notes and templates for the production of the GS1 and PEPPOL plans. Some guidance notes were issued at the end of December 2014 and have been used as the basis for the production of this Board report and associated GS1 and PEPPOL adoption plan. The DH will issue further guidance in due course direct to the named GS1 Lead, Jon Tomlinson

Throughout the implementation of the standards it is critical to be cognisant of who should be involved and what processes and procedures will be impacted.

4.4 GS1 Use Cases

The use cases as shown below impact all of the GS1 ‘keys’ and it is necessary to note that certain use cases are affected by multiple GS1 keys. The use cases have been taken, verbatim, from the DH publication “GS1 and PEPPOL Adoption, Getting Ready” (December 2014). The GS1 keys in the square brackets (“[“ & “]”) have been added to show where the keys could be applied.

GS1 Keys:

Global Location Number (GLN). Place

Global Trade Item Number (GTIN). Product

Global Service Relationship Number (GSRN). Person

Global Individual or Returnable Asset Identifier (GIAI/GRAI). Asset

Global Document Type Identifier (GDTI). Document

4.4.1 Use Case 1 - Inventory management

Many products [GTIN] provided by suppliers [GLN] to the NHS already carry GS1 barcodes and, over time, all products [GTIN] will be required to comply with this requirement. These barcodes can be used to manage inventory in all locations [GLN] around a trust, from central stores [GLN] to local stock rooms in wards and departments [GLN]. Scanning the barcode enables key data to be captured electronically and exchanged without manual intervention into patient administration, electronic records [GDTI] and purchase order processing systems.

4.4.2 Use Case 2 - Purchase-to-pay processing

The use of PEPPOL messaging standards supports the electronic transfer of information between trust [GLN] and supplier [GLN], without manual intervention. Together with the GS1 coded product information [GTIN] this enables automated matching of order, invoice and delivery notification speeding up subsequent payment. The accuracy and automation of barcodes reduces costs in requisitioning, ordering and payment.

Manufacturer Distributor Trust Legal entity

4.4.3 Use Case 3 - Product safety recall Forthcoming European legislation will require hospitals [GLN] to be able to electronically track and trace medical devices [GTIN / GIAI] to individual patients [GSRN]. Scanning barcodes on the patient wristband and on the device [GTIN / GIAI], into the patient record [GDTI] enables product safety recalls to be managed, facilitating prompt recall of affected patients [GSRN] upon receipt of a product recall notice [PEPPOL], together with identification and isolation of faulty products [GLN and GTIN / GIAI]. Secondary Use Cases

4.4.4 Use Case 4 - eMedicines The use of solutions such as robotic dispensing can utilise barcodes for input into the storage area [GLN] and retrieval for dispensing [GSRN]. The use of GS1 standards can provide access to product information and enable process controls to ensure the efficient management of pharmaceuticals [GTIN]. Hospital pharmacy manufacturing units can assign GS1 barcodes in the same way as commercial manufacturers to enable automated data capture processes within the hospital.

4.4.5 Use Case 5 - Surgical instrument management GS1 barcodes can be etched onto individual surgical instruments [GIAI and GTIN] and trays [GIAI] so that when used on patients [GSRN] or passing through sterilisation processes [GLN] they can be scanned and recorded, enabling events around individual instruments [GIAI and GTIN] to be accurately monitored and any restrictions on usage strictly complied with. Complete trays [GIAI] can be tracked and traced using GS1 barcode labels.

4.4.6 Use Case 6 - Medical equipment management GS1 barcodes can be applied to individual items [GIAI] of medical equipment, enabling equipment to be identified and tracked in and out of equipment libraries and point-of- use locations [GLN]. This leads to improved equipment utilisation, greater scheduled maintenance compliance and better equipment availability. At the point of care, use of the equipment can be associated with the barcode patient wristband [GSRN].

4.4.7 Use Case 7 - Community equipment management Identifying all loan stock assets [GRAI] with a unique GS1 barcode or RFID tag enables community equipment [GRAI] to be tracked throughout their full life cycle. This leads to more cost effective processes, better asset utilisation and an improved service for patients [GSRN]. The barcode can be scanned, along with location [GLN] and patient identifiers [GSRN], to record the asset [GRAI] when issued, returned, decontaminated and taken back into stock [GLN].

4.4.8 Use Case 8 - Medical records management Medical records [GDTI] can be identified with a unique GS1 bar code or RFID tag. Coupling the GS1 bar code with GS1 location number [GLN] information and uploading that to the Medical Records Management system enables the accurate tracking of medical records [GDTI] throughout the estate [GLN]. This leads to improved patient [GSRN] care by having records to hand and improves efficiency by reducing time taken to locate specific records. This consistency of identification will also help with transition to electronic records.

4.4.9 Use Case 9 - Pathology sample management GS1 standards can be used to accurately track samples from patient [GSRN] to laboratory [GLN and GIAI*], reducing the incidence of lost samples and helping to make results available as quickly as possible. Through scanning each barcoded sample along with the GS1 location identifier [GLN], progress can be recorded through to use in patient [GSRN] diagnosis.

• In this case the GIAI has not been explicitly stated but would be used to denote the device(s) by which the sample was extracted as well as the device(s) that were used in the analysis of the sample in the laboratory.

4.5 Global Location Number (GLN)

Global Location Numbers (GLN’s) are 13 character codes that are used to identify physical locations, entities and departments within an organisation – be it an NHS Organisation or a Supplier. In the current deployment of systems across the NHS, organisations use many different references (some system or manually generated) to identify locations. The deployment of GS1 GLN codes will ensure that all locations and entities involved in the NHS Supply Chain processes are uniquely identified, thus enabling:

• Integration of systems;

• Future proofing systems and solutions for changes in structure;

• Ensuring the product requested is delivered to the correct organisation and location within the Trust;

• Efficiencies in Master Data Management (e.g. Vendor records) where a number of inefficiencies exist (e.g. multiple records of the same vendor named slightly differently); and,

• Increased accuracy in purchase to pay transactions.

4.5.1 GLN Registry and Trust Adoption

The NHS is to establish a national GLN registry. The registry will be a repository of all GLN data from Trusts and their suppliers – in effect the ultimate address book for UK healthcare. The Trust as a member of GS1 will already be provided a Global Company Prefix (GCP) enabling them to allocate GLN numbers. The service will be managed by the Health and Social Care Information Centre on behalf of the NHS.

The Trust will be required to allocate GLN numbers to all internal locations that are deemed to require a location code. These include:

• The Trust – The code used to identify the Trust as a legal entity. This is currently allocated as 5053291000001

• Ship to Locations – Where suppliers physically deliver goods and services to;

• Deliver to Locations – The department or location of the final destination within the Trust for the product;

• Racks/shelves/cabinets or cupboards that may be used to store controlled stock levels within the final product destination location; and,

• Bill to Location – where suppliers send their invoice (i.e. Accounts Payable or outsourced service provider).

The Trust will need to build these into a hierarchy to ensure that the goods are delivered to the correct location within the Trust.

The Trust currently has a location coding systems in use. It will be necessary to replace or cross reference these to GLN codes.

The adoption of GS1 standards for GLN codes will initially focus on supply chain, however the Trust should look to roll out GS1 standards to other areas once the opportunities have been identified and scoped.

For example, the Trust will also be able to use GLN codes for the following purposes:

• Asset tracking – i.e. where a piece of equipment is located or stored within the Trust. Essentially Inventory Management for Assets; and

• Bed Management – Where a patient is currently within the hospital.

Trust Entity (GLN)

Ship to Location (GLN)

Deliver to Location (GLN)

Shelf/Rack/Cupboard (GLN)

Pay Site (GLN) Purchase Site (GLN)

4.5.2 GLN Supplier Adoption

Suppliers to the NHS are required to comply with GS1 standards as part of the terms and conditions of the new NHS contract. Suppliers are therefore requested to register with GS1 and load their catalogue data into the GS1 accredited GDSN datapool. As part of this process the Trusts will be required to identify suppliers by GLN numbers.

A number of current systems (Oracle and EDS) use various forms of supplier identification which will need to be migrated to the GLN system.

Suppliers will be required to implement a hierarchy for their organisations that is very similar to the hierarchy deployed within the Trust. The hierarchy will be as follows:

• The Supplier – The code used to identify the legal entity of the supplier;

• Purchase Site – Where suppliers process the Trust’s purchase orders. There could be multiple procurement sites for the larger suppliers, or suppliers with multiple branches;

• Pay Sites – where suppliers process their sales invoices (i.e. the Trust’s Accounts Payable Invoices).

The GLN codes will need to be integrated to the ERP system against the supplier header and site records in the systems identified. The appropriate GLN against each of the supplier records in the systems will ensure that supplier data across the Trust is consistent across all applications, therefore increasing efficiencies, reducing maintenance and providing accurate data for analysing spend by supplier.

4.6 Global Trade Item Number (GTIN)

The implementation of the NHS eProcurement strategy will mean that all suppliers of products and services to the NHS will be mandated to load their product data into the Global Data Synchronisation Network (GDSN) through a GS1 certified data pool. As part of this upload process, suppliers will be required to load their globally unique GTIN codes for all products and services that they supply to the NHS.

The suppliers will load their products into the GDSN with the associated GTIN. The data will be accessed by the NHS proprietary data pool where requested by the individual NHS Trust. The data will then be pulled into the Product Information Management system (PIM), allowing the Trust to integrate this data to their local catalogue management system or be available for download and integration to their requisitioning system(s) directly.

Supplier Entity (GLN)

Pay Site (GLN) Purchase Site 1 (GLN)

Purchase Site 2 (GLN)

The GTIN will reference a number of data attributes that may be needed within the local systems, either for end user choice purposes (images, Unit of Measure, Unit of Issue and price) or for regulatory and reporting purposes (such as Unique Device Identification).

The Trust will need to adopt GTIN numbers for the identification of all products and services that are procured at the Trust. The major challenges that the Trust needs to address are:

• The GTIN reference and GTIN product description must be integrated into the Finance and Procurement system(s). The data (plus other vital item attributes to perform the transactions) must be accessible in such a way for the end users to identify the products and services that they wish to request;

• The NHS Supply Chain systems (currently eDC/SOLO only) will need to be integrated to the PIM to receive a download of the data (and updates) from the GDSN. This integration is vital to ensure all point of demand systems at the Trust receive consistent product data. The local catalogue provider will need to be commissioned to create the interfaces (should they not exist).

4.7 Global Document Type Identifier (GDTI)

Global Document Type Identifiers are for documents that infer obligation, title or status. These are documents that need specific control greater than most documents.

The composition of the identifier follows the same structure as all other GS1 identifiers with a leading company prefix and trailing validation checksum. The full identifier structure is shown below;

Documents that would require such control would include, but are not limited to:

• Medical records;

• Education certificates;

• Driving licences;

• Insurance documents;

• Letters of credit;

• Bills of Lading;

• Contracts;

• Warranty documents;

• Receipt notes;

• Invoices; and

• Transfer documents.

4.7.1 Trust Adoption and maintenance

The implementation of Global Document Type Identifiers (GDTIs) should only cover documents that infer obligation or title. The application of GDTIs in the Trust would enable the Trust to track critical documents, such as medical records, and trace utilising serialisation.

The Trust will need to ensure that medical records are allocated a GDTI and that the systems that use medical records (i.e. PAS) can accept the information. If such documents are printed then they must be physically marked with the GDTI (either a 1D barcode or 2D DataMatrix).

These documents, if inadequately controlled, may result in legal action, loss of goods and/or finances. The implementation of the control can be achieved via already existing systems such as finance, HR or contract management systems as well as dedicated document control systems. Any new systems, such as a dedicated document control and/or library system, would need to be integrated with all document generating systems such as the Sema Helix PAS system or Oracle

4.8 Global Product Classification (GPC)

The DH mentioned in the eProcurement strategy that they are considering a review of the recommended product category structure deployed across the NHS. Purchasing categories are deployed in the Finance and Procurement system for the following reasons:

• To generate the subjective code (i.e. what the item/service is) element in the chart of accounts coding structure;

• Implementation of business rules in the workflow to ensure appropriate users approve requisitions for certain categories (e.g. IT Equipment); and

• Facilitate the analysis of expenditure by category with the Trust and across the NHS.

The Trust currently use NHS e-Class product classification codes. selected. The Trust has the ability to aggregate reporting across categories using the business intelligence system, to review expenditure by e-Class, therefore providing Procurement with information to identify savings opportunities.

If the DH select an alternative category structure it is likely to be the GS1 supported GPC classification system. As mentioned previously in the document, product data will be loaded by all suppliers to the NHS into the GDSN through a GS1 certified data pool. If suppliers are expected to load categories with the product data this will need to be GPC since GPC is the only classification standard that is supported by the GDSN.

If the coding standard is to change the following will need to be updated within the Trusts systems:

• Classification codes – The NHS e-Class codes and mapping to subjective codes will need to be end dated with the new classification coding structure taking effect, this process will be handled by the Trust System Administration Team and, if outsourced to the Trust’s ERP provider

• Classification mapping – The e-Class codes are currently mapped to national subjective codes (for accounting purposes), changes to the category structure will require Finance or a central body to map the new codes to the national subjective codes.

• Procurement Reports – The Trust will need to review the suite of procurement reports that are generated. These reports will possibly need to be updated with the new category coding structure.

• Business Intelligence – The business intelligence data warehouse will need to be reviewed to ensure that any changes to the structure of the coding are accurately reflected in the reporting table structure.

• Workflow Rules – The workflow rules relating to the e-Class codes for “Technical Approval” will need to be updated to reflect the new classification codes, this will help to ensure that requisitions raised under the new classification system are routed appropriately to the correct named individual within the organisation.

• Local Catalogue system – The local catalogue system (Nexus),and/or catalogue data tables in Oracle will need to be updated to reflect the changes in the new coding structure.

• NHS Supply Chain – The NHS Supply Chain systems use NHS e-Class as a core part of the functionality and interface files. The classification standards will therefore need to be updated by NHS Supply Chain as part of this exercise.

It has to be emphasised again that the DH are yet to make a decision on the classification standards. Therefore the tasks and impact outlined above will only need to be implemented should the DH decide to promote a new coding structure for the NHS. The amount of work and planning for a coding structure change should not be underestimated, it is therefore suggested that the GS1/PEPPOL compliance plan is revisited and updated should a coding structure change be recommended by the DH.

5. Pan European Public Procurement On Line (PEPPOL)

5.1 What is PEPPOL?

Pan European Public Procurement On-Line (PEPPOL) is a European Union funded messaging standard that allows buyers of goods and services and suppliers to transact electronically between each other in a standard format.

5.2 Implementing PEPPOL at the Trust

The standard format allows hospitals to transact with its suppliers in a far more efficient manner for both the supplier and the hospital.

The NHS eProcurement Strategy requires 3 document types to be transacted through a PEPPOL compliant access point. These document types are:

1. Purchase Orders (PO);

2. Advanced Shipment Notices (ASN); and,

3. Accounts Payable Invoices (INV).

5.2.1 Purchase Orders

The Trust generates 56,082 Purchase orders per annum The break-down of the number of orders issued by the Trust is as follows:

Delivery Method Number

Post 888

E-mail 4955

Fax 910

XML 25019

The Trust is required by the guidance to issue the following % of orders through a PEPPOL compliant access point:

Year ended % of total orders Number of Orders*

March 2018 80% 44,865

* Based on current volumes.

In order for the Trust to be compliant with this process the Trust need to implement a PEPPOL compliant access point3. The Exchange provider will manage all the connections with the suppliers chosen PEPPOL access point. This means that if the Trust integrates a PEPPOL compliant Exchange they will be compliant if they issue all orders through this delivery method.

5.2.2 Advanced Shipment Notices

The Trust do not currently receive ASN’s from their suppliers. A number of suppliers have the capability to issue ASN’s, however the Trust will need to sign up to a PEPPOL compliant Exchange to receive ASN’s.

5.2.3 Invoices

The Strategy promotes the use of electronic invoices; the presence of electronic invoices will make the full purchase to pay transactional process completely automated. Electronic invoices will allow the Accounts Payable team at the Trust (or outsource partner if re-tendered) to focus on resolving exceptions. The presence of an electronic order and electronic invoice will mean once goods or services are received at the Trust, the invoice will be available for payment (as long as the invoice matches the details on the purchase order within agreed tolerances).

A number of suppliers can provide electronic invoices, these invoices will however need to be integrated to the Trust’s PEPPOL compliant access point and then imported into the Oracle system for 3-way matching and payment to be completed

The current invoice volumes at the Trust are 95,742 per annum. The Trust currently processes invoices into Accounts Payable

Input Method Number

Manual 71,700

Ready to Pay (Pharmacy) 23,960

Ready to Pay (other) 82

XML 0

The Trust is required by the guidance to issue the following % of invoices through a PEPPOL compliant access point:

Year ended % of total orders Number of Invoices*

March 2018 80% 76593

* Based on current volumes.

3 List of PEPPOL compliant exchanges are available at: http://www.peppol.eu/about_peppol/members

6. Findings and recommendations

6.1 Overview

This section of the report contains all the findings and observations from the interviews and meetings attended 23rd June 2015 (Interviewees detailed in Appendix B). The recommendations made are based upon best practice and DH guidance on how to implement GS1 standards.

The findings and recommendations are split out into the following sections:

• governance,

• GS1 adoption,

• PEPPOL adoption,

• communications and

• reporting.

These findings and recommendations form the basis for the adoption plan (appendix E) with the recommendations being outlined as work streams in the adoption plan.

6.2 Governance

Appropriate governance arrangements are vital to any successful programme of this importance and complexity. A number of recommendations around appropriate governance for the programme are listed below.

6.2.1 In order to maximise the probability of successfully delivering the requirements, the implementation of GS1 and PEPPOL standards should be treated as a Programme. The GS1 implementation does not currently have an overarching Governance Framework in place. Without a clear framework that is endorsed at Divisional, Executive and Board level, there will inevitably be ambiguity and inconsistency in many areas of the programme in terms of accountability, treatment of risk, awareness and GS1 implementation.

Recommendation – A Governance Framework should be created to manage the GS1 and PEPPOL Adoption Programme. The framework should detail the following:

• Background and scope;

• Scope of the programme;

• Accountability for delivery of the GS1 and PEPPOL implementation;

• Programme organisation and reporting lines;

• Role and responsibilities of the GS1 Implementation Committee and any subcommittees;

• Risk management process;

• Issues, assumptions and dependencies management;

• Definition of Red, Amber and Green for issues and dependency management; and,

• Clear guidance on how to monitor and report on milestones.

The Governance Framework should be endorsed by all senior management and the Trust Board. The Framework should be produced in line with the DH Guidance and best Programme Management Practice.

6.2.2 The DH guidance and GS1 implementation notes strongly recommend the appointment of a GS1 Lead to oversee the implementation of GS1 standards and to be accountable for the programme.

Recommendation – It is recommended that the Trust Board approve the appointment of the CFO, Neil Nisbet as Executive Director/GS1 Lead and Brian Newman as Non-Executive Director

6.2.3 It is strongly recommended that the Programme is overseen by a GS1 Advisory Group. The Group should have clear terms of reference (TOR). The Group meetings should provide a detailed focus on the exceptions and issues that are directly affecting the delivery of the GS1 and PEPPOL implementation.

Recommendation – A GS1 Advisory Group should be formed. Reports on exceptions, missed milestones and risks should be generated and be the focus of the meeting for the Group and Divisions.

6.2.4 The Trust will have a significant task to implement the GS1 standards across the organisation. The implementation will require substantial internal resources to ensure the implementation plan is delivered in line with timescales outlined in the adoption plan (appendix E). As with many projects and programmes it is very difficult to focus on day to day business as usual activity at the same time and thus, the GS1 adoption may lose focus.

Recommendation – The Trust should look to appoint a Programme Manager to oversee the implementation of GS1 standards across the Trust. With Project Managers being allocated to the implementation of specific GS1 deliverables and System Owners being allocated to the implementation within their allocated System.

6.2.5 The GS1 implementation will require clinical engagement at many levels in the process. The Clinicians should be at the forefront of the programme in order to identify areas where GS1 standards can be applied to improve patient safety and drive efficiency.

Recommendation – The Trust should request that the Medical Director and/or Director of Nursing support communication events or are involved to a greater extent within the GS1 Governance process.

6.2.6 A Project Initiation Document (PID) should be created for each GS1 Key implementation. The PID documentation should capture milestones, tasks, initial risks and issues at a local level and will include how the project will be governed and controlled.

Recommendation – A standard PID should be created to ensure all projects are managed similarly.

6.2.7 The Trust will need to provide the GS1 and PEPPOL adoption plans to the DH and will be potentially audited on progress against tasks and milestones. It is therefore essential that the Board and senior stakeholders are provided with an appropriate highlight report on a periodic basis outlining progress against milestones and raising awareness of issues and risks that may require resolution at a senior level.

Recommendation – A report template should be drafted and issued on a periodic basis to senior stakeholders to ensure they are kept appraised of progress, risks and issues etc.

6.2.8 The Trust should set up a risk and issue log for the duration of the implementation of GS1 and PEPPOL standards. This risk scoring methodology should reflect the 5 x 5 scoring methodology deployed at the Trust. Any risks meeting the defined criteria should be added to the Trusts Board Assurance Framework (BAF).

Recommendation – Set up a risk and issue log for the duration of the GS1 adoption programme.

6.2.9 Compliance to processes and procedures will be critical to the adoption of GS1 standards. It is therefore recommended that the Trust update their Purchasing Strategy and Standard Operating Procedures to reflect the changes in the way that goods and services should be sourced and requested by staff in the Trust.

Recommendation – The Trust should update their Procurement Strategy and Standard Operating Procedures (SOP) to reflect the changes in process required to adopt GS1 and PEPPOL standards.

6.3 GS1 Adoption

6.3.1 There is, as yet, no formal deadline for GS1 adoption; the DH has indicated that there will be a certification system indicating the level of GS1 adoption in each Trust.

Recommendation – The timing of GS1 and PEPPOL adoption should be predicated on the timing of the update to core systems and the implementation of the electronic patient record system. All other systems which could use GS1 identifiers should be specified for GS1 compliance as and when updates to these systems are undertaken.

6.3.2 The Trust currently maintains a significant number of business systems (see table below) that captures Places, Products and People as well as Documents and Assets.

Recommendation – The Trust should appraise the specifications of all systems currently being updated and enhanced to review that the GS1 standards stated in the table below are implemented. The Trust should prioritise these ‘quick wins’ and then review the Informatics system upgrade plan to review whether it is appropriate to wait for a planned upgrade or request an unplanned upgrade.

The table below identifies which GS1 Keys will need to be handled by the Trust’s existing systems

System Details GLN GTIN GSRN GDTI GR/IAI

Finance System Oracle X X X X

Pharmacy System EDS X X X

NHS Supply Chain (SOLO)

LOL X X

Inventory System X X X

eCatalogue System Nexus X X X

Pathology System X X X X

Medical Engineering System

X X X

Theatre Materials System

X X X

Estates Services System X X X

Catering System X X X X

Sterile Services System X X X X

Bank Nurse System X X X X

Patient Admission System

Sema Helix X X X

Medical Records None X X X X X

6.3.3 GSRN

6.3.3.1 The Trust has already commenced the implementation of some GS1 standards with the adoption of the patient wrist band standard ISB1077.

Recommendation – The Trust should seek to promote the utilisation of the wristbands through Automatic Information and Data Capture.

6.3.4 GLN

6.3.4.1 The Trust is a member of GS1 and as such been allocated a Global Company Prefix (50552284) to generate its own GS1 Keys such as GLN numbers and GTIN numbers. GLN numbers will need to be assigned to all Trust locations that will be involved in the supply chain and payment process.

Recommendation – The Trust should allocate GLN location identifiers to all stock holding and patient interaction (e.g. Theatres) locations and they should be clearly documented. It is advised that when GLNs are documented that a hierarchy of GLNs is noted as this will support system use of the locations.

6.3.4.2 The Trust should appoint a custodian for the GLN allocation. This custodian should manage the set-up of any location details that require a GLN to be applied; this will include the Finance system, inventory system and materials management system (with NHS Supply Chain). Any location identifiers currently assigned by other systems (e.g. PFI buildings currently use a proprietary location identification system) should be cross referenced to the Trust’s own GLN identifiers. The Trust’s GLNs should be maintained and updated in the national GLN Registry.

Recommendation – The GLN allocation process and interface with the national GLN registry should be managed by a named individual at the Trust, with a deputy trained on the GLN allocation process for business continuity purposes.

6.3.4.3 The Trust currently has 20,335 suppliers in their Finance system. These suppliers should all provide their GLN number for the payment site and purchasing site(s) as part of the requirement for suppliers to the NHS to be registered with GS1. GLN numbers for suppliers will allow the Trust to reduce with confidence the number of suppliers within their database (removing duplicates); it will also reduce the risk of matching invoices to the wrong supplier account. It may also be prudent to review the active list of suppliers at the Trust.

Recommendation – The Trust should require all suppliers to provide GLN numbers for their organisation, pay sites and purchase sites.

6.3.4.4 The Trust must accommodate GLN numbers for suppliers within Oracle

Recommendation – The Trust need to seek guidance from their providers to agree how the GLN numbers will be accommodated as per the hierarchy.

6.3.4.5 The Trust currently holds locations (requisition points) in their Finance system and NHS Supply Chain. The locations will need to be reviewed for necessity and allocated with a Trust GLN number (sourced from the Trust’s GLN allocation system). The hierarchy for the Trust’s GLN adoption is as follows:

Recommendation – The Trust need to undertake a mapping exercise for all current location information held within Oracle These locations, and their hierarchy, will need to be mapped to the Trust’s GLN allocation system.

Trust Entity (GLN)

Ship to Location (GLN)

Deliver to Location (GLN)

Shelf/Rack/Cupboard (GLN)

Pay Site (GLN) Purchase Site (GLN)

6.3.4.6 The Trust has a number of source systems that generate transactions that relate to procurement

activity or transactions that relate to asset management activity. These systems are listed in the table below:

System Details

Finance System Oracle

Pharmacy System EDS

NHS Supply Chain (SOLO)

NHS Supply Chain (Mat Man)

Inventory System

Pathology System

Medical Engineering

Sterile Services

Catering System

Theatre Materials System

Estates Services System

Bank Nurse System

All of the systems will need to be updated with the GS1 Keys, GTINs for procured items, GLNs for inventory locations, GSRNs for patients or Trust employees and GIAIs for asset identifiers.

Recommendation – The providers of the systems will need to be engaged to ensure that their systems will accommodate GS1 keys, interface with any external GS1 data sources such as GLN registry and PIM/Data Pool and a timeline specified for such compliance.

6.3.5 GTIN

6.3.5.1 The Trust needs to receive a feed from the national PIM Provider that includes the GTIN code for the product or service that they wish to procure. As outlined below this feed will need to be loaded into a local catalogue system, the system will then need to interface data to the various point of demand systems at the Trust. All of the point of demand systems should be able to accommodate the GTIN code (and item description) and relevant UDI data (batch number, lot number and serial number) for medical devices.

It has to be noted that the current version of the P2P system Oracle will not be able to cope with the datasets that are required as the fields required do not exist. The NHS eProcurement strategy recommends that each NHS acute provider adopts a local catalogue system. The catalogue system provider can then manage the integration with the PIM and the other point of demand systems.

Recommendation – The Trust should discuss the requirement for a local catalogue solution to receive data from the PIM, procure a local catalogue system and interface item data into point of demand systems.

6.3.5.2 The Trust has PO coverage of circa 70%. One aim of the Strategy is to take staff away from administrative duties such as ordering and managing stock. While the training of staff to use formal ordering systems will provide a transitional step the end aim should be to automatically capture requirements from usage data or forecast data (e.g. elective lists) and, in concert with an inventory management system and an asset management system, ensure that demand for products across the trust is captured and fulfilled automatically.

Recommendation – The Trust need to embark upon a training exercise for their staff who raise requisitions to make them aware of how to source a product from the eCatalogue rather than either a paper based requisition or a free text requisition, and to use this training as the start point for implementing systems which automatically capture requirements (e.g. from scanning products at point of use or forecasting from planned elective lists) and automatically manage the replacement of consumed stock according to procurement work-flow and policy.

6.3.6 GDTI

6.3.6.1 The implementation of GDTIs will require the Trust to decide the numerical and attribute storage methodology. It will be necessary that the Trust should develop a document control strategy that complies with GS1 standards and meets the needs of the Trust, particularly in terms of the migration to Electronic Patient Records (EPR).

Recommendation – The Trust should investigate the PAS, Sema Helix, as to how GDTIs can be generated and controlled. The Trust must introduce GDTI identification of all documents as a means to ease transition to electronic records.

6.3.7 GPC

6.3.7.1 The adoption of GS1 standards may mean a change to the purchasing categories deployed at the Trust. The current classification standard deployed at the Trust is based on NHS e-Class but with local variations for specific categories. The DH have indicated in the procurement strategy that the classification methods for products will be reviewed at a later date and may be required to change. It is likely that the DH will implement the GS1 standard GPC classification system (as this is the only classification standard supported by the GDSN). This, however, has not been confirmed, but the Trust and the system providers should be aware that changes may be forthcoming that will require mapping exercises and system updates if implemented.

Recommendation – The Trust should keep abreast of publications from the DH that may promote the adoption of a new classification standard.

6.4 Capacity and GS1 Capability

6.4.1 The Trust will need to implement GS1 standards across the organisation. The implementation does not just relate to supply chain, but recommends deployment to all areas where GS1 standards can improve efficiency and processes. The staff that will be responsible for the implementation of GS1 standards and processes should be trained and accredited in GS1 standards.

Recommendation – The Trust should look to engage with GS1 to train the key staff involved in the process to ensure they are GS1 accredited to help with the wider deployment of GS1 standards.

6.4.2 It is vital that all staff involved in the processing of transactions in the Finance and Procurement systems are aware of GS1 and PEPPOL and how this will be deployed at the trust.

Recommendation – The Trust should train all staff involved in Supply Chain, Procurement and Finance activity on the eProcurement strategy, GS1 and PEPPOL. This training could be delivered by the GS1 accredited member of staff referenced in 6.4.1.

6.5 PEPPOL Adoption

The Trust is required to implement PEPPOL standards for delivery and receipt of electronic documents with suppliers. In order to achieve compliance, it is recommended that the following actions are implemented:

6.5.1 The Trust is required to issue purchase orders to suppliers through a PEPPOL compliant access point.

Recommendation – The Trust should procure and integrate a PEPPOL compliant access point to their Finance and Procurement Systems.

6.5.2 The DH guidance requires the Trust to meet key targets for the % of Purchase Orders issued through the access point to its suppliers.

Recommendation – The Trust should work with their access point provider to on-board as many trading partners as possible to receive orders through their PEPPOL compliant access point. The Trust should focus on high volume suppliers rather than high value suppliers increasing efficiency (the transaction value to processing cost ratio will generate a better return). This will require analysis of the PO output from the Trust with the access point provider, the access point provider should then engage with the suppliers (on behalf of the Trust) to migrate them over to receiving orders from the PEPPOL access point.

6.5.3 The Trust uses approximately 20,335 suppliers and creates an average of 21 new suppliers every week.

Recommendation – The Trust should insist that any new suppliers should be able to accept purchase orders from the Trusts PEPPOL access point. These can be received via e-mail (delivered from the access point) so should not pose any barrier to suppliers receiving orders.

6.5.4 The Trust currently has Purchase Order coverage of circa 70%. The Trust should look to maximise the number of Purchase Orders going through the Oracle P2P System.

Recommendation – The Trust should, as part of the programme, analyse the PO coverage and focus on migrating as many orders as possible into Oracle for processing. This will in turn increase the number of orders being processed through the PEPPOL compliant access point.

6.5.5 The eProcurement Strategy requires the Trust to process invoices and Advance Shipment Notices (ASNs) through their PEPPOL Access point. No electronic invoices and no ASNs are currently processed by the Trust into the Oracle System.

Recommendation – The Trust should engage with providers to review how ASNs and electronic invoices can be processed or include this in the specification of any future systems.

6.6 Communications

6.6.1 A Communications Strategy will be vital for the awareness and adoption of GS1 standards. The absence of a strategy may mean that effective communications are not being delivered to the wider Trust to promote GS1 standards adoption. An effective strategy will detail the messages the organisation wishes to deliver, the frequency they will be delivered, which channel(s) will be used, the intended audience and how to measure the effectiveness of the communication. The channels that could be used include the setting up of an intranet page on GS1, a GS1 blog, Intranet splash pages, drop in events, articles in Trust newsletters and updates at management briefings.

Recommendation – A Communications Lead should be appointed to the GS1 Adoption Programme. They will lead on the drafting and delivery of communications on success stories and updates in the GS1 adoption Programme. Communication of innovative ideas that have led to increased productivity or reduction in costs should help to promote a change in culture of GS1 from a traditional NHS Programme to a genuine change and transformational focused programme.

6.6.2 The Trust should consider emphasising the importance of the GS1 implementation and the benefits that this can bring to the Trust.

Recommendation – The Trust should plan a launch of the Programme. This launch should focus on the GS1 and PEPPOL requirements, benefits to the organisation, governance framework, etc. The launch may also refocus individuals on ideas and innovation that may help to identify other areas where the standards could be adopted that bring additional benefits to the Trust.

6.7 Reporting

6.7.1 The Trust should develop reports from Discoverer showing GS1 compliance by business area for all GS1 Keys.

Recommendation – The Trust should develop Business Intelligence reports showing compliance by directorate, department, cost centre and individual. These reports will highlight where focus should be made to ensure full compliance.

6.7.2 The Trust should develop reports from Discoverer showing the tracking of the benefits from implementing GS1 and PEPPOL standards.

Recommendation – The Trust should develop reports for KPIs that reflect the benefits of the eProcurement strategy implementation.

6.7.3 The Trust should continue to develop the Data Warehouse and QlikSense reporting offering to better capture the additional data made available by the use of GS1 coding

Recommendation – The Trust should continue with it’s current operational investment plans for robust and comprehensive reporting including PLICS.

7. Adoption Plan

The adoption plan (see appendix F) is based on an indicative 4 year implementation built on the information taken from the interviews (list of attendees in appendix B). There are internal and external factors that will affect the length and complexity of the implementation such as the sourcing of core systems as well as the prospect of the DH implementing a new product classification scheme (GPC).

The adoption plan should be reviewed and endorsed by the Trust to ensure that the time scales for the implementation are in line with the procurement and implementation of the new systems alongside a review of available resources. The plan will require further review once the business case is drafted and the project is approved to commence.

The scale of the task should not be underestimated and although the strategy is titled “eProcurement Strategy” the programme of change and investment covers the entirety of the Trust.

The assumptions made to generate the adoption plan are listed below.

• The DH launch the procurement for the PIM and DataPool in Q4 2015/16.

• The PIM and DataPool values exceed the requirements for OJEU rules and are sublect to OJEU tendering laws.

• The OJEU tender will be open, the DH will issue a Prior Information Notice, use Electronic Tender Documents and issue the Contract Award Notice via Electronic Notification. PIM and DataPool will therefore be ready for implementation by the DH 82 days after contract notice (Q2 2016/17).

• The implementation, by the DH, of the PIM and DataPool takes 3 months allowing Trusts to transact Q3 2016/17.

• The core project team is a dedicated full time resource with adequate cover (there are no significant reductions in resource around August).

• The GS1 Advisory Group is a part time resource but is available when required.

• All risks and issues are treated in a timely manner and there are no breaches in project tolerances causing the project to pause or disband.

• All other system providers are aware of the requirements of GS1 standards and are currently working on patches or upgrades.

• The Trust opts to implement the GS1 keys when appropriate for core business system upgrades and implementations.

• The DH does not change product classification within the 4 year period.

• The Trust IT Strategy is able to incorporate GS1 and PEPPOL requirements without mjor overhaul.

• The DH does not adjust the scope of the GS1/PEPPOL adoption criteria.

Appendix A Glossary

The table below contains the definition for terms used throughout this document:

Term Meaning ADE Adverse Drug Event. A non-planned negative effect of a used drug. May be due

to incorrect drug used or a reaction to a drug used ADR Adverse Drug Reaction. Negative reaction to a drug used AE Adverse Event. See ADE AIDC Automatic Identification and Data Capture. Such as barcode scanning and the

associated data posting Assumption An assumption is something that we expect to happen BAF Board Assurance Framework CIP Cost Improvement Plan CPE/CPD Centre for Procurement Efficiency (Was Centre for Procurement Development) DataMatrix GS1 approved 2D barcode to enable AIDC via line of sight only DataPool Database of master data that can be accessed by those with the correct access

rights Dependency A relation between activities, such that one requires input from the other DH Department of Health DM+D Dictionary of Medicines and Devices. HER Electronic Health Record. See EPR EPR Electronic Patient Record. The record of a patient and their care requirements

held by the NHS/Trust ERP Enterprise Resource Planning; a term that is used for business management

systems which are designed to integrate the data sources and processes of an entire organisation. Examples in the NHS include Integra, E-Financials (ABS) and Agresso.

GCP Global Company Prefix. The unique company GS1 membership ID GDSN Global Data Synchronisation Network. Allows real-time data master sharing

between partners GDTI Global Document Type Identifier. Documents of importance such as driving

licences, insurance policies and shipping forms. These documents infer a right or obligation, such as ownership, military service etc…

GIAI Global Individual Asset Identifier. Similar to GTIN but specifically for registered assets such as capital equipment

GLN The Global Location Number (GLN) is part of the GS1 systems of standards. It is a simple tool used to identify a location and can identify locations uniquely where required. The GS1 Identification Key is used to identify physical locations or legal entities.

GMDN Global Medical Device Nomenclature. A system of internationally agreed generic descriptors used to identify all medical device products.

GPC The GS1 standard Global Product Classification standard for classifying products. GRAI Global Returnable Asset Identifier. Similar to GTIN but specifically for returnable

packaging items such as pallets, containers etc… GRN Goods Receipt Note GS1 GS1 is a neutral, not-for-profit, international organisation that develops and

maintains standards for supply and demand chains across multiple sectors. GSRN Global Service Relation Number. An identifier for a single user or provider of

goods or services. An example would be a doctor, nurse or a patient GTIN Global Trade Item Number (GTIN) is an identifier for trade items developed by

GS1 HIBCC Health Industry Business Communications Council. Global Supply Chain standards

organisation for the medical device sector Highlight Report A short report sent to the Programme Office on a periodic basis highlighting the

current status of an individual scheme HIN Health Industry Number. A unique identification for trading partners HSCIC Health and Social Care Information Centre Issue Issues can impact existing risks and create new risks; therefore the Risk Log

should be examined alongside programme issues and updated where necessary PAS Patient Administration System PEPPOL Pan European Public Procurement On Line PIM Product Information Management- Primary Packaging First level of packaging. This would be the packaging for a single SKU Project Initiation Document (PID)

The document outlining the details of each individual scheme and what needs to be done from a high level in order to deliver the benefits expected

Provider NHS Trust QIA Quality Impact Assessment QIPP Quality, Innovation, Productivity and Prevention RAG Red, Amber, Green rating applied to risks, issues, assumptions and dependencies. RFID Radio Frequency Identification. Method of AIDC that uses radio frequency to

allow for non-line of sight scanning Risk Uncertainty of Outcome – whether positive opportunity or negative threat Secondary Packaging A level of packaging that may contain multiple SKUs Serialisation The process of assigning a unique identifier to each product package such that

different packages of the same product are distinguishable. SKU Stock Keeping Unit. The unit of consumption SSCC Serial Shipping Container Code. The unique identification of a tertiary package SUI Serious Untoward Incident. Same as ADE Tertiary Packaging A level of packaging that may contain multiple secondary packaged items Track and Trace The process of tracking a product through the supply chain UDI Unique Device Identification. The component/lowest level numbering structure UPN Repository An online database with product master data, part of the HIBCC standards.

Appendix B Staff Interviews and Meetings

B.1 Staff interviews and meetings

The table highlights the staff interviewed during the diagnostic review process.

Name Role Date Janine Harrison PAS/Theatres/Health Records 24/06/15 Andrena Watson PAS/Health Records 24/06/15 Duncan Brown Sterile Services 24/06/15 Matt Ryan Pharmacy 24/06/15 Vicky Hull Finance 24/06/15 Lyndsey Roberts Finance 24/06/15 John Cliffe Informatics 24/06/15 Nigel Appleton IT 24/06/15 All staff members are thanked for their time and co-operation in helping to provide information to support this review.

B.2 Key Stakeholders identified but not interviewed

Name Role

Appendix C Department of Health e-Procurement Strategy

C.1 Department of Health e-Procurement

The e-Procurement strategy was formally launched in May 2014. The published strategy can be downloaded via the following link:

https://www.gov.uk/government/publications/nhs-e-procurement-strategy

Appendix D GS1 and PEPPOL adoption plans guidance

D.1 Department of Health GS1 and PEPPOL implementation guidance

The DH issued guidance notes to all acute providers in December 2014 covering recommended steps for the implementation of GS1 and PEPPOL standards at Trusts. The guidance notes have been referenced throughout this document.

Appendix E The Shrewsbury and Telford Hospital NHS Trust GS1 and PEPPOL Adoption Plan

E.1 GS1 and PEPPOL Adoption Plan

The plan, of which below is an extract, has been developed based on the feedback of key stakeholders at the Trust. The timing on the plan is only suggested and the Trusts plans for software procurement, upgrade and implementation would significantly impact these dates. Therefore the dates should be reviewed with the Informatics Director during the initial stages of implementation to ensure that they are in line with the wider informatics strategy. This plan will be managed by the GS1/PEPPOL lead for the Trust with updates being provided to the board on a regular basis.

The adoption plan’s success is predicated on the assumptions listed in section 7 as well as the adequate control and implementation of the 3 core enablers. The core enablers are listed below and are colour coded in the adoption plan that follows.

a. Location numbering. This covers the utilisation of Global Location Numbers.

b. Catalogue management. This covers the utilisation of Global Trade Item Numbers.

c. Patient identification. This covers the utilisation of Global Service Relationship Numbers.

Item Responsibility Start Date Completion Date GS1 Adoption Project Start Up GS1 Lead identified NED / Chief Exec

01-May-15 01-May-15 Trust GS1 Project Manager identified and appointed GS1 Lead

Item Responsibility Start Date Completion Date Establish Executive Support Executive Management approval obtained to initiate project and the supporting teams

Trust Executive Management Team 30-Jun-15 30-Jun-15

Project Governance GS1 Advisory Group set up - Representatives secured from Finance, IT, Procurement, Theatres, Pharmacy, Training, Operations and Communications. Internal & External

GS1 Project Manager

16-Jul-15 06-Aug-15 - Meeting schedule agreed GS1 Project Manager - Terms of Reference approved at initial meeting GS1 Advisory Group GS1 Operational Team set up - Document Team roles and responsibilities GS1 Project Manager

11-Aug-15 29-Sep-15 - Appoint owner for each GS1 application GS1 Project Manager - Team training materials developed and memebers trained Training Team - Circulate GS1 FAQs Communications Lead Project Initiation Develop PID and Outline Plan (covering all GS1 key outline plans) GS1 Project Manager

06-Aug-15 20-Aug-15 Project Controls / Reporting process agreed GS1 Project Manager Project Governance agreed GS1 Project Manager

Item Responsibility Start Date Completion Date Communications - Develop Communication plan covering internal and external communications and execute

Communications Lead 20-Aug-15 11-Sep-15 Benefits management approach documented GS1 Project Manager

06-Aug-15 15-Sep-15 PID (and Outline Adoption Plan) Approval by Project Board GS1 Project Manager Process Mapping Gather process maps for all affected processes GS1 Project Manager /

Process owners 15-Sep-15 20-Sep-15 Review process maps GS1 Project Manager /

Process owners Patient Wristbands (GSRN Adoption) – Core Enabler: Patient Identification

Identify key Stakeholders from the areas affected to form temporary project team

- Catering GSRN Lead

29-Sep-15 29-Sep-15

- Clinics GSRN Lead - EBME GSRN Lead - Informatics GSRN Lead - Medical Records GSRN Lead - Pathology GSRN Lead - Pharmacy GSRN Lead - Procurement GSRN Lead - Sterile Services GSRN Lead - Theatres GSRN Lead - Wards GSRN Lead

Item Responsibility Start Date Completion Date Patient Identification Undertake GAP analysis to appraise level of Patient ID adoption and system utilisation

GSRN Lead

29-Sep-15 07-Jan-16 Commission third party to develop interfaces with systyems GSRN Lead Develop & Test interfaces GSRN Lead Develop operating procedures GSRN Lead "Go Live" GSRN Lead Care Provider Identification Review Payroll system for GS1 readiness GSRN Lead / HR

07-Jan-16 07-Jan-16

Allocate GSRN to all employees and update systems GSRN Lead Undertake GAP analysis where Employee ID should be used to link to other information (such as patient and/or service)

GSRN Lead

Develop and Test interfaces for systems that require employee specific information (such as ERP for approval limits)

GSRN Lead

Develop operating procedures GSRN Lead "Go Live" GSRN Lead

Item Responsibility Start Date Completion Date GLN Adoption - Core enabler: Location Numbering Identify key Stakeholders from the areas affected to form temporary project team

- Catering GLN Lead

07-Jan-16 07-Jan-16

- Clinics GLN Lead - EBME GLN Lead - Estates GLN Lead - Finance GLN Lead - Informatics GLN Lead - Medical Records GLN Lead - Pathology GLN Lead - Pharmacy GLN Lead - Procurement GLN Lead - Sterile Services GLN Lead - Theatres GLN Lead - Wards GLN Lead

Preliminary preparation tasks Confirm GLN Registry membership status (GCP - Global Company Prefix)

GS1 Project Manager

06-Aug-15 20-Oct-15 Appoint GLN Accountable Owner (likely to be systems accountant ) GS1 Project Manager - Master GLN Information reviewed and updated if incorrect GLN Lead

Item Responsibility Start Date Completion Date IT System Readiness - Identify all systems which are required to support GLN requirements

GLN Lead

08-Oct-15 08-Oct-15

- Finance and Procurement systems GLN Lead - Pharmacy Procurement systems (JAC/Ascribe/Bedford) GLN Lead - Catering procurement system GLN Lead - Estates Procurement System GLN Lead - NHS Supply Chain GLN Lead - E-Commerce Exchange (e.g GHX) GLN Lead - Medical Engineering GLN Lead - Agency/Bank GLN Lead - Others GLN Lead - Document system schematic GLN Lead

13-Oct-15 12-Dec-15

- Engage with each System Owner - internal and external and review GLN outline adoption plan

GLN Lead

- Identify all GAPS in solutions where GS1 and PEPPOL standards cannot currently be adopted

GLN Lead

- Update and issue Adoption plan to incorporate the necessary system changes

GLN Lead

- Commission any 3rd Party System updates as appropriate GS1 Project Manager

Item Responsibility Start Date Completion Date Data Data definitions agreed - how to use / apply GLNs in the Trust - Implementation Strategy

- Bill to, Ship to and Deliver to locations GS1 Project Manager

22-Oct-15 11-Jan-16

Document draft GLN implementation strategy GLN Lead Identify active locations from ERP, NHS Supply Chain (Req Points, Ship to and Bill to)

Systems Accountant

Identify all current suppliers Procurement Lead Draft GLN Hierarchy documented GLN Lead GLN Hierarchy reviewed & approved GS1 Advisory Group Draft GLN implementation Strategy including GLN Organisation Hierarchy circulated for review

GS1 Project Manager

GLN implementation Strategy including Organisation GLN Hierarchy approved

GS1 Advisory Group

Systems data update - System locations updated in line with validated data GS1 Project Manager 10-Feb-16 10-Feb-16 GLN validation with NHS GLN Registry (managed by HSCIC) - Provide data to Registry / Build approved hierarchy in the GLN Registry

Systems Accountant

11-Mar-16 10-May-16 - Location omissions received and investigated Systems Accountant - Revised hierarchy reviewed with and approved by GS1 Advisory Team and GS1 Operational Team

GS1 Project Manager

- Update system locations for omissions Systems Accountant

Item Responsibility Start Date Completion Date GLN reconciliation with Suppliers - Reconciliation of GLNs to Supplier account numbers (Investigate and resolve any discrepancies)

Systems Accountant 24-May-16 23-Jun-16 - Update location master record and internal systems as

appropriate Systems Accountant

GLN reconciliation with Suppliers - Update location master record with supplier Accounts (as advised by system provider)

Systems Accountant 07-Jul-16 30-Aug-16

- Send location master to the Suppliers for review and validation Procurement Lead - Update location master record (ensuring a 1:1 record is maintained between Supplier Acc Number and GLN) and internal systems as appropriate

Systems Accountant

GLN reconciliation with E-Commerce Partner - for example GHX - Reconcile GLN master record with E-Commerce system and update as appropriate

Systems Accountant 06-Sep-16 13-Sep-16

Transacting with Suppliers using GLNs - Work with E-Commerce provider to identify Suppliers who can accept and process GLNs

GLN Lead

27-Sep-16 26-Feb-17 - Commence GLN transmission test with suppliers GLN Lead - Roll out GLN transmission to all suppliers GLN Lead - Communicate roll out progress in line with Communications Plan Communications Lead

Item Responsibility Start Date Completion Date Standard Operating Procedures - Draft standard operating procedures to ensure GLN adoption is continually reviewed and maintained

GLN Lead 27-Sep-16 10-Nov-16

- Procedures reviewed and approved GS1 Advisory Group GTIN Adoption – Core enabler: Catalogue management Identify key Stakeholders from the areas affected to form temporary project team

- Catering GTIN Lead

27-Sep-16 27-Sep-16

- Clinics GTIN Lead - EBME GTIN Lead - Estates GTIN Lead - Finance GTIN Lead - Informatics GTIN Lead - Medical Records GTIN Lead - Pathology GTIN Lead - Pharmacy GTIN Lead - Procurement GTIN Lead - Sterile Services GTIN Lead - Theatres GTIN Lead - Wards GTIN Lead

Item Responsibility Start Date Completion Date IT System Readiness - Identify all systems which are required to support GTIN requirements

GTIN Lead

11-Sep-16 10-Nov-16

- Finance GTIN Lead - Procurement GTIN Lead - Inventory / Materials Management GTIN Lead - Patient Administration GTIN Lead - Business Intelligence GTIN Lead - NHS Supply Chain GTIN Lead - Pharmacy GTIN Lead - Catering GTIN Lead - Estates GTIN Lead - Agency Staff/Bank GTIN Lead - Medical Engineering GTIN Lead - Document system schematic Systems accountant - Engage with each System Owner - internal and external to understand the impact of GTIN adoption

GTIN Lead

- Review GTIN outline adoption plan with System Owners GTIN Lead - Update and issue Adoption plan GS1 Project Manager UDI (Surgical Instrument Management , Medical Equipment

Item Responsibility Start Date Completion Date Management) Discuss with Inventory System provider how Lot number, Serial Number and Expiry date will be populated/captured

UDI Lead

18-Oct-16 17-Feb-17

Undertake GAP analysis on inventory system and reporting solution to ensure that it can accommodate the fields and interact with other necessary systems

UDI Lead

Commission Interface and its development from PAS system to Inventory solution

Procurement Lead

Procure new hardware (if needed) to capture the data and association to patient ID

Procurement Lead

Develop process documentation and operating procedures UDI Lead Train Theatres staff on new processes Training Team Data Document draft GTIN utilisation strategy GTIN Lead

17-Nov-16 16-Apr-17

- Analysis completed of current and future supply chain and distribution models to identify GTIN usage

Procurement Lead

- Technical Teams briefed on GTIN format, application and storage GTIN Lead - Analysis of organisation development plans completed to establish future GTIN usage

GTIN Lead

- Each system surveyed for GTIN usage GTIN Lead - Data collection findings considered GTIN Lead - Survey findings compiled into a report for GS1 Advisory Group review and validation

GTIN Lead

Validated survey findings used to workshop draft GTIN implementation plan - note plan to consider patient safety and value added benefits

GTIN Lead

GTIN implementation Strategy approved GS1 Advisory Group

Item Responsibility Start Date Completion Date Data collection Identify the following groups for each packaging configuration they supply

Procurement Lead

07-May-17 04-Jun-17

- Manufacturers Procurement Lead - Distributors (NHS Supply Chain, Squadron, Bunzl, Movianto etc..) and / or

Procurement Lead

- Suppliers Procurement Lead Contact the groups based on the data above, to establish if they have a GTIN for each packaging configuration they supply

Procurement Lead

If a GTIN is not assigned to a product - "supplier" asked to contact GS1 to obtain a GTIN and load to the GDSN via the HSCIC solution

Procurement Lead

Engage Supplier Involvement - Contact the identified Suppliers with the prepared GTIN communication - feedback requested

Procurement Lead 05-May-17 04-Jun-17 - Analyse Supplier feedback to understand their capabilities and

impact to operations and staff Procurement Lead

Conduct Transactional Testing with Suppliers using GTINs - Work with E-Commerce provider to ensure feed from Product Information Management System (PIM) is in place and working

GTIN Lead

30-Apr-17 13-Aug-17 - GTIN roll out plan developed GTIN Lead - Roll out GTIN transmission testing and adoption to all Suppliers with data sourced from PIM

GTIN Lead

- Communicate roll out progress in line with Communications Plan Communications Lead

Item Responsibility Start Date Completion Date Refine initial GTIN Implementation Plan - Initial GTIN Implementation plan updated for experience to date, focus to remain on key benefit areas - patient safety, supply chain, finance

GTIN Lead 01-Sep-17 01-Sep-17

Standard Operating Procedures - Draft standard operating procedures to ensure GTIN adoption is continually reviewed and maintained

GTIN Lead 01-Sep-17 01-Oct-17

- Procedures approved by Advisory Group and Operational Team GS1 Advisory Group PEPPOL Adoption Identify key Stakeholders from the areas affected to form temporary project team

- Catering PEPPOL Lead

01-Oct-17 01-Oct-17

- Clinics PEPPOL Lead - EBME PEPPOL Lead - Estates PEPPOL Lead - Finance PEPPOL Lead - Informatics PEPPOL Lead - Medical Records PEPPOL Lead - Pathology PEPPOL Lead - Pharmacy PEPPOL Lead - Procurement PEPPOL Lead - Sterile Services PEPPOL Lead - Theatres PEPPOL Lead - Wards PEPPOL Lead

Item Responsibility Start Date Completion Date

Review PEPPOL compliant access points PEPPOL Lead

22-Sep-17 28-Nov-17 Discuss with ERP provider options ICT Lead Procure access to PEPPOL compliant access point Procurement Lead Procure connector from ERP system to access point Procurement Lead Bussiness Message Transmission Commission any work required with ERP provider and PEPPOL access point

PEPPOL Lead

14-Nov-17 12-Feb-18

Test integration with high volume suppliers PEPPOL Lead Monitor number of transactions being processed through access point

PEPPOL Lead

Review and implement process changes for those high volume suppliers not providing electronic messages

PEPPOL Lead

Train team on processes and implement Training Team Project Close Lessons learnt review completed GS1 Project Manager

19-Feb-18 09-Apr-18 Project Close report drafted including lessons learnt GS1 Project Manager Project Close report approved GS1 Project Manager Post implementation review completed GS1 Advisory Group

Appendix F The Shrewsbury and Telford Hospital NHS Trust GS1 and PEPPOL Benefits Calculator

F.1 Cost and Benefit Calculator

During April 2015 the DH published the Benefits Calculator that, with inputs from the user, allows the Trust to develop a high level calculation of the financial benefits of implementing the strategy. Although this does not provide sufficient detail to support a business case the document does support the justification for the development of the business case.

Below is the extract of the Trust’s Benefits Calculator which is followed by a return on investment graph highlighting when the savings generated by the implementation funds the costs of investing.

GS1 & PEPPOL standards and user case implementation, cost & benefits summary

2015

H2 H1 H2 H1 H2 H1 H2 H1 H2 H1 H2 H1 H2

Core enablers

National E procurement compliance plan - GTIN's and GLN's in PIM

All 'Core Enabler' activities

Primary use cases

Trust wide inventory and supply chain management

Automate Purchase 2 Pay

H2 H1 H2 H1 H2 H1 H2 H1 H2 H1 H2 H1 H2 Total

Costs £243,542 £292,250 £614,250 £625,708 £461,750 £417,500 £150,000 £142,708 £106,250 £106,250 £106,250 £106,250 £106,250 £3,478,958

Benefits £0 £0 £0 £0 £226,833 £272,200 £3,041,700 £910,450 £1,114,200 £1,114,200 £1,114,200 £1,114,200 £1,114,200 £10,022,183

Cashflow -£243,542 -£292,250 -£614,250 -£625,708 -£234,917 -£145,300 £2,891,700 £767,742 £1,007,950 £1,007,950 £1,007,950 £1,007,950 £1,007,950 £6,543,225

Cumulative cash flow (ROI) -£243,542 -£535,792 -£1,150,042 -£1,775,750 -£2,010,667 -£2,155,967 £735,733 £1,503,475 £2,511,425 £3,519,375 £4,527,325 £5,535,275 £6,543,225

2021

20% 50% 80% 90% 95% 99%

2016 2017 2018 2019 2020

20212015 2016Benefit:Cost analysis

National infrastructure in place by July 2016: GS1 datapool - PIM

- PEPPOL framework agreements

2017 2018 2019 2020

Benefit cost analysis 2015 2015 2016 2017 2018 2019 2020 2021H2 H1 H2 H1 H2 H1 H2 H1 H2 H1 H2 H1 H2

Cashflow -243542 -292250 -614250 -625708 -234917 -145300 2891700 767741.7 1007950 1007950 1007950 1007950 1007950Cumulative cash flow (ROI) -243542 -535792 -1150042 -1775750 -2010667 -2155967 735733.3 1503475 2511425 3519375 4527325 5535275 6543225ROI discounted at 5% per year -241735 -527874 -1124643 -1723653 -1937202 -2061788 698376 1416550 2348676 3266896 4171367 5062243 5939674

Total costs £ 243541.7 292250 614250 625708.3 461750 417500 150000 142708.3 106250 106250 106250 106250 106250Core enablers One off 221250 265500 265500 265500 44250 0 0 0 0 0 0 0 0

Annual 22291.67 26750 26750 26750 26750 26750 26750 26750 26750 26750 26750 26750 26750total Core enablers -243542 -292250 -292250 -292250 -71000 -26750 -26750 -26750 -26750 -26750 -26750 -26750 -26750

Inventory and supply chain ma One off 0 0 267500 267500 267500 267500 0 0 0 0 0 0 0Annual 0 0 54500 54500 54500 54500 54500 54500 54500 54500 54500 54500 54500total Inventory and supply chain managem 0 0 -322000 -322000 -322000 -322000 -54500 -54500 -54500 -54500 -54500 -54500 -54500

Purchase2Pay One off 0 0 0 7291.667 43750 43750 43750 36458.33 0 0 0 0 0Annual 0 0 0 4166.667 25000 25000 25000 25000 25000 25000 25000 25000 25000total Purchase2Pay 0 0 0 -11458.3 -68750 -68750 -68750 -61458.3 -25000 -25000 -25000 -25000 -25000

Total Beneits £s 0 0 0 0 226833.3 272200 3041700 910450 1114200 1114200 1114200 1114200 1114200Core enablers Annual 0 0 0 0 226833.3 272200 272200 272200 272200 272200 272200 272200 272200Inventory and supply chain ma One off 0 0 0 0 0 0 2172000 0 0 0 0 0 0

Annual 0 0 0 0 0 0 597500 597500 597500 597500 597500 597500 597500total Inventory and supply chain managem 0 0 0 0 0 0 2769500 597500 597500 597500 597500 597500 597500

Purchase2Pay Annual 0 0 0 0 0 0 0 40750 244500 244500 244500 244500 244500

All 'Core Enabler' activities

Automate Purchase 2 Pay

Trust wide inventory and supply chain management

(£3,000,000)

(£2,000,000)

(£1,000,000)

£0

£1,000,000

£2,000,000

£3,000,000

£4,000,000

£5,000,000

£6,000,000

£7,000,000

H2 H1 H2 H1 H2 H1 H2 H1 H2 H1 H2 H1 H2

2015 2016 2017 2018 2019 2020 2021

Cost

s / B

enef

its

Benefits: P2P

Benefits: Inventory

Benefits: Core Enablers

Costs: P2P

Costs: Inventory

Costs: Core Enablers

ROI

Doscounted ROI

Appendix G The Shrewsbury and Telford Hospital NHS Trust GS1 and PEPPOL Definition Factors

Factor Scale

Teaching Hospital Yes Linkage to institute No

Governance Foundation Non-FT

Financial performance >10% Deficit <10% Deficit Break Even Positive (surplus)

Case Mix General acute Some specialisms Specialist centre

Main Locale City Centre Urban Rural

Size (based on bed numbers) <450 beds 450 – 650 650 - 900 >900 beds

Number of sites 1 2 3 4 5+

Process maturity Red Amber Green

CQC assessment Outstanding Good Requires improvement Inadequate

NHS litigation authority assessment (Turnover / Contribution)