Medicines optimisation & the model hospital

Transcription

1 Medicines optimisation & the model hospital - Securing value from medicines Andrew Davies, Professional Lead for Hospital Pharmacy, NHS Improvement Commissioning Chemotherapy Services Conference 28 th November

2 We need to stop taking medicines for granted Medicines help a lot of people to get well but: Medication safety continues to be a serious issue: Around 5-8% of hospital admissions are medicines related, many of which are preventable Bacteria are becoming resistant to antibiotics through overuse which is a global issue Up to 50% of patients don t take their medicines as intended meaning their health is affected Use of multiple medicines is increasing over 1 million people now take 8 or more medicines a day 300m of medicines wasted The NHS spends 16.8 billion a year on medicines ( 1 in every 7 that the NHS spends) and they are the most common treatment in the NHS.

3 Achieving the Five Year Forward View Mind the gap s For the NHS to meet the needs of future patients in a sustainable way, we need to close all three gaps: 1 Health and wellbeing gap Radical upgrade in prevention 2 Care and quality gap New Care Models and new support 3 Funding and efficiency gap Efficiency and investment

4 Future growth in medicines spend Primary care Hospital & community health sector Total Gross spend m Impact of new medicines Increasing numbers of medicines used Increasing age of the population Data source: HSCIC: Hospital Prescribing: England,

5 Medicines Value Programme: Next Steps on the NHS Five Year Forward View and Carter Report The NHS wants to help people to get the best results from their medicines while also achieving best value for the taxpayer Programme involves NHS England, NHS Improvement, NHS Digital and Health Education England It is about using medicines better - savings will be reinvested in improving patient care and providing new treatments to grow the NHS for the future Through the regional offices, linking with STPs and ACOs, and nationally coordinated with AHSNs, Getting It Right First Time and NHS Right Care and NHS Clinical Commissioners to create a single voice Four Regional Medicines Optimisation Committees are connecting CCGs and providers with the national programme to take coordinated action 1 The NHS policy framework that governs access to and pricing of medicines 2 The commercial arrangements that influence price 3 Optimising the use of medicines 4 Developing the infrastructure to support an efficient supply chain

6 Four levers to obtain value 1. The NHS policy framework that governs access to and pricing of medicines The approach to pricing and access to medicines in the NHS is supported by a national policy framework We need to make sure that the products which the NHS buys are clinically and cost-effective NICE conducts Health Technology Assessments on new drugs to determine this This sits alongside a national policy on pricing and reimbursement for medicines used in the NHS across the whole of the UK

7 2. The commercial arrangements that influence price Cost Our aim: maximising value for the NHS at each stage in the value cycle of medicines Market Entry Extended Indications Competitors/ substitutes Generics How do we manage new access opportunities with constraints on NHS purchasing power? New types of drugs and technology continue to be developed: precision medicine, gene therapy, immunotherapy, AI Mean that current approaches to health technology assessment, reimbursement and contracting may not always be fit for purpose We need to think about outcome conditional reimbursement, and new partnerships with industry,

8 3. Optimising the use of medicines To support the NHS, NHS England has set up four Regional Medicines Optimisation Committees (RMOCs), chaired by regional medical directors RMOCs are connecting CCGs and providers with the national programme to take coordinated action Initial priorities: Biosimilars Generics Polypharmacy Low value medicines Personalised medicines

9 Regional Medicines Optimisation Committees Purpose and scope: Monitor and support implementation of national advice and guidance Provide and disseminate resources to support and accelerate implementation Consider the implications of new ways of working and technological innovations Provide consistent advice on medicines optimisation Reduce duplication Horizon scan to identify challenges / issues to benefit from a system-wide approach Supported by the Specialist Pharmacy Service:

10 RMOC membership New medicines leadership team working across NHSE and NHSI to support RMOCs Each RMOC supported by NHSE/NHSI Regional Pharmacy Lead and Regional Pharmacy Dean in HEE Linking into CCG Area Prescribing Committees and Trust Drug and Therapeutics Committees

11 Priorities 4. Developing the infrastructure to support an efficient supply chain Digital Medicines 1: Digitising community pharmacy and medicines 2: Pharmacy supply chain and secondary uses 3: Integrating community pharmacy Hospital Pharmacy Transformation 1: Medicines optimisation in hospitals 2: Infrastructure and Enabling Technologies 3: Workforce Optimisation Community Pharmacy

12 Aseptic Service Review NHSI has asked Deloitte to build the evidence base to help aseptic units develop sustainable, resilient, future-ready operating models 1 3 Materials to support Summary of current state of development of resilient, pharmacy aseptic services high quality, and safe services NHS and Commercial Aseptic Compounding organisations Promote a consistent and comprehensive approach 2 4 Aseptic service dataset Best practice library On-going collection to align with Model Hospital Help aseptic services understand and apply best practices 12

13 Approach Our review will include quantitative and qualitative analysis and will seek best practices locally and internationally Quantitative One-off data collection All aseptic units in England Building on previous templates On-going data collection Limited selection of key metrics New analysis and mapping Visual display of key analytics Qualitative NHS & Commercial Interviews Chief Pharmacists / Technical Service Leads STP Leads Industry networks Commercial compounding organisations Desk research HPTPs, STPs, Model Hospital, Carter Literature review 13

14 Scope Scope aims to deliver insight, evidence, and options for the many important strategic decisions aseptic services are considering What is the demand? What is supplied? Who supplies & from where? How is supply managed? 1.Products & trends 2.Products & materials 3.Supply location & outsourcing 4.Staff 5.Estate & equipment 6. Logistics Demand by product type & location Pipeline product trends e.g. genomics, biologics Policy impact e.g. R&D Product, format range & rationalisation Procurement practice Pricing practice Policy impact e.g. R&D Geo coverage & supply consolidation Ward vs. pharmacy preparation Outsourcing (NHS & commercial) Staffing models Careers Succession plans Policy impact e.g. Brexit Equipment status and obsolescence Facility investment Maintenance QA, QC Stock levels Waste Delivery frequency Patient access Risk & contingency 14

15 How to get value from the spend on medicines Value is measurable improvement in patient outcomes while maintaining an affordable medicines bill Making sure patients get the right choice of medicine Improving the quality (safety, effectiveness, patient experience) of prescribing and medicines use Making how we purchase and supply medicines more efficient

16 Hospital Pharmacy & Medicines Optimisation: Increased access to innovative and life changing medicines Drugs such as Infliximab have significant beneficial impact on patients and slow disease progression Analysis shows more patients are accessing Infliximab (increase from 0.75million doses/month to 1.1million) NHS cost due to biosimilar reduced would have been 19.5million/month actually 8million

17 Hospital Pharmacy & Medicines Optimisation: Increased access to innovative and life changing medicines Drugs such as Infliximab have significant beneficial impact on patients and slow disease progression Analysis shows more patients are accessing Infliximab (increase from 0.75million doses/month to 1.1million) NHS cost due to biosimilar reduced would have been 19.5million/month actually 8million

18 Biosimilar market share in treatment days Biosimilar uptake (Treatment days) 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% M0 M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12 M13 M14 M15 M16 M17 M18 *Rituximab uptake reaches 34% in August 2017 (source: NHS figures) M19 M20 M21 M22 M23 M24 M25 M26 M27 M28 Infliximab Etanercept Rituximab (IV market only)* Source: QI MIDAS Restricted MTH Jun 2017; Each product treatment day share calculated with respect to the individual, relevant accessible market

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20 Commissioning Framework for Biological Medicines Published September 2017 In partnership with industry To support commissioners to act promptly to make the most of the opportunity presented by increased competition in biological medicines, including biosimilar medicines Sets out actions which can be taken by patients, prescribing clinicians, care providers and commissioners to realise the therapeutic and economic opportunities of biological and biosimilar medicines In particular, seeks to set out the importance of a collaborative approach

21 Model Hospital

22 Model Hospital (2)

23 Hospital Pharmacy & Medicines Optimisation: Top 10 Medicines opportunities being identified & monitored as t trust and medicine level! Use of medicines being identified and uptake or spend reductions being identified. Totals for of > 240million identified. Trust engagement for change & performance reporting. Utilise Rx-Info Define system trust and drug level data

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25 Hospital Pharmacy & Medicines Optimisation: Reduced spend (and increased use) of individual medicines can be tracked monthly Monthly spend on 4 high cost medicines can be shown to be reducing due to moves to Biosimilars/generics 47m The 4 drugs (Infliximab, Etanercept, Rituximab and Imatinib) show a reduced spend but increased usage Cost 27m Reduction from circa 47million/month to 27million Volume of product same/higher Volume

26 Hospital Pharmacy & Medicines Optimisation: Reducing the rate of growth in annual medicines spend Annual growth in Medicines spend from HSCIC and NHS Digital reports showed >17.5% year on year growth +18% +18.5% +17% +16% +6.5% Significant reduction shown in reduced to circa 6.5% based on NHS I data from Rx-Info Define system To end M7-149million/ 146million saved!

27 Hospital Pharmacy & Medicines Optimisation: Lost savings opportunities for the NHS being reduced & planned for Complex clinical changes involving medicines such as biosimilars require better planning. Tools have been developed to identify how much the NHS lost monthly getting to 80% uptake. Support information & communication under development to implement at scale & pace. See

28 Data, data, data! E-Prescribing & Medicines Administration Monthly medicines spend data Medicines (& Pharmacy) CIP s Reference costs Clinical outcomes from Medicines = Medicines Optimisation Costing Transformation Programme Research Genomics/personalised medicine

29 Thank you! 29