New commercial support units will help
achieve efficiencies in drug purchasing
In the NHS
a QIPP is
no joke
By Francesca Rivers, MBioch
c
T
ough financial times are PRIMARY CARE
making their mark on the NHS TRUSTS ARE
as much as any institution —
ALREADY PAYING
arguably more so with the
FOR THINGS THAT
expectation that the NHS will deliver
WERE PREVIOUSLY
£15–20bn of efficiency savings over
PAID FOR OUT OF
the next few years. So how, exactly,
CENTRAL BUDGETS
are the health departments planning
d
to make these substantial savings at
no cost to patient care, and what
shifts might we expect to see in the
supply and management of
medicines in the NHS?
Pharmacist Peter Rowe is leading
a national medicines use and
procurement workstream as part of
the “quality, innovation, productivity
and prevention” (QIPP) programme,
which has been charged with what he
dubs the “formidable task” of making
such savings by the end of 2014.
Speaking at the summer
symposium of the Guild of
Healthcare Pharmacists’
procurement and distribution
interest group, held in Birmingham
on 10 June, Mr Rowe said primary
care trusts are already subsidising or
paying for things that were
previously paid for out of central
budgets. “That will undoubtedly get
worse next year,” he said and,
although the Government has yet to
confirm exactly what the future
funding arrangements will be, he
warned: “The bottom line is [that
PCTs will have] a great deal less
Francesca Rivers is a news and
feature writer for The
Pharmaceutical Journal.
Vol 2 July/August 2010 Clinical Pharmacist 239
Cutting costs to reinvest bodies that became operational
NEWS FEATURE
across England in April 2010.
Use of generic medicines presents a prime opportunity to slash the drugs bill at no cost to patient CSUs are headed up by the
care, according to chairman of the British Generic Manufacturers’ Association Warwick Smith. procurement, investment and
The UK currently has the highest generics usage and the lowest generics prices in Europe, commercial division of the NHS
which together drive the drugs bill down by £8.5bn a year, he said. While agreeing that it is not Commercial Medicines Unit —
always clinically appropriate to dispense generic medicines in place of branded products, he formerly the pharmacy division of
argued that savings can be made through generic substitution or increased generic prescribing. the NHS Purchasing and Supply
Alison Clough, commercial and communications director at the Association of the British Agency, which was decommissioned
Pharmaceutical Industry, added that savings made through generic prescribing could cover the
earlier this year — and are intended
costs associated with bringing innovative new medicines into the market — a view echoed and
to provide support and resources to
hailed as a win-win by Peter Sharott, chairman of the NHS Pharmaceutical Market Support Group.
Compared with the rest of Europe, the UK lags behind in terms of market share and use of
help NHS staff and managers
innovative medicines, said Mrs Clough. She claimed that the pharmaceutical industry is well develop their business knowledge.
positioned to help bring the UK out of recession and said that a balance must be struck Business development manager at
between driving down the medicines bill and fuelling growth in the sector. the CMU Beth Loudon told the
meeting that four of the CSUs have
been exploring how the units can be
than [they have] ever had over the medicines management and used in practice to drive
past 13 years, and we’re going to procurement, with the exception of commercially sound medicines use.
have to cut our cloth to work within the Prescription Price Regulation A final draft of the findings is due to
very austere times.” Scheme. Many of the workstream’s be circulated through the CSUs and
goals are based around ensuring pharmaceutical procurement
Getting value for money medicines are prescribed, taken and networks in August and should help
Drugs spending will undoubtedly be managed properly, which could strategic health authorities to ensure
a target when looking for improve patient outcomes and get CSUs drive efficiencies through
opportunities to cut NHS costs. better value not just from the drugs improved medicines management.
According to Department of Health bill but across the whole system. Nevertheless, Miss Loudon
figures, hospital drugs spending is Key targets include aligning suggested, all of the easy changes to
inflating at a rate of between 14% primary and secondary care NHS medicines procurement have
and 22% per annum, whereas drugs prescribing, putting appropriate already been made, and “radical
spending in primary care is more or medicines use at the heart of solutions” are now needed to bring
less flat, said Mr Rowe. If the inflation commissioning and driving the about any further improvements to
is at the upper end of that range, he efficient use of medicines in primary the supply system.
suggested, any growth in the NHS care. As part of this work, the use of Peter Sharott, who is chairman of
will go to pay for the increase in “specials” is to be reviewed, said Mr the NHS Pharmaceutical Market
medicines spend in hospitals, “which Rowe, after initial DH analyses Support Group, agreed that CSUs
is why we need to make sure we’re indicated that around £50m is spent could play a valuable role over the
getting value for money”. on specials each year when licensed next year.
The QIPP medicines workstream alternatives could be prescribed in The PMSG has drafted a revised
— one of 12 within the QIPP their place. “I cannot see how you national strategy and set of standards
programme — will be examining can conceivably justify prescribing for collaborative medicines
every aspect of policy relating to specials when there are licensed procurement and management, which
products which, on the face of it, do reflect the fact that procurement is
the same job,” he argued. becoming a more collaborative
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He also urged pharmacists to process, handled (at least for now) at a
encourage use of over-the-counter strategic health authority level rather
medicines as part of the Government’s than solely within PCTs. In fact, the
drive towards self care, which could importance of collaborative working
cut healthcare costs across the board was a recurring theme at the PDIG
and also leave pharmacists free to symposium, and Mr Sharott warned
provide more clinical services. that pharmacists who fail to align their
Allowing more medicines to move approach with the wider NHS agenda
into the OTC arena would bring the risk losing control over medicines
UK in line with the rest of Europe, procurement — potentially to those
where far more medicines are outside the pharmacy family.
available OTC, he added. “I think CSUs are about
providing more pharmaceutical
Improving procurement leadership and accountability for
Putting QIPP’s economising pharmacy activities,” he said, adding
strategies into action will fall upon that accountability will become far
commercial support units (CSUs) — more important for the NHS in the
newly founded regional delivery years to come.