HIV Homecare – the London Experience Philip Aubrey Medicines Procurement Specialist – London & East of England LPP – P&MM Operational Lead National Homecare Symposium - 15th January 2009 Overview Commissioning of HIV services in London Background to HIV homecare in London Tendering for a London HIV Homecare Service Retender of London HIV Homecare 2008 Outcome of London HIV Tender 2008 Commissioning of HIV services in London The London HIV Consortium manages the overall commissioning and provision of HIV services across London London Specialised Commissioning Group (LSCG) manage the commissioning of HIV services from the 31 PCTs to the 24 HIV provider trusts across London 2007/08 budget - £211m (65% on ARVs) Growth in activity - 7.6% Background to HIV homecare in London In 2004/05 - the HIV Consortium decided that London HIV patients should be offered the opportunity to receive their antiretroviral therapy through a home supply arrangement. This followed previous experience at the Royal Free Hospital who at the time had 380 patients on HIV homecare. Other London trusts with HIV homecare activity – UCLH, GOS and C&W. Background to HIV homecare in London Drivers: • Provides patient choice • More convenient for some patients • Patients can choose between their medicines being delivered by van or via the post • Frees up NHS staff time for other HIV duties • Removes a burden from already overloaded hospital pharmacy dispensaries • Financial benefit as medicines are VAT exempt Tendering for a London HIV Homecare Service Agreement of stakeholders on how to construct tender Design of tendering model NHS PaSA to undergo tender on behalf of the London HIV Consortium Specification of tender – used NHMC original specification No of patients eligible Homecare market intelligence From Royal Free model 25% of patients on treatment should be eligible for homecare Stakeholders Patient – Public HIV Commissioners Engagement nurses (PPE) Senior Pharmacy London Clinicians Managers HIV Homecare Tender HIV Consortium HIV Prescribing Pharmacists Advisor Procurement NHS PaSA Pharmacists Design of Tendering Model - 2005 Framework contract Suppliers are invited to price for a van or postal delivery depending on the number of patients they have on service Patient bandings 3 monthly supply of patient medication (4 deliveries per year) List A – ARVs (pan London contract prices) List B – miscellaneous (source at lowest cost) Suppliers must provide financial data to LSCG on a monthly basis London HIV homecare contract - 2005 Commenced 1st July 2005 Duration - 2+2 Awarded to 4 suppliers Each supplier awarded geographically: HaH – North Central London (except UCLH) Firstplus – North West London (except C&W) HCL – North East London Intecare – South London Note – Firstplus – terminated contract in Mar 07 London HIV homecare contract - 2005 Homecare suppliers buy ARVs at list price They then provide manufacturers with dispensing data Manufacturers reimburse homecare suppliers difference between list price and contract price Provider trusts are allowed to keep 20% (now increased to 25%) of any savings to fund infrastructure costs Retender of London HIV Homecare 2008 Similar model to 2005 Homecare suppliers invited to price (van and postal) on patient numbers up to 6000+ in bandings of 500 for 3, 4, 5 or 6 monthly deliveries Evening, weekend and emergency delivery prices were also requested Patient numbers on therapy are confirmed by the trusts Example of pricing by patient banding 3-MONTHLY PRICING Postal Mon- Van normal Van non-normal Emergency Sunday delivery Sat 3- hours Mon- hours (excl Van Sat courier delivery charge monthly Fri Sat/Sun) Bidder Patient_Numbers Months Supplier A 1 - 499 Months3 Supplier A 500 - 999 Months3 Supplier A 1,000 - 1,499 Months3 Supplier A 1,500 - 1,999 Months3 Supplier A 2,000 - 2,499 Months3 Supplier A 2,500 - 2,999 Months3 Supplier A 3,000 - 3,499 Months3 Supplier A 3,500 - 3,999 Months3 Supplier A 4,000 - 4,499 Months3 Supplier A 4,500 - 5,999 Months3 Supplier A 5,000 - 5,499 Months3 Supplier A 5,500 - 5,999 Months3 Supplier A 6,000 + Months3 Retender of London HIV Homecare 2008 New NHMC specification used for tender Suppliers were requested to supply monthly management information and KPI data to PaSA Pre-tender meeting with all homecare suppliers – 8th May 2008 6 suppliers submitted tenders Shortlisted to 5 after PQQ Retender of London HIV Homecare 2008 Tenders were scored using the eAward system by myself, NHS PaSA and 2 HIV Pharmacy Leads Final adjudication – 1st Aug 2008. Adjudication panel consisted of: • Procurement pharmacists • NHS PaSA • Prescribing Advisor to HIV Consortium • Patient – Public Engagement representative • Commissioners • HIV Pharmacy Leads Weightings Measure Weighting Homecare supplier 20 infrastructure Quality Assurance 12 Storage and 20 distribution Customer service 18 Price 30 Total 100 Outcome of London HIV Tender 2008 Awarded the existing 3 homecare suppliers to the framework This was mainly due to higher service charges from the other two tenderers New patients in Supplier A trusts will commence with Supplier B Percentage market share of London HIV homecare patients by supplier 14% 20% Supplier A Supplier B Supplier C 66% Percentage of Patients on HIV Homecare compared to Total Number of Patients on Treatment by Trust Total number of patients on HIV homecare - 5974 (Jan 2009) 60% 50% 40% %age of patients on HIV homecare by trust 30% Average number of patients on HIV homecare across London 20% 10% 0% T st T ru I T tG T tO T st Q ru L T tM T tC T tD T H T tN T tR T tU T st F T st J T tA T tB T tE T tK T tP T tS ru V W T st T st st T st s s s s s s s s s s s s s ru st s ru ru ru ru ru ru ru ru ru ru ru ru ru ru ru ru ru ru ru T London HIV Homecare Savings Year Saving 2005-2006 £999,020 2006-2007 £1,200,488 2008-2009 £268,609 Any Questions?
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