Homecare Service Agreement by irt55043

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									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%




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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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