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This event has been accredited by the College of Pharmacy Practice against the Royal Pharmaceutical Society's CPD competency framework. Update “What is happening in the medicines homecare market?”. Allan Karr, MRPharmS, DipM, MBA. Chairman, National Homecare Medicines Committee.

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This event has been accredited by the College of Pharmacy Practice against the Royal Pharmaceutical Society's CPD competency framework.
allan karr mrpharms dipm mba chairman national homecare medicines committee

Update

“What is happening in the medicines homecare market?”

Allan Karr, MRPharmS, DipM, MBA.

Chairman, National Homecare Medicines Committee

Allan Karr, MRPharmS, DipM, MBA.

Chairman, National Homecare Medicines Committee

medicine homecare services
Medicine Homecare Services

Aim is to :

“Support patients with chronic and acute illnesses in the community.”

medicines supply chain
Medicines Supply Chain

Homecare delivery service

R&D

Manufacturer

Original patent holder

EMEA

MHRA

Production

unit

Ward

Production unit

Specials

Manufacturer

Hospital pharmacy

Distributor & Wholesaler

Patient

MEDICINES MANAGEMENT

Generic

Supplier

Community pharmacy

EMEA

MHRA

Production unit

Dispensing doctor

PI

Supplier

homecare service process
Homecare Service Process

Consider product and type of service – obtain approval e.g. DTC, PCT’s

  • Methodology for recruiting/registering patients
  • Prescription process e.g. clinical check, chasing Rx
  • Agree performance standards with provider

Contract with Homecare services provider

Communication process between all parties

Invoice and Payment

Monitor and audit performance

Home care company can then provide the service e.g. purchase, dispense, deliver and administer medicines. General/Value added e.g. Collection of waste, education and support. Data management, Training, Clinical Governance & Audit

risk management potential
Risk Management Potential

Increasing Risk

& Increasing Cost

& Increasing Complexity

Preparation Aseptic

Nurse Administration

Nurse Administration

Dispensing Process

Dispensing Process

Dispensing Process

Delivery Process

Delivery Process

Delivery Process

Delivery Process

Increasing value added service

existing therapeutic areas
Existing Therapeutic Areas
  • Cardiology
  • Oncology
  • Cystic fibrosis
  • Dermatology
  • Gastroenterology
  • Haematology
  • Haemophilia
  • HIV
  • Hypopituitarism
  • Lyposomal storage disorders
  • Multiple Sclerosis
  • Post-menopausal Osteoporosis
  • Primary Immunodeficiency Disease
  • Renal dialysis and transplant
  • Schizophrenia
  • Respiratory disease
  • Rheumatoid arthritis
  • Rheumatology
  • Thalassaemia
current medicinal products that have been supplied via homecare services
Current medicinal products that have been supplied via Homecare Services
  • Home parental nutrition
  • IVF Treatments
  • Adult growth hormone
  • Milrinone
  • Trastuzumab
  • Epoetin
  • Anitbiotics
  • Etanercept
  • Efalizumam
  • Methotrexate
  • Adalimumab
  • Imiglucerase
  • Epoetin
  • Blood coagulation factor VIII & IX
  • Anti-retrovirals
  • Somatropin (human growth hormone)
  • Desferrioxamine
  • Interferon
  • Beta-interferon
  • Topotecan 
  • Teraparatide
  • IV/SC immunoglobulin
  • Darbepoetin 
  • Immunosuppressants for renal transplant
  • Clozapine 
  • Terbutaline
  • Adalimumab
  • Infliximab
  • Teraparatide
  • Methotrexate 
  • Desferrioxamine
  • Herceptin
current list of homecare providers
Current List of Homecare Providers

Air products

Calea Uk

Careology

Central Home Care

(Alliance Unichem)

Flexible Home Care

Health Care at Home/ADS

Evolution (AAH/Celesio)

Intecare

Nutricia Clinical Care

Bupa/Clinovia

Polarspeed

Mawdsley Brooks

Baxter/Willow

Medco

DHL

what are the benefits of medicines homecare
What are the benefits of Medicines Homecare

Discharge patients sooner

Reduce non-essential OPD appointments & admissions

Moves workload from dispensary to administration

Reduced waiting times

Financial?

Organisation

Increased choice

Time saving - no waiting in OPD

Reduced travel

Convenience

Quality of life – less hassle

Less risk of HCAI

Patient

Capacity gains

Reduces stress in the dispensary

Refocuses skill mix and clinical priorities

Reduced waiting times for non-home care patients.

Pharmacy

Policy

Capacity

Efficiency

Control

Patient choice

Financial

Primary care

benefits drivers pharma industry perspective
Benefits/Drivers Pharma Industry Perspective

Company is closer to the patient. Increase opportunity for DTC marketing? Fewer control systems?

Ability to offer reduced prices to customers without loss of profit e.g. part of NICE “patient access scheme” process.

More control over the supply chain

the procurement framework and contracting models
The Procurement Framework and Contracting Models

1. Host Trust Tender Model

  • Trust selects the service
  • Specification developed and tendered
  • Trusts selects a preferred provider

2. Pharma CompanyModel

  • Pharma tender or selection
  • New distribution route
  • No NHS involvement

models of distribution
Models of Distribution

Hospitals/

PCT’s/CPH’s

Hospitals/

PCT’s/CPH’s

Homecare

Supplies

Homecare

Supplies

Pharmaceutical

Manufacturers

Pharmaceutical

Manufacturers

Relationship? No Tendering

Tendering

Relationship? No Tendering

Tendering

the governance and quality issues with outsourcing comes risk
The Governance and Quality Issues - with outsourcing comes risk

Services are not the same as products e.g.

Absence of inventory from trust perspective

People as part of the service

Greater involvement of customers

Greater difficulties in maintaining quality standards

Importance of time factor

the governance and quality issues with outsourcing comes risk1
The Governance and Quality Issues - with outsourcing comes risk

Prescription checking and validation

Aseptic preparation and administration

Technical and clinical advice

Responsibilities and liabilities of each party

Performance standards

Error and complaint monitoring

the clinical governance framework
The Clinical Governance Framework

Risk management e.g. assessment and risk reduction techniques

Establishment of quality systems and performance standards

Inclusion in Trust Clinical Governance procedures

Must have a clear contractual relationship

between purchaser & provider

what are the outstanding issues
What are the Outstanding Issues?

NHS strategy e.g. private sector, do-it- yourself (OPAT), FP10(HP)?

Confirmation/clarity on VAT position

Agreed product list for home care

Ensure adherence to professional practice & Clinical Governance.

Operational systems need improving e.g. employing home care co-ordinators, electronic links with home care suppliers.

Data management

what are the outstanding issues1
What are the Outstanding Issues?

Clarification of PCT/GP/Commissioners role

Fit in new financial structure e.g.Tariffs, Financial resources

Relationship between manufacturer, home care service provider and Trusts

Managing a contracted service effectively

Development and use of common contracts

Development of performance standards & audit arrangements?

Unbundling of costs from products

what are the outstanding issues2
What are the Outstanding Issues?
  • What will be the impact of new home care services suppliers

Recognition that the home care market exists and is becoming more important

role of the national medicines homecare committee
Role of the National medicines Homecare Committee

Hospitals/PCTs/CPH’s

NHMC role

Effective Working

Relationships

Pharmaceutical

Manufacturers

Home Care

Supplies