NOEL J STAUNTON (BSc, MRPharmS, MBA, Dip H.Econ)

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NOEL J STAUNTON (BSc, MRPharmS, MBA, Dip H.Econ)

• Pharmaceutical Consultant-3i consultancy ltd
• Work with Pharma companies (Pfizer, GSK, BI,
  Novartis, Flynn, Shire, Galderma, Stiefel,
  Solvay, Takeda, Lundbeck etc, etc)
• Mob [phone]. E mail noel_at_3iconsultancy.com

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TODAY

• NHS reorganisation Why?
• PBR
• PBC
• WCC

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TODAY

• Darzi Polyclinics
• Pharmacy White Paper
• PCO levers

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Remember, people interpret things differently.

• In July 2002 the WHO asked the UN Security
  Council
• What, in your honest opinion, can we do to solve
  the problem of the shortage of food in the rest
  of the world?

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Didnt work because

• East Europeans didnt understand the word
  honest
• Chinese didnt understand opinion
• Middle Easterners didnt understand solve
• South Americans didnt understand problem
• Western Europeans didnt understand shortage
• Africans didnt understand food
• Americans didnt understand rest of the world

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NHS REORGANISATION - WHY?
Were spending more s per head on health than
EU15 and EU27 countries but our outcomes are poor
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MOST (ALL?) NHS CHANGES REVOLVE AROUND SPENDING
MORE IN PRIMARY CARE AND LESS IN SECONDARY CARE

• PBR
• PBC
• World Class Commissioning
• GP contract, Community Pharmacy contract,
  Consultants contract
• Nurse and Pharmacist Prescribing
• Managing long term conditions
• Etc, Etc, Etc

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PBR

• Old system - block contracts
• PAY FOR WHOLE POPULATION
• Dont know how much hospital care costs
• Cant disinvest from secondary care
• New system - PBR
• PAY FOR EACH INDIVIDUAL PATIENT
• National tariff
• CAN DISINVEST FROM HOSPITALS

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PBR

• England only (but Celtic nations eventually)
• Copy of US system which DOES reduce hospital stay
  (Ref HSJ, 9th Dec 04, P 16)
• International phenomenon DRGs first in the USA
  -Medicare
• France uses US DRGs
• Italy uses modified version of US DRG system
• Germany Netherlands from 2003
• England, Australia, Norway, Austria, Finland,
  Sweden, Japan and Canada have own case mix tools

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PBR - example acute MI

• A 55 year old man with a history of heart
  disease is admitted to coronary care with an MI.
  His condition is complicated by heart failure.
  He is discharged after 32 days.

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PBR - example acute MI

• Patient is discharged from hospital.
• Hospital finance clerk reads patients notes and
  types into her computer
• Primary diagnosis MI
• Secondary diagnosis -CHF
• PBR software spews out a code HRG E11

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PBR - example acute MI

• HRG E11 - non-elective spell 4,787
• 2 extra days _at_ 183 366
• Total charged to PCT 5,153

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PBR
PBR

• The tariff covers EVERYTHING that happens to the
  patient whilst in hospital (drugs, tests etc)
• Overseas PBR has stimulated primary care
  prescribing (in order to prevent expensive
  hospital tariffs)
• Overseas PBR has threatened secondary care
  prescribing (the hospital earns the same amount
  regardless of which drug they use) UNLESS the
  drug reduces length of stay
• Birth of real pharmaco economics in UK?

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PBC

• Fund holding DID change how many patients went
  into hospital (unlike HAs, PCTs, and other NHS
  changes) (Ref Health Foundation, Oct 04)
• PBC born in England only (April 05) and
  voluntary
• Resuscitated in April 06 through the GMS
  contract

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PBC efficiency gains

• Practices meant to keep at least 70 of any freed
  up resources
• This wasnt happening so BMA said dont do PBC
  UNLESS you get a written agreement (HSJ 19th
  April 07, P8).
• Resources freed up may be spent on
• Equipment
• Training, clinical and non-clinical staff
• Premises development with specific PCT board
  approval
•  
• Freed up resources can be shared across a wider
  group of practices

Practice Based Commissioning achieving universal
coverage Jan 06
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PBC Currently results arent great

• Audit Commission said
• Weve not yet seen any real evidence of it (PBC)
  leading to the redesign and transformation of
  services that was hoped.
• They blame PCTs and the way they have set PBC
  budgets. (Ref HSJ 22 Nov 07, P 7).
• However PBC is here for medium term at least
• NHS to use private firms to assist PC clusters
  with business cases (Ref HSJ 24 July 08, P 6)

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World Class Commissioning

• Adding life to years and years to life.
• Commissioning Assurance Handbook, dated 4 June
  2008. PCTs will be assessed against three
  elements Outcomes, Competencies and Governance.
  PCTs need to complete a self assessment and
  submit materials by end October 2008.
• PCTs to be ranked from 1 to 5 (5 a WCC)

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DARZI-Polyclinics

• Each PCT in England must have a new Polyclinic
• Also over 100 new GP practices in
  under-doctored PCTs (mainly NE and NW England)
• Contracts will be awarded Dec 08
• Real reason for doing this is to introduce some
  fat into the fire of change
• Many private companies bidding including Virgin,
  United Healthcare, BUPA. Virgin have had
  expressions of interest from 300 GP practices,
  Ref HSJ 22 May 08, P 11 but have now PULLED out
  of opening GP surgeries (Ref GP 26th Sep 08)

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DARZI - Polyclinics

• Set-up costs met by DOH - 250-800m.
• Winners will develop new services funded by
  start-up monies in competition with existing
  practices
• Some existing practices may go bust
• Practices will increasingly work in groups with
  shared approaches to medicines management
• Practices won by United Health, Care UK, Virgin,
  will restrict access, employ GPs and look to
  widespread formularies and prescribing policies

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Pharmacy White Paper

• (Green paper, White Paper, Bill, Legislation)
• White paper proposes that pharmacies will
• prescribe certain common medicines, be first port
  of call for minor ailments, saving every GP the
  equivalent of around one hour per day
• provide support for people with long-term
  conditions
• be able to screen for vascular disease and
  certain STDs, such as Chlamydia
• work much more closely with hospitals to provide
  seamless care
• play a bigger role in vaccination.

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Pharmacy White Paper

• Lets not forget
• Pharmacies currently only doing 85 MURs each
  (allowed to do 400) (Ref PJ 2 Aug 08, P 121)
• Lots of previous false dawns for pharmacy
• PWSI announced 2 years ago but only 2 (yes 2) in
  England

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Some things are obvious
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PCO LEVERS

• PCOs are proven to influence prescribing
• National audit office survey of 2,000 GPs in 07
• Atorvastatin Losartan in decline
• Prescribing incentive scheme is main lever
• PCOs reserve powerful levers for top priorities
  (normally big cost savings)

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PCO LEVERS

• Prescribing incentive schemes
• 5 lever, only for big savings (e.g. statins,
  sartans, antidepressants etc)
• Practice support pharmacists
• 5 lever, only for big savings
• ScriptSwitch
• 3 lever, smaller cost savings and quality issues
  
• Monthly Rx newsletters/Guidelines etc
• 2 lever, reinforce others
• Guidelines
• 1 lever, let someone else waste time on these

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NOEL J STAUNTON (BSc, MRPharmS, MBA, Dip H.Econ)

• Pharmaceutical Consultant-3i consultancy ltd
• Work with Pharma companies (Pfizer, GSK, BI,
  Novartis, Flynn, Shire, Galderma, Stiefel,
  Solvay, Takeda, Lundbeck etc, etc)
• Mob [phone]. E mail noel_at_3iconsultancy.com