Medicines Management Team Roles in Commissioning how is it for you

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Medicines Management Team Roles in Commissioning
how is it for you?

• Sue Carter
• Area Head of Medicines Management, West Sussex PCT

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Practice Based Commissioning

• The transfer of many health service commissioning
  responsibilities, along with the associated
  indicative budgets, to primary care clinicians
  and other healthcare professionals. They will
  determine the range of services to be provided
  for their population with the PCT acting as their
  agent to undertake any required procurements and
  administration, and supporting all commissioning
  processes.
• (Thanks to Hampshire LPC!)

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So Whats The Problem?

• Marketing medicines management
• Do PBC stakeholders and Programme leads always
  know when to consider medicines in service
  redesign care pathways?
• Do they know what we do?
• Do PCT management know what we do?
• Structural change ? decreased awareness?
• Working collaboratively all fields of practice
• PCT ? locality ? practice-based
• Wider support within pharmacy profession?

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Stretched in all directions?
PBC
CONTRACTOR EXPECTATIONS
PROFESSIONAL REGULATION
DH EXPECTATIONS
PCT MEDICINES MANAGEMENT
CORPORATE
PROGRAMMES
WORKFORCE ISSUES
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PBC Prescribing

• Organic PBC development through enabling
  guidance wide variation in structures,
  processes, resources, priorities
• NHS Benchmarking Network Survey
• 21 of PCTs have devolved prescribing budgets to
  PBC localities
• . So over three quarters of PCTs have not
• Only two PCTs reported ring fencing the
  prescribing budget
• NHS Benchmarking Network Practice Based
  Commissioning Survey and Benchmarking Analysis
  Interim report 8th May 2009

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TOP DOWN
TENSIONS IN COMMISSIONING
IMPROVED OUTCOMES
COMPETITION CHOICE
BOTTOM UP
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Commissioning Lifecycle

• At West Sussex PCT the model used to explain
  commissioning is called The Commissioning
  Lifecycle

• Planning
• Buying
• Checking

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West Sussex PCT
Lets work together
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An alternative PBC

• Planning
• identifying population needs
• reviewing finances and services
• deciding priorities ensuring that public
  resources are used effectively to promote health
  and wellbeing and support high-quality services
• allocating resources
• designing services
• Buying
• finding suitable providers through various buying
  routes e.g. tender.
• shaping structure of supply e.g. contracting
  with health care providers to deliver those
  services

• planning capacity and managing demand
• providing robust contracts
• Checking
• supporting patient choice
• managing the performance of health service
  providers and taking action to ensure that
  plans and standards are met
• seeking public and patient views
• adjusting plans in light of these outcomes.

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Priorities

• Corporate
• Controlled Drugs
• Medicines Safety
• Quality, governance and standards
• Budget resource management
• Medicines management
• Prescribing support in practices, at meetings
  ad hoc
• PBC projects priorities
• Practice Prescribing Visits (incl. QOF Meds 6
  10)
• Commissioning pharmaceutical services
• Strategic
• Operational
• Pharmaceutical Needs Assessment
• Pharmaceutical public health

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Priorities

• Support to commissioning of other services
• PBC localities
• Programme boards
• Medicines in Commissioning Toolkit
• Non-medical prescribing
• PCT decision making about medicines
• New legislation
• Policies
• Process
• Interface with other organisations

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Local Area Developments So Far

• Medicines management priorities in 3 consortia
• Key therapeutic areas quick wins
• Scriptswitch
• Practice Based Support
• Data
• Woundcare
• Dietetics in primary care
• Specials
• BCBV

• Varying engagement with 8 PBC leads consortia
• Focus on practice-based support
• Prescribing locality group as sub-group of PBC
  Consortia
• PBC hosting of programmes aligned medicines
  management input?

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RACI

• For each medicines management workstream, RACI
  should be identified
• RESPONSIBILITY
• ACCOUNTABILITY
• identify who should CONTRIBUTE
• Identify who should be INFORMED

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Virtual Team Cycle to support Programmes/PBC
Programme/PBC Project lead
Notification that resource is required
Job descriptions amended to reflect Project
Management role
Department Heads
Time required
Notification of RACI for project
Identification of A for Programme/PBC
Allocation of Resources
Reporting of time/availability
Plan time across allocated Programmes/PBC
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Commissioning Medicines

• From a medicines management perspective we need
  to consider how we "commission" medicines in line
  with the commissioning cycle. Do we do a lot of
  this already and just need to make the links more
  obvious?

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Commissioning cycle for medicines

• Assess needs PNA, JSNA input,
• Review current service provision audit, review,
  customer feedback
• Decide priorities national local drivers,
  safety, logistics, resources
• Design service prescribing support SOPs, safe
  secure access to medicines in other services
• Shape structure of supply - specify outcomes
  desired, write service specs, primary care
  contracting
• Manage demand and ensure appropriate access to
  care pharmaceutical services, contracting
• Clinical decision making clinical engagement
• Managing performance prescribing support,
  medicines safety etc

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Outcome-based specifications

• .. for Pharmaceutical Medicines Management
  Services?
• Use during the planning and buying process
  for a procurement or for a planned investment so
  that potential service providers have a clear
  understanding of your requirements.
• If you include it in signed contract
  documentation, it becomes contractually binding,
  and subsequently it can used as the basis of
  performance management during the lifecycle of a
  contract.

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Integrating Medicines Mgt With PBC

• Proactive marketing of medicines management to
  PBC stakeholders
• Align medicines management prescribing
  priorities workstreams with PBC priorities
• Structural alignment with PBC localities
• Sharing collaboration to avoid duplication
• Statutory roles at PCT or provide from localities
  up?

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Harriet Lewis Trafford PCT - 2008
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Next steps in West Sussex

• Pilot RACI for Medicines Management in 1 locality
• Pilot medicines management in virtual teams
  review of capacity demand
• Improve awareness of PBC leads Programme Leads
  of all medicines management roles
  responsibilities marketing
• Business cases for additional locality support,
  managed by PCT Medicines Management leads
• Programme budgeting approach to include
  prescribing?

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Next steps in West Sussex

• Shared understanding throughout team of new needs
  and ways of working
• Team structure review
• Team roles review
• Development needs and competency gap analysis
• Motivation retention of existing excellent team
  through more change