Hospital Pharmacy and Medicines Optimisation Project · 2017. 12. 7. · 1 Hospital Pharmacy and Medicines Optimisation Project HOSPITAL PHARMACY TRANSFORMATION PLAN March 2017 1.Executive
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Hospital Pharmacy and Medicines Optimisation Project
HOSPITAL PHARMACY TRANSFORMATION PLAN
March 2017
1. Executive Summary
1.1 The Birmingham and Solihull Transformation Plan (STP) made up of all health
providers including the three CCGs, two local authorities, seven hospitals, one
mental health trust and one community trust, sets out a five-year plan to
ensure local leaders work together to deliver better health and care for local
people. There are three strategic objectives including creating efficient
organisations and infrastructure, transformed primary, social and community
care (Community Care First) and Fit for Future secondary and tertiary
services. There isn’t a designated pharmacy/medicines management work
stream within the STP but work to generate savings is underway within the
CCGs.
1.2 It is likely that any service redesign across the STP and which involves
medicines management will require the engagement of the secondary care
pharmacy teams.
1.3 There is a proposed merger by acquisition of Heart of England NHS
Foundation Trust by University Hospitals of Birmingham. The clinical case of
change is being finalised and subject to satisfactory approval by various
organisations including the Competition and Marketing Authority and NHS
Improvement the Trusts could become one organisation as early as October
2017. This provides opportunities for the two acute Trust pharmacy
departments to work together to scope further ideas for improved efficiency
and productivity. The Trusts are already working together on digital systems
which includes electronic prescribing and administration.
1.4 The West Midlands Chief Pharmacists and East Midlands Chief Pharmacists
have been working collaboratively over the wider STP footprints on two
specific projects reviewing provision of aseptics services and medicines
information. Other projects may come to light as each service is scoped.
1.5 The Hospital Pharmacy Transformation Plan (HPTP) has been developed
through various discussions in the pharmacy and general management
teams. A project board has been established will develop, review and update
the detailed work plan and on an on-going basis scope potential productivity
2
and efficiency opportunities. This will be undertaken in collaboration with other
Trusts in the STP footprint where appropriate. The plan includes reference to
efficiencies already in place, work already underway and further opportunities.
2. Carter Metrics and Model Hospital Benchmarks
2.1 Currently, Heart of England NHS Foundation Trust (HEFT) has a main
pharmacy department in each of the three hospital sites which provides a
comprehensive service including:
Clinical pharmacy/patient safety services
Dispensing services for in-patients, discharge and outpatients
Medicines procurement*
Ward stock distribution
Aseptic compounding (chemotherapy)*
Financial management of medicines spend
Medicines Information*
A number of these services* have been centralised to one site since the
three hospitals merged in 2007.
The outpatient dispensing service is outsourced on the Birmingham
Heartlands Hospital site although a different model is being developed and
will take into consideration plans for Good Hope and Solihull Hospitals.
2.2 Comparing the Trust data with national and peer benchmarks the key areas
for improvement include:-
Increasing the uptake of biosimilars
Increasing the number of active non-medical pharmacist prescribers
Implementing EPMA across the Trust including outpatients and
specialist areas including chemotherapy
Improving medicines reconciliation metrics
Reducing stock holding in pharmacy stores
Improving access to clinical pharmacy and medicines management
service at weekends
3
3. Opportunities for transformational change (HPTP Plan Summary)
The Model Hospital and national benchmarking data had identified areas of further improvement and form the basis of the
identified work streams. Work streams will be established to review each element of the pharmacy service. A detailed project
plan will be developed by April 2017. This table highlights our current position to demonstrate that a number of the Carter
recommendations have already been implemented and new initiatives identified that requiring scoping.
Element of
Pharmacy Service
Current Position Actions underway/proposed for HPTP Timescales
SUPPLY CHAIN
A review of procurement processes is
being undertaken by Interim Head of
Procurement
Reviewing with view to implementing
rationalisation opportunities and efficiencies
across Birmingham and Birmingham and Solihull
STP and pending Trust merger
Q4 2018/19
Procurement of
Medicines
The pharmacy directorate is responsible
for the procurement of all medicines in the
Trust (or other departments under Chief
Pharmacist delegation)
Outsourced partner for outpatient
dispensing purchases own medicines in
accordance with Trust contracts.
Centralised procurement on behalf of all 3
sites.
CMU contracts are applied and contract
Implementation of e-invoicing is currently being
implemented. There is work underway to
improve our current position to >90%.
Medicines usage and expenditure software and
reporting tools are being purchased and will be
utilised to facilitate analysis of medicines
expenditure
To scope collaborative opportunity post-merger
with a view to applying larger volumes discounts
Q3 2017/18
Q2 2017/18
Q2 2018/19
4
information applied to local ordering
systems.
CMU/Regional Medicines Optimisation
Pharmacist – this post was established on
a fixed term contract hosted by the
WMAHSN following a paper presented to
Trust Directors of Finance – Trust will
continue to contribute to salary to continue
to obtain benefits from appointment.
To continue to work with HTE who aim to
maximise value from regional procurement
frameworks.
A significant review was undertaken of
coding of medicines, especially high cost
drugs. A new pathway has been recently
developed to ensure all the key
stakeholders are informed of new
commissioning policies involving high cost
drugs. This work is undertaken in
conjunction with the finance and income
teams.
There is an established pharmacy cost
improvement group which reviews ideas
and proposals of future schemes.
for medicines.
To review information & recommendations from
Medicines Optimisation lead pharmacist
following their collaboration with other
procurement hubs and procurement leads and
implement local actions as required.
Local dashboard under development – to
provide data as requested to benchmark and
monitor uptake of initiatives.
The NHSI list will be reviewed by the pharmacy
CIP group and develop a plan for quick
On-going
Q2 2017/18
On-going
5
Blueteq is available for NHSE
commissioner approval for CDF drugs and
other specialities.
Operational indicators/KPIs are in place
and monitored monthly including stock
turnover, waste and outstanding invoices
implementation
Stores/
Distribution
Automation already in place at Heartlands
and Solihull Hospitals. Used for most stock
supplies and dispensing. Business case
for robot at Good Hope has been
unsuccessful for several years as unable
to demonstrate financial benefits.
Current stock holding (quantity) is 17.4
days (over 5 days).
Rationale to review stock holding – critical
medicines need to be in excess of 15 days
due to supply chain issues; need to look at
high cost drugs and number of days stock
holding as cash becomes a key issue.
Deliveries per day – in excess of 5 per day
To review literature for documented benefits of
ward based automation with a view to
developing a business case and options
appraisals document. To work collaboratively
with other Trusts which have implemented
similar schemes to identify lessons learnt.
To scope feasibility of reducing stock holding of
medicines supplied by wholesaler from 14 to 7
days.
To scope feasibility of reducing stock holding of
medicines supplied by manufacturer from 42 to
28 days (or less without introducing risks)
Deliveries will be a significant challenge since as
a minimum there are 4 wholesalers delivering
twice a day plus other ad hoc deliveries from
manufacturers. Unlikely to be achieved unless a
Q4 2017/18
Q2 2017/18
Q2 2017/18
Q4 2018/19
6
Internal project completed to move specific
large volume lines to internal direct to ward
delivery to reduce stockholding – findings
did not support implementation at this time
central Regional store in place. To scope
opportunities following merger by acquisition.
To scope opportunities for packing and
distribution of boxes from site/s with pharmacy
automation. May include supplies from central
store if established
To undertake critical review of ward stock lists
When the commercial market is more mature a
managed service for the end to end supply chain
may be available. To review literature and other
resources as these services become available
Q3 2017/18
Q3 2017/18
Q4 2019/20
Dispensing An outsourced dispensing service for
outpatients has been in existence at BHH
since 2007. A recent tender was awarded
to the current provider (Boots) for a further
5+ 5years and includes a similar service to
GHH but subsequently rejected. Both
parties are working together to develop
exit strategy and alternative model sought.
Outpatient drug treatment referral letters
used for non-urgent treatment.
Blister packs prepared by outsourced
To identify alternative model for outsourced
dispensing service following final decision of
tender. Model will need to take account of
opportunities for the repatriation of FP10s,
improved formulary management, homecare &
logistics and provision of blister packs for each
site.
To scope opportunities for outsourced model for
GHH and SH.
To scope opportunities for extending medicines
delivered through homecare/outsourced
provision with a view to maximising savings for
Q4 2017/18
Q3 2018/19
Q3 2018/19
7
partner for two of the hospital sites Trust, local CCGs and NHSE. Subject to
outsourced model in situ.
To scope opportunities for dispensing discharge
medicines with potential to create capacity for
extending clinical service and new savings
Q4 2017/18
Aseptics /
Chemotherapy
Aseptics dispensing services have been
centralised to one site three years ago.
The unit is unlicensed and medicines are
prepared under section 10 Medicines Act.
This means a product has to be prepared
for a specific patient against a prescription.
An external review was undertaken in
2013 and the recommendation was not to
license the unit at that time. Before this is
revisited again, the results of the EM/WM
aseptics review will be taken into
consideration.
A local Trust provides contingency in
emergency. At weekends urgent treatment
is obtained from a licensed manufacturer
under an SLA.
Procurement of high volume, lower cost
prefilled syringes to ensure effective use of
workforce for higher cost, lower volume
East and West Midlands HPTP Aseptic
Collaborative in place. Phase 1 is an initial
scoping exercise to look at the services provided
currently, the facilities and variation. This will in
turn support phase 2 which is looking at project
team to look at case for change – each Trust will
contribute to the project costs for phase 2
To implement NHSE dose banding schedules as
per CQUIN 17/18
To scope requirement to implement ‘campaign’
production with a view to improving cost
efficiency via vial sharing
Q4 2017/18
Q4 2017/18
Q3 2017/18
8
items and trials. Prefilled products allow
service to be more responsive as these
are quicker to deliver.
Homecare Significant growth has been seen in the
use of home care for medicines supply.
Business case has been written identifying
need for additional resources.
Trust is compliant with Hackett Report
(2010) recommendations.
Home care framework is in place to ensure
cost effective service is available.
Working collaboratively with other Trusts in
West and East Midlands by sharing SOPs
to introduce more efficient processes
where appropriate
To scope further opportunities for provision of
homecare of high cost medicines with a view to
realise further savings.
To work with income team with regards to
shared savings benefits being agreed with
commissioners.
To assess current resource to deliver current
homecare service (review business case) and in
light of home care funding framework being
prepared by NHSE.
To scope opportunities to share workload with
homecare hubs across Birmingham and Solihull
STP
On-going
Q2 2017/18
Q2 2017/18
Q2 2017/18
Quality
Management
Systems
The QC of piped medical gases is
undertaken by an external provider with
contract managed through estates.
QA support for Farwell Audit for aseptics
services and ad hoc advice is available
from Bristol Hospital via an SLA.
To scope potential collaborative opportunities
with other WM (and EM) Trusts to establish local
QA service across the STPs within the patch
(Birmingham and Solihull) and in neighbouring
STPs (Staffordshire, Shropshire, Telford and
Wrekin, Derbyshire, Nottinghamshire,
Leicestershire and Rutland, Black Country,
Coventry and Warwickshire and Herefordshire
Q4 2018/19
9
and Worcestershire).
ADVISORY
SERVICES
Medicines
Information
The Trust Medicines Information service
has been centralised to one site for
several years.
The West Midlands Regional Medicines
Information Service is based at Good
Hope Hospital.
Trust MI service provides education &
training for pre-registration pharmacists for
another hospital in the W Midlands
All clinical pharmacists can access MI
Databank on both sites.
Trust MI service supports a patient
helpline for medicines queries post
discharge
MI pharmacists support the formulary
management processes and management
of new drugs with support from the
Interface Prescribing Manager (a post
shared with the CCGs).
Collaboration has already started with the
Regional Medicines Information Service and a
temporary shared pharmacist post will
commence in November 2016.
Until the SPS review has clearly defined the
roles of Regional Medicines Information and the
resources available, further collaboration is
limited. Single site may be an option but
investment to estate will be required.
WM/EM Chief Pharmacist review of local
provision of Medicines Information Services
across STPs (Birmingham and Solihull,
Staffordshire, Shropshire, Telford and Wrekin,
Derbyshire, Nottinghamshire, Leicestershire and
Rutland, Black Country, Coventry and
Warwickshire and Herefordshire and
Worcestershire). To review collaborative
opportunities once report is available
Complete
Q4 2018/19
Q4 2017/18
10
Formulary A Trust interface formulary has been
available for many years but following the
creation of a new Area Prescribing
Committee for pan Birmingham and
Solihull and environs, this has been
updated following harmonisation of all the
formularies in pan Birmingham.
Additionally hospital only medicines are
included in the Trust netformulary.
There is a robust process in place for the
management of high cost drugs and other
new medicines. NHSE and CCG
commissioned policies are also managed
effectively to ensure quick access to new
medicines and appropriate systems are in
place to ensure the correct coding of
medicines including high cost medicines.
EPMA system helps control the prescribing of
new medicines which are not formulary. This is
monitored by the Medicines Assessment and
Advisory Group by reviewing new medicines
added to the system.
Looking at using warnings/decision support tools
on EP to help manage medicines choice.
To review stock control system and supporting
processes to address key challenge where a
high cost medicine is used for different
indications and it is commissioned for only one
indication.
To review local processes for managing the
introduction of new medicines following
implementation of Regional Medicines
Optimisation Committees (Apr/May 2017)
On-going
On-going
Q4 2017/18
Q2 2017/18
EDUCATION &
TRAINING
Training provided
to pre-registration
technicians and
pharmacists
Pre- registration technicians are fully
outsourced (including all assessing) to an
external provider
Participated in centralised recruitment of
pre-registration pharmacists (Oriel)
Due to changes in regional funding a review of
the current pre-registration technicians training
pathway to be reviewed & apprenticeship
scheme scoped – lead by HEE.
Q4 2017/18
11
NVQ assistant
staff
All training for NVQ qualification is
outsourced
Complete
Post registration
Pharmacy staff
Pharmacists undergo formal post grad
training from external sources e.g. diploma
in clinical pharmacy, lab final product
release, specialist training, independent
prescribing, PTQA
To scope opportunities of sharing expertise of
specialist pharmacists across local STP footprint
or within West Midlands with a view to
minimising costs associated with staff attending
courses off site.
Q4 2017/18
Undergraduate
training
Support is currently provided for Aston
University pharmacy undergraduates lead
by Teacher-Practitioner funded by Aston
University
To scope opportunities for reviewing & extending
support to universities e.g. Aston, Birmingham,
Keele and Wolverhampton across STPs
(Birmingham and Solihull, Staffordshire and
Black Country)
To consider developing shared posts with
universities in local STP (Birmingham and
Solihull)
Q2 2018/19
Q4 2017/18
SERVICES TO
EXTERNAL
ORGANISATIONS
Community
Services
Trust staff provide a medicines
management and clinical pharmacy
service to Solihull community as directed
by the CCG. Clinical service and
governance processes support local care
To scope further opportunities to work with community service leads to prevent admissions e.g. Solihull Together, GP confederations/CCGs To scope opportunities for collaborative working with Birmingham Community Health Trust with a view to introducing efficiencies across
Q3 2018/19
Q4 2017/18
12
homes and residential accommodation
Challenge: Changing environment within hospital, CCGs, Solihull connect and formation of GP federations
community teams
To explore joint working with the community
services care home pharmacists/ practice
support pharmacists/rapid response pharmacist
To explore collaborative working across all the
sectors including care homes, community
pharmacies, CQC and the HEFT community
services team including medical team
To scope requirements of patients in other
intermediate care facilities e.g. St. Giles
To scope opportunities to review new
admissions to care homes e.g. to target elderly
patients being discharged home from HEFT
To review all activities undertaken by the current
community pharmacy services team and assess
if it requires pharmacist/technician involvement
CLINICAL
SERVICES
Clinical service
provision by
Patient facing activities by pharmacists
assessed as 82% following time and
motion audit undertaken using
Quality Improvement projects are being used to
help pharmacists prioritise patients requiring
review of high risk medicines, missed doses,
On-going
13
pharmacists documentation agreed within WM.
Band 6 pharmacist rotation (4 months) has
been in place for three years following an
internal staffing transformation. Clarity
regarding line management and rotational
management has been developed.
Training packs in place with pharmacists
encouraged to work towards the Royal
Pharmaceutical Society General Level
Framework.
Band 7 pharmacists undergo an annual
rotation.
Prescribing pharmacists – 14% (of all
pharmacists in establishment). Most are
delivering service in specialist areas
Clinical teams focused on improving
patient flow and working with Trust
transformation teams
Summary Care Records and Your Care
Connected used routinely to support
medicines reconciliation by medicines
management ward based teams
clinical verification and to help with prioritisation
of workflow. Dashboard is in development and
will be used to monitor performance and
efficiencies.
A critical review of the rotations is underway to
inform a recruitment and retention strategy
which is in development.
NMP pharmacy strategy has been developed.
Implementation plan in place. To identify roles
and responsibilities in conjunction with Trust
Advanced Practice strategy.
To scope opportunities to collaborate with
primary care medicines management leads to
appoint shared posts which should help with
recruitment and retention.
To scope benefits of appointing/sharing posts
with commissioners (already working on
antifungals post with NHSE).
To scope opportunities for specialist pharmacists
taking the lead for their speciality across
Birmingham and Solihull & pending Trust merger
to ensure consistency and reduce variation.
Q2 2017/18
Q4 2017/18
Complete –
on hold
Q4 2018/19
Q3 2018/19
14
Development of
ward based
pharmacy
technicians
Registered technicians support
pharmacists by undertaking medicines
reconciliation, medication history taking
and ward based dispensing
Ward based services are under review to ensure
technicians are provided service on the most
appropriate wards e.g. complex patients, high
turnover.
To review extended roles and responsibilities of
technicians e.g. medicines ordering with aim to
free up time for pharmacists to focus on
medicines optimisation at ward level.
E-ordering processes being reviewed on EP for
nurses
To scope opportunities in collaboration with
nursing managers for technicians to be involved
in ward based administration to release time for
nurses leading to improvement in patient safety
and patient care.
Q3 2017/18
Q3 2017/18
Q2 2017/18
Q4 2017/18
Embedding the
principles of
Medicines
Optimisation
Traditional clinical verification reviews
undertaken by pharmacists
To scope opportunities for increasing utilisation
of medicines optimisation resources and toolkits
with a view to implementing new critical review
of prescribed medicines and their place in
therapy e.g. in accordance with NICE, de-
prescribing, horizon scanning
Q4 2017/18
SEVEN DAY
SERVICES
15
Pharmacy Seven
Day Services
Business case approved in 2014-15 to
support the delivery of a targeted clinical
pharmacy service on a Saturday and
Sunday in the mornings of Saturday and
Sunday on two sites.
Single On-call pharmacy service provided
across all sites. New rotas have been
implemented in Feb 17 after consultation
with pharmacists to provide equity in
delivery of the service and ensure senior
support is available for the junior
pharmacists.
To scope further opportunities for extending
service at weekend with reference to 7 day
service report issued recently and Keogh
recommendations
To scope further opportunities for providing on-
call support across wider organisation pending
merger.
Q4 2017/18
Q4 2019/20
(subject to final
acquisition)
NHS DIGITAL
HEALTHCARE
Pharmacy
Computer System
JAC is used for stock management and
procurement processes
JAC worksheets are utilised in the aseptics
dispensing unit
EPTTOs and eTTOs available – TTOs
available electronically to GPs (although
work is on-going regarding future content
and shared information and formatting)
JAC v 2016 – capital bid approved but on
NHS digital roadmap to be developed in
conjunction with interim IT management director.
To scope rationalisation of back office functions
across merged organisation e.g. informatics,
pharmacy systems with view to improving
productivity and efficiency
Q4 2017/18
Q3 2018/19
16
hold pending implementation of alternative
system post-merger. Timescales to be
agreed which affect whether upgrade
occurs.
EPMA JAC EPMA system - Implemented across
all sites in all areas except cancer
services, critical care, paediatrics,
maternity and some outpatient areas.
External review of IT infrastructure has put
a hold on EP chemo implementation
although funding and resources available
in original business case. Project initiation
meetings had restarted but now on hold
pending review of concerns raised locally
about system.
Implementation of new EP system to be agreed/
timescales unknown. Dependent on potential
merger timescales.
To standardise electronic prescribing systems
across merged organisations
To implement EPMA in general and specialist
areas including chemotherapy pending outcome
of proposed merger by acquisition Trusts.
Q4 2019/20
dm+d
Falsified
Medicines
Directive
An upgrade of the pharmacy stock
management system to deliver essential
standards is awaited from JAC. See
above – re JAC v2016
To ensure reporting is dm+d compliant Q2 2017/18
MEDICINES
OPTIMISATION
CQUIN – The proposed Medicines Optimisation
CQUIN for 17/18 and 18/19 supports the
To adopt the MO CQUIN in April 2017 to drive
the HPTP workstreams around outpatient
Q1 2017/18
17
MO reporting swift introduction of biosimilar agents,
improving data quality of use and
outcomes of high cost medicines, use of
lowest cost dispensing channels and
compliance with approved guidelines
(reviewing and switching).
dispensing, homecare, medicines optimisation,
digital transformation and medicines cost
reporting.
To consider development of business case for
additional resource to support implementation of
MO CQUIN.
Q1 2017/18
Biosimilar switch All new patients are initiated on infliximab
from April 2016. A plan for implementation
of other products was prepared but uptake
has been slow (as per metric)
To work with directorates to increase uptake of
biosimilars
To work with commissioners regarding shared
benefits savings schemes which would
encourage a quicker uptake
Implementation plans prepared for Infliximab,
rituximab, etanercept
On-going
On-going
Q3 2017/18
Generic contracts E.g. Implement generic voriconazole Complete
Top 10 drugs
savings – NHSI
There is a pharmacy group comprising
senior pharmacists, finance and general
management who meet to identify and
agree CIP plans. CIP over achieved year
to date. This group will review the
proposed top 10 list and agree how to
implement if relevant.
To review Regional Procurement Update
To participate in national audit to measure local
procurement services when audit tool is
available
To utilise specific tools being developed within
the procurement network to support the
collection of the metrics in a standardised way
and to facilitate benchmarking
To undertake review of over-labelled products
Q1 2018/19
Q1 2018/19
18
newsletters and implement proposed
savings opportunities.
and pre-packs to ensure a more efficient and
cost-effective supply & aligning with work due to
be undertaken by NPPSC.
To scope collaborative opportunities to
rationalise unlicensed medicines across the local
STP (Birmingham and Solihull) in conjunction
with procurement hubs & aligning with work due
to be undertaken by NPPSC.
Q1 2018/19
Q1 2018/19
IVIG outcomes Dispensing information is provided to
NHSE.
Local database in place for recording
required information
To scope what resources are required with a
view to ensuring outcome data is added to
national database for supply and demand
Q1 2017/18
CLINICAL TRIALS
Pharmacy support Trustwide medication
research trials.
To scope opportunities of utilising clinical
pharmacists in specialist clinics e.g. cancer with
a view to increasing uptake of investigational
medicinal products rather than licensed
medicines – research project in planning stages
Q3 2017/18
19
4. RISKS AND MITIGATIONS (might happen)
Risk identified Mitigation Plans Risk Remaining
Loss of WM Regional MO post at the end of
March 2017 would result in lack of coordination
across the WM Region, links to National
Procurement Committee / other Regional
Procurement posts and national agenda.
Future funding model is under
consideration with likely interim
contribution from each Trust in the
West Midlands.
Hospitals benchmark their own
medicines use and expenditure and
utilise CMU data to benchmark prices
paid or non-compliance with contracts.
Slower uptake of new medicines – peer
pressure
Automation: capital monies not available to
replace current robots at BHH and SH
pharmacies
Risk register – impact on work flow,
stock holding and staffing
Requirement for additional staffing
Slower dispensing/supplies
Regular breakdowns affecting work flow
Single supply chain – requires 100% medicines
lines to be provided by one
supplier/wholesaler. Links to Pharma and
opening up supply chains re: specific drug
lines.
To review medicine lines and see
whether suppliers can be rationalised
allowing for sufficient contingency
should a supplier not be available to
supply
5 deliveries per day
Capacity of manufacturing units is limited.
NHSE working with industry to ensure dose
banded doses are available.
To outsource prefilled products where
strengths available to reduce in-house
dispensing
Maximum efficiency not realised
Homecare –additional resources business
case is not funded – will limit future savings
Review procurement process to identify
other efficiencies e.g e-invoicing to free
Maximum benefits not realised
20
opportunities. Invest to save business case. up capacity
SPS review – final decision outstanding
regarding roles and responsibilities of regional
service & associated funding. What will hub
and spoke look like?
Local MI and regional MI service work
independently
Some resources shared
Some resources used and purchased
independently
Estate not shared
EPMA implementation – utilisation of system
from neighbouring Trust (potential merger)
Current system in place – request
upgrade in interim
High risk areas remain without
electronic prescribing system
Non-medical prescribing – funding and
capacity on courses for prescribing may not be
sufficient
Prioritise senior pharmacists, 8a and
above and then band 7 to undertake
training.
May take several years before band 6
and 7 pharmacists offered prescribing
training opportunities.
Outpatient pharmacy – financial sustainability
dependent on there being no changes to VAT
legislation and a viable profit net distribution
with NHSE
Local agreement with NHSE
commissioning to ensure outsourcing
provision is viable.
FP10s (loss of formulary control)
Outsourcing service is withdrawn,
reduced VAT savings opportunities
Ward based automation – costs of purchasing
cabinets may not be feasible from a financial or
operational perspective
Cabinets or automation phased in over
several years. Return on investment
quoted as 4 years
Traditional storage for
ward/departments remains in place
Rationalisation of aseptics services Loss of resilience, loss of income from
NHSE for aseptic services on site,
increased level of waste
Investment required to maintain quality
of aseptic dispensing units
21
5. ISSUES AND MITIGATIONS (will happen)
The following issues have been identified to happen during the course of the project:
Issues identified Mitigation Plans Risk Remaining
HEE funding and training course loss for 7 pre-
reg pharmacist posts may cease from July 18
due to changes
Uncertainty remains for training provision,
course changes and effects on service
capacity
Preparation of business to recruit
pharmacy technician (band 4) posts
prevent reduction from service provision
and capacity.
Business case may not be funded or
partial funding.
Unable to contribute to service provision
as currently part of workforce
HEE (HEWM) central funding and training
course loss for 6 pre-reg technician posts –
cease from Sept 2017
Preparation of business to secure
funding apprentices (student technician
posts and training course funds form
Trust.
Business case may not be funded or
partial funding. Negative impact on
pharmacy technician succession
planning.
Written by:
Tania Carruthers Clinical Director of Pharmacy
Divisional lead sign off: Dr Alan Jones, Divisional Director (Div 1)
Executive lead sign off: Julian Miller, Interim Finance Director
31.3.17
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