HIV Homecare – the HIV Homecare – the London Experience London Experience Philip Aubrey Philip Aubrey Medicines Procurement Specialist – London & Medicines Procurement Specialist – London & East of England East of England LPP – P&MM Operational Lead LPP – P&MM Operational Lead National Homecare Symposium - 15 National Homecare Symposium - 15 th th January January 2009 2009
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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.
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HIV Homecare – the HIV Homecare – the London ExperienceLondon Experience
Philip AubreyPhilip AubreyMedicines Procurement Specialist – London & East of Medicines Procurement Specialist – London & East of
EnglandEnglandLPP – P&MM Operational LeadLPP – P&MM Operational Lead
National Homecare Symposium - 15National Homecare Symposium - 15thth January 2009 January 2009
OverviewOverview
Commissioning of HIV services in Commissioning of HIV services in LondonLondon
Background to HIV homecare in Background to HIV homecare in LondonLondon
Tendering for a London HIV Tendering for a London HIV Homecare ServiceHomecare Service
Retender of London HIV Homecare Retender of London HIV Homecare 20082008
Outcome of London HIV Tender 2008Outcome of London HIV Tender 2008
Commissioning of HIV services in Commissioning of HIV services in LondonLondon
The London HIV Consortium manages the The London HIV Consortium manages the overall commissioning and provision of HIV overall commissioning and provision of HIV services across Londonservices across London
London Specialised Commissioning Group London Specialised Commissioning Group (LSCG) manage the commissioning of HIV (LSCG) manage the commissioning of HIV services from the 31 PCTs to the 24 HIV services from the 31 PCTs to the 24 HIV provider trusts across Londonprovider trusts across London
2007/08 budget - £211m (65% on ARVs)2007/08 budget - £211m (65% on ARVs) Growth in activity - 7.6%Growth in activity - 7.6%
Background to HIV homecare in Background to HIV homecare in LondonLondon
In 2004/05In 2004/05 - - the HIV Consortium decided the HIV Consortium decided that London HIV patients should be offered that London HIV patients should be offered the opportunity to receive their the opportunity to receive their antiretroviral therapy through a home antiretroviral therapy through a home supply arrangement. supply arrangement.
This followed previous experience at the This followed previous experience at the Royal Free Hospital who at the time had Royal Free Hospital who at the time had 380 patients on HIV homecare.380 patients on HIV homecare.
Other London trusts with HIV homecare Other London trusts with HIV homecare activity – UCLH, GOS and C&W.activity – UCLH, GOS and C&W.
Background to HIV homecare in Background to HIV homecare in LondonLondon
Drivers:Drivers:• Provides patient choiceProvides patient choice• More convenient for some patientsMore convenient for some patients• Patients can choose between their medicines Patients can choose between their medicines
being delivered by van or via the postbeing delivered by van or via the post• Frees up NHS staff time for other HIV dutiesFrees up NHS staff time for other HIV duties• Removes a burden from already overloaded Removes a burden from already overloaded
hospital pharmacy dispensarieshospital pharmacy dispensaries• Financial benefit as medicines are VAT exemptFinancial benefit as medicines are VAT exempt
Tendering for a London HIV Tendering for a London HIV Homecare ServiceHomecare Service
Agreement of stakeholders on how to construct Agreement of stakeholders on how to construct tendertender
Design of tendering modelDesign of tendering model NHS PaSA to undergo tender on behalf of the NHS PaSA to undergo tender on behalf of the
London HIV ConsortiumLondon HIV Consortium Specification of tender – used NHMC original Specification of tender – used NHMC original
specificationspecification No of patients eligibleNo of patients eligible Homecare market intelligence Homecare market intelligence From Royal Free model 25% of patients on From Royal Free model 25% of patients on
treatment should be eligible for homecaretreatment should be eligible for homecare
StakeholdersStakeholders
CommissionersPatient – Public
Engagement(PPE)
Clinicians
HIVPharmacists
ProcurementPharmacists
NHS PaSA
HIV ConsortiumPrescribing
Advisor
SeniorPharmacyManagers
HIVnurses
LondonHIV
HomecareTender
Design of Tendering Model - 2005Design of Tendering Model - 2005
Framework contractFramework contract Suppliers are invited to price for a van or postal Suppliers are invited to price for a van or postal
delivery depending on the number of patients delivery depending on the number of patients they have on servicethey have on service
Patient bandingsPatient bandings 3 monthly supply of patient medication (4 3 monthly supply of patient medication (4
deliveries per year)deliveries per year) List A – ARVs (pan London contract prices)List A – ARVs (pan London contract prices) List B – miscellaneous (source at lowest cost)List B – miscellaneous (source at lowest cost) Suppliers must provide financial data to LSCG on Suppliers must provide financial data to LSCG on
a monthly basisa monthly basis
London HIV homecare contract - London HIV homecare contract - 20052005
Commenced 1Commenced 1stst July 2005 July 2005 Duration - 2+2Duration - 2+2 Awarded to 4 suppliersAwarded to 4 suppliers Each supplier awarded geographically:Each supplier awarded geographically: HaH – North Central London (except UCLH)HaH – North Central London (except UCLH) Firstplus – North West London (except C&W) Firstplus – North West London (except C&W) HCL – North East LondonHCL – North East London Intecare – South LondonIntecare – South London
Note – Firstplus – terminated contract in Mar 07Note – Firstplus – terminated contract in Mar 07
London HIV homecare contract - London HIV homecare contract - 20052005
Homecare suppliers buy ARVs at list priceHomecare suppliers buy ARVs at list price They then provide manufacturers with They then provide manufacturers with
dispensing datadispensing data Manufacturers reimburse homecare Manufacturers reimburse homecare
suppliers difference between list price and suppliers difference between list price and contract pricecontract price
Provider trusts are allowed to keep 20% Provider trusts are allowed to keep 20% (now increased to 25%) of any savings to (now increased to 25%) of any savings to fund infrastructure costsfund infrastructure costs
Retender of London HIV Homecare Retender of London HIV Homecare 20082008
Similar model to 2005Similar model to 2005 Homecare suppliers invited to price Homecare suppliers invited to price
(van and postal) on patient numbers (van and postal) on patient numbers up to 6000+ in bandings of 500 for 3, up to 6000+ in bandings of 500 for 3, 4, 5 or 6 monthly deliveries4, 5 or 6 monthly deliveries
Evening, weekend and emergency Evening, weekend and emergency delivery prices were also requesteddelivery prices were also requested
Patient numbers on therapy are Patient numbers on therapy are confirmed by the trustsconfirmed by the trusts
Example of pricing by patient Example of pricing by patient bandingbanding
Bidder Patient_Numbers Months
Postal Mon-Sat 3-
monthly
Van normal hours Mon-
Fri
Van non-normal hours (excl Sat/Sun)
Van SatEmergency
courier deliverySunday delivery
charge
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
3-MONTHLY PRICING
Retender of London HIV Homecare Retender of London HIV Homecare 20082008
New NHMC specification used for New NHMC specification used for tendertender
Suppliers were requested to supply Suppliers were requested to supply monthly management information and monthly management information and KPI data to PaSAKPI data to PaSA
Pre-tender meeting with all homecare Pre-tender meeting with all homecare suppliers – 8suppliers – 8thth May 2008 May 2008
6 suppliers submitted tenders6 suppliers submitted tenders Shortlisted to 5 after PQQShortlisted to 5 after PQQ
Retender of London HIV Homecare Retender of London HIV Homecare 20082008
Tenders were scored using the eAward Tenders were scored using the eAward system by myself, NHS PaSA and 2 HIV system by myself, NHS PaSA and 2 HIV Pharmacy LeadsPharmacy Leads
Final adjudication – 1Final adjudication – 1stst Aug 2008. Aug 2008. Adjudication panel consisted of:Adjudication panel consisted of:
• Procurement pharmacistsProcurement pharmacists• NHS PaSANHS PaSA• Prescribing Advisor to HIV ConsortiumPrescribing Advisor to HIV Consortium• Patient – Public Engagement representativePatient – Public Engagement representative• CommissionersCommissioners• HIV Pharmacy LeadsHIV Pharmacy Leads