Ensuring that the NHS achieves best value from high cost drugs within specialised commissioning requires close working between pharmacy and analytics professionals.
When three NHS England regional specialised commissioning teams needed additional capacity and capability to support them with their medicines optimisation responsibilities, dedicated resource from Arden & GEM’s clinical support service was provided.
Over a two-year period, our pharmacist was embedded within regional teams to provide oversight of the drugs challenges process including unit pricing, ensure appropriate reporting was available to underpin decision making, and undertake analysis and horizon scanning to improve value. This was achieved through close working with both regional colleagues and the CSU’s business intelligence service.
The challenge
Specialised commissioning teams within NHS regions are tasked with ensuring that the NHS achieves the best value for money when prescribing high cost drugs (HCDs) with a focus on quality of care and experience for patients. Delivering against these objectives requires specialist pharmacy knowledge, strong links with business intelligence teams and the ability to engage with and bring together a range of stakeholders.
When the NHS regional specialised commissioning teams in the South East, South West and Midlands needed additional capacity and capability to support them with their medicines optimisation responsibilities, dedicated resource from Arden & GEM was embedded with a focus on identifying cost savings and improving value schemes for HCDs. Arden & GEM has an experienced clinical support service with cross sector knowledge of primary, secondary and tertiary care.
Our approach
Arden & GEM’s medicines optimisation team began working with regional specialised commissioning teams in December 2020, initially in the South East and South West and latterly with the Midlands, with clearly defined responsibilities and KPIs.
Managing the drugs challenges process
While automated monthly challenge processes had been built into a national Drugs Challenges Application (DCA) – involving various logic including national NICE guidance – there was still a need for adjustments to be made which reflected local commissioning arrangements. By embedding a pharmacist with both HCD expertise and analytical skills within the South West regional team, Arden & GEM was able to manage this process.
The pharmacy resource quickly built strong working relationships with the business intelligence team responsible for the DCA as well as attending the bi-monthly Drugs Challenges Working Group meetings within specialised commissioning, producing bespoke reports, supporting with drug challenges and ensuring the DCA was up to date.
This oversight and liaison role has:
- Improved the accuracy and quality of drug mapping and challenges leading to better outcomes and reducing unnecessary challenges
- Resolved regional queries relating to commissioning details and drugs mapping
- Identified and corrected errors and anomalies through liaison with colleagues
- Updated incorrect challenges.
Overseeing reporting
Once drugs budget and contract monitoring reports were received by regional teams, any unexpected changes or anomalies were highlighted and investigated. Findings were reported and any relevant narrative, e.g. a change in guidance, was added to the report to give commissioners a full and clear picture.
Where new, or refinements to existing, monthly reports were needed, the pharmacist engaged with specialised commissioning pharmacy teams and analysts to understand what was needed. Report areas included top drugs spend, drug variances, trends and tracking, and financial analysis to support contract assurance processes and collaborative working within systems.
An additional novel circular spend report was also created for the South West regional team through Blueteq® (report matching) to enable regions to monitor and understand the cost and activity impact of NHS England Specialised Services Circulars. Examples include lenalidomide and enzalutamide PAS price drops.
Horizon scanning
To support the South West regional team better understand potential specialised commissioning changes for 2022/23, a piece of horizon scanning work was undertaken. Using information from a range of specialist reference sources, new medicines or new uses for existing medicines were identified.
Improving value
A range of drugs spend reports and analysis was completed to determine the implications on spend, average patient cost and savings of newly commissioned drugs, new guidance, national incentive schemes, pathway changes and the effects of COVID-19.
This complex analysis was focused on improving value and included projects such as the haemophilia A framework where cost savings analysis was generated for switching patients onto the most cost-effective product, with presentations delivered to educate them on the national framework and potential opportunities for their region. As recommendations were implemented, actual savings were then tracked and monitored using Blueteq® spend reporting.
Finalising shared care agreements
Following the successful delivery of support to the South East and South West teams, the Midlands specialised commissioning pharmacy team requested dedicated senior pharmacist resource with a focus on shared care agreements within rheumatology and dermatology.
Shared care agreements enable patients to receive care in an integrated and convenient manner through seamless prescribing and monitoring of medicines. In the two identified specialisms patient care needed to be appropriately transferred from three specialist ‘hub’ providers to a number of smaller acute trusts (‘spokes’).
By working closely with tertiary centre HCDs and lead pharmacists, and liaising directly with consultants, five shared care agreements were finalised to clearly identify the eligibility criteria, treatment and responsibilities of clinicians for specific patients, enabling care to be safely and effectively delivered closer to a patient’s home.
The outcomes
Over a two-year period, Arden & GEM’s clinical support service was able to provide capacity and expertise in this challenging field of pharmacy practice. The three regions were supported across a broad range of areas including drugs challenges, unit pricing, report development, horizon scanning and shared care agreements.
As a result, in-house teams now have the processes, approaches and tools in place to underpin effective decision-making and achieve best value. A comprehensive handover was undertaken which included training new starters to complete core tasks.
You can find out more about the services provided by our medicines optimisation team here.