The NHS England Midlands Region specialised commissioning pharmacy team agreed a package of support with Arden & GEM that would see the CSU’s medicines optimisation team provide additional capacity and capability in invoice validation, drugs challenges, contract meetings and commissioning query response.
Utilising strong clinical, analytical and technical skills, the medicine’s optimisation team worked collaboratively with the specialised commissioning pharmacy team to identify process improvement opportunities which made better use of automation. As a result, the regional pharmacy team now has new tools in place which are delivering significant efficiency savings and improved reporting accuracy.
The challenge
The specialised commissioning pharmacy team within the NHS England Midlands region is tasked with ensuring best value in relation to high cost drugs. Achieving this requires a focus on invoice validation, drugs challenges, contract meetings and responding to commissioning queries. But with existing staff redeployed into roles supporting the COVID-19 pandemic, the regional team needed additional capacity and expertise to deliver these requirements.
The necessary processing, monitoring and reporting would require expertise not just in pharmacy but also strong analytical skills. A package of support was agreed with the Arden & GEM medicines optimisation team in summer 2021 and was subsequently extended in 2022 to include a greater focus on data analysis, manipulation and interpretation.
Our approach
As part of this package of support, the medicines optimisation team provided the following services:
- Support of drugs challenges process
- Price checks on priority drugs and providers
- Trend analysis of NCDR data
- Closed loop process for specialised services circulars
- Reporting and analysis to support contract assurance and invoice validation
- Responding to provider queries
- Support to implement and monitor improving value schemes.
Two team members were assigned to support the region which added breadth of knowledge and resilience into the service.
Identifying improvement opportunities
As part of the monthly drugs challenges process, two sets of reports needed to be produced:
- A spend vs allocation report – which documents the spend against budget, and the % underspend or overspend, for each provider and is used to inform budgeting and high-level reporting
- A financial adjustments report – which records the transfer of funds needed between NHS England and Trusts following agreed drugs challenges.
The existing reporting processes were manually intensive, involving the line by line transfer of data from multiple downloaded sources. The collaborative team soon identified that the repetitive and data heavy nature of these processes could be made more efficient through automation.
Combining expertise in medicines optimisation with experience of using IT applications to automate and standardise processes, the Arden & GEM team proposed a new approach that would:
- Speed up processing time
- Increase efficiency
- Eliminate the potential for human error
- Develop one click solutions where possible.
Process review
The medicines optimisation team began by reviewing each part of the current process to document the tasks involved and identify any opportunities for streamlining. This process flow was then used as the template for automation and coding.
Developing the solution
Through a highly iterative process, two new coded solutions were developed, using macros and XLOOKUP functionality within Microsoft Excel templates to enable the ‘one click’ processing of data.
The spend vs allocation tool shows monthly and year to date C&V and block spend by Trust while the financial adjustment tool uses process automation to create an output of financial adjustments required by Trust.
The efficacy of the new tools was tested prior to launch by applying them to historical data to retrospectively identify errors in the previous process. Using beta testing to demonstrate the solution’s efficiency and accuracy also helped to reassure stakeholders.
Supporting users
The whole regional specialised commissioning pharmacy team was trained on using the new tools with end-to-end instructions embedded into the workbook. This reduced the need for future training sessions and helped to increase the team’s self-sufficiency as the tools became part of business as usual process.
The outcomes
Through deploying a unique combination of clinical and technical expertise, a new automated process for reporting was delivered with significant potential efficiency savings to free up resource to focus on more value added tasks such as data analysis.
Utilising an automated solution also eliminates the risk posed by manual error which could result in the incorrect transfer of funds between NHS England and Trusts.
"The collaboration between the NHS England Midlands specialised commissioning pharmacy team and Arden & GEM brought valuable support and expertise to enhance the reporting processes within the team. The input from the CSU team provided additional capacity and capability in automated invoicing for drug challenges and high-cost drugs analysis.
The analytical and technical skills enabled us to identify process improvement opportunities and propose solutions incorporating automation and tools such as macros and XLOOKUPs. The tools developed by the CSU initially brought about significant efficiency savings and improved reporting accuracy. Arden & GEM’s input, expertise and collaborative efforts were instrumental in identifying areas for improvement and implementing interim solutions that improved efficiency."
Susanna Allen, Regional Head of Pharmacy Commissioning at NHS England Midlands Region
The reporting solution has acted as a catalyst for a long term internal project to completely revamp systems and processes, leveraging technology, automation and better ways of working.