Transforming hospital pharmacy: one year on

Source: NHE July/August 2018

Andrew Davies, professional lead for hospital pharmacy at NHS Improvement (NHSI), runs through the significant developments that have taken place across the health service since trusts produced local pharma plans as part of Carter Review recommendations.

In February 2016, Lord Carter of Coles published his report on unwarranted variation in the NHS. It identified that the NHS could save £800m by 2020-21 in non-specialist acute hospitals through medicines optimisation and transforming hospital pharmacy services.

The report’s recommendations were accepted in full by then health and social care secretary Jeremy Hunt. A key element was that trusts should develop, through the Hospital Pharmacy Transformation Programme (HPTP), local plans by April 2017, with each trust board nominating an executive director to work with their chief pharmacist to implement their plan.

These changes were to be overseen by NHSI, and in collaboration with professional colleagues locally, regionally and nationally. Trusts were asked to increase the numbers of pharmacist prescribers, drive the introduction of e-prescribing and medicines administration, provide more accurate cost coding of medicines, and review infrastructure services including medicines procurement, supply chain and aseptic services, so that their pharmacists and clinical pharmacy technicians spend more time on patient-facing medicines optimisation activities.

Since the publication the Carter report, there have been significant policy developments across the NHS which have impacted both on the shape of the HPTP plans and their implementation. In particular, the advent of sustainability and transformation partnerships (STPs) and the establishment of integrated care systems have encouraged a greater degree of collaboration on supporting infrastructure for the provision of pharmacy services.

To support these developments, NHSI and NHS England have created four joint regional pharmacy posts. The post-holders monitor and support the  implementation of HPTP plans, and work with the newly-created Regional Medicines Optimisation Committees and the four regional pharmacy posts in Health Education England (HEE) to realise the strategic vision of medicines value, as well as providing professional leadership for an increasingly clinically-facing profession.

In March 2017, NHS England published the ‘Next Steps on the NHS Five Year Forward View,’ which included a 10-point efficiency plan. This introduced a national Medicines Value Programme, bringing together various initiatives across the health and care system under the professional leadership of the chief pharmaceutical officer for England (CPhO). This made explicit NHSI’s dual role in supporting the delivery of the NHS efficiency plan (through the Model Hospital’s Top 10 Medicines list) and working with hospitals to deliver the main Carter report recommendations.

In December 2017, the CPhO, Dr Keith Ridge, received a brigaded national report that outlined the significant progress made across the NHS. The hospital pharmacy transformation plans provided a  snapshot at a particular moment in time and will be reviewed and flexed in the years to 2020-21. Many plans were built on existing work, facilitated by enhanced levels of cooperation and collaboration across established networks and geographies.

Notable examples include the Yorkshire stores project, the East/West Midlands aseptics collaboration, the Greater Manchester health and care programme, and ‘Our Dorset’ and South London STPs. The plans also set out the ambition for clinically-facing pharmacy in supporting seven-day services, its contribution to patient flow, and medication safety.

The report showed that throughout the Carter programme, the level of engagement from hospital pharmacy teams has been excellent. All non-specialist acute hospitals (with a single exception) produced hospital pharmacy transformation plans that have been ratified through their trust boards and that demonstrate a clear understanding of the Carter report. The pharmacy community embraced the challenge of eradicating unwarranted variation and the opportunities for service transformation.

In addition to the above work, NHSI  is also leading the Getting it Right First Time (GIRFT) programme, which is focused on clinically-led and data-driven reviews of patient-level clinical pathways in secondary care. As part of the GIRFT programme, a number of common themes have been recognised within the 36 clinical work streams. These have subsequently become cross-cutting work themes including hospital pharmacy and medicines optimisation. This approach will also support GIRFT’s intention to embed a new kind of ‘business as usual’ in secondary care, in which a provider or clinician ‘getting it right first time’ is the established norm to a greater degree than at present. In other words, unwarranted variation is minimised, and any remaining unwarranted variation is addressed effectively through a process of continual quality improvement.

Like the GIRFT programme, the Hospital Pharmacy & Medicines Optimisation programme has been data-driven throughout, and the NHSI Model Hospital system had supported a range of metrics designed to show improvements in both how services are delivered in line with the Carter principles but also, through the Top 10 medicines, in the scale of delivery of savings achieved. This is further linked to the uptake of innovative medicines such as biosimilars and the use of generic medicines, which in 2017-18 delivered £324m of benefit to the NHS together with increased access to medicines for patients.

As the programme looks forward to 202021, the importance of the digital medicines agenda in supporting GIRFT, the Medicines Value Programme, and the full optimisation of the use of medicines has been recognised. Funding announced by Hunt in February will shortly be made available for NHS trusts who have not yet started to introduce e-prescribing and other digital infrastructure enhancements that will continue to support the optimal use of medicines and the pharmacy teams who support the best use of medicines.


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