INNOVATION & EFFICIENCY
Independent commissioner Shailen Rao discusses efficiency issues relating to medicine procurement. W
hy is it that NHS organisations are so fixated on reducing prescribing
costs, when medicines only make up 18% of total healthcare costs?1
Should we not
look at the targeted and intelligent com- missioning of medicines and the services related to them, in order to optimise how we use the other 82%?
Where we are now
As a medicines management pharmacist and commissioner, I recognise that we do need to use that 18% of NHS resources better – after all, it equates to £11bn,1
so
even a 5% reduction in costs is substantial. However, we also need to recognise the fol- lowing limitations:
• The obvious quick wins have largely been implemented; e.g. the ‘switch’ opportuni- ties in the National Prescribing Centre QIPP document,2
which highlight areas
where prescribing savings can be made, of which many are at best a clinical equiva- lent at a lower price. • The short-term savings made on some of these switch programmes may in fact po- tentially lead to deterioration of care over time, or even lead to additional cost else- where in the system; e.g. reduced blood pressure control, leading to increased events and consequentially increased hos- pital costs.
The new paradigm: commissioning for medicines
It is clear that we need to move the focus from the often-mentioned ‘silo mentality’ on the medicines budget, where we resist any medicine that has a higher acquisition cost, to a paradigm where we look more closely at the total healthcare costs relating to medicines use.
We now need to evaluate medicines and be prepared to disinvest in certain medicines, however low the acquisition cost, and be prepared to invest in alternatives or new- er technologies that can provide a much greater quality and financial return to the NHS and clinical benefits to patients.
We need to recognise that realising the benefits of such medicines, will require more fluidity between drugs budgets and
those for services; it will also require us to be more capable and creative about how services are re-designed and delivered.
Can we really find examples where we can invest in medicines that will simultaneous- ly improve the quality of care and improve productivity whilst preventing future mor- bidity and cost?
IV iron: case study in how to com- mission for medicines
No complicated modelling is needed when you understand the following fact: commu- nity services using newer IV iron prepara- tions to deliver high doses in a shorter time would use less overall NHS resources than older preparations, which require multi- ple visits or much longer infusion times, whether in community or a hospital set- ting.2
Well, that’s a no-brainer then, isn’t it? You don’t even need to understand iron-defi- ciency anaemia, to see the benefits for both patient and health economy of such an in- novation.
However, in order for the benefits to be realised, different parts of the health economy do need to work together. When truly commissioning medicines, it is vital to understand that it will no longer be ac- ceptable for providers to resist innovations such as newer IV irons on the basis of high-
er acquisition costs or worse still, because its use may reduce hospital activity and reduced potential income for the provider.
An indication of the opportunity is the QIPP initiative undertaken by Royal Corn- wall Hospitals Trust and published on the NHS Evidence website,3
which estimates
an annual saving of £29,000 per 100,000 population by shifting administration of IV iron into the community using an older IV iron preparation. Services designed around newer IV irons may deliver even greater ef- ficiencies.
In the new age of commissioning for medicines the new currency and driver for change will in fact be: “How does the use of this medicine reduce overall healthcare utilisation and, therefore, costs and ul- timately, how will it enhance the patient pathway?”
References
1. What you need to know about prescribing, the ‘drugs bill’ and medicines management; A guide for all NHS managers. December 2008. National Prescribing Cen- tre.
www.npc.nhs.uk/resources/nhs_guide_for_man- agers.pdf 2. Giving intravenous iron in patients’ homes and com- munity hospitals. NHS Evidence.
www.evidence.nhs.uk/ qipp 3. QIPP – Key therapeutic topics – medicines manage- ment options for local consideration, Version 3.1 up- dated document, July 2011. National Prescribing Centre.
www.npc.co.uk/qipp/
FOR MORE INFORMATION
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www.viforpharma.com national health executive Nov/Dec 11 | 41
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