Scottish Government

Bid number (for EG use)

Lead bidder

paul.o'donnell@northglasgow.scot.nhs.uk

0141 211 2296

Brief description of the aims of the project

The NHS is gaining increasing experience of providing high-tech healthcare in the home environment. This is becoming an accepted model of health care provision for certain patient groups. The NHSGG project aim is to establish a service model which delivers improvements in the current procurement and administration processes whilst improving the care for the patient. The provision of care to patients whose treatment requires the supply and/or administration in the home environment must be carried out within a framework of clinical and corporate governance that assures safety, clinical and cost effectiveness, quality and legality of the service.

Clear description of what the EGF money would be used to buy

A central facility that will manage existing homecare contracts and will facilitate potential new homecare services. This facility will work with procurement to agree best contract prices and develop service agreements with homecare providers. It will also provide a central co-ordinating function between the clinical and commercial sector. New and improved ways of working homecare services will be a key function of the facility.

This requires to be staffed with administration and procurement staff under the direction of clinical pharmacists. The total cost of this facility in terms of staffing is £180k pa.

Stage 2 bid development support

• Secure external management consultancy advice to map out, and potentially, lead and direct efforts across NHSGG and with other identified partners. This would facilitate the re-engineering of the service which is currently fragmented across Primary and Secondary Care.
• Used to employ medium term management support to develop the service through establishing a central office and to recruit and train staff. Necessary backfill arrangements would be made to release key personnel.

Partners to the project likely to commit resources

Commercial partners, Community Health Partnerships, Social Work, Patient Support Group,. Discussions with these parties are in their very early stages.

Names of other organisations with whom the project has been discussed (to assist the introductions process)

NHSGG Prescribing Management Group
Clinical Services, NGUHD
Medical Service, NGUHD

Local Medical Committee, NHSGG

Glasgow and WOS Zone Medicines Procurement Committee
Renal Medicines Committee, Western Infirmary
CHP
Community Support Groups
Consideration will be given to opening discussions with Boards surrounding Glasgow whose patients are referred to consultants in NHSGG for prescription of relevant medication.

Evidence that suggested approach has been deployed successfully elsewhere

NHSGGHIV Service

NGUHD recently established a contract with a homecare provider for 125 patients with HIV attending out-patient clinics at Gartnavel General Hospital. This has proven very acceptable to patients and staff and will save the service around £700/patient/annum, after costs to the homecare provider have been paid.

Oxford Transplant Centre

The Oxford Centre has over 900 patients with functioning kidney grafts and performed nearly 100 renal transplants last year. Unusually, the Oxford centre provided most patients with all their medications throughout the life of the transplant, instead of transferring care back to a GP. In November 2001 the Oxford Centre initiated a medication home delivery service for out-patients. A key role of transplant out-patient clinic co-ordinator was also created to assist with patient recruitment and to deal with ongoing clinical and admin. matters relating to the patient/homecare interface. ( ref. Prowse and Scott, Pharmaceutical Journal, 1 ^st May 2004, pp's 547-551))

Are there any restrictions to potential for enlargement of the project (i.e. technology, number of partners etc)

It is anticipated that, if successful, this will provide a model that could be utilised by other Boards within Scotland

Benefits projected from the project

• Is in line with the principles of "Building a Health Service Fit For The Future" ( NHS Scotland National Framework for Service Change)
• Patients usually prefer to be treated in the comfort and privacy of their own home and clinical evidence shows that in some cases there is a better response to treatment. The proposed model will support this arrangement.
• Patients enjoy a better quality of life.
• Patients often require less frequent journeys to hospital and to the GP which can be uncomfortable and time-consuming.
• Can reduce workload on hospital clinicians, whilst retaining overall clinical responsibility.
• Can reduce treatment costs both in terms of use of resource and overall procurement costs. Clinical evidence is that patients respond quicker to treatment in the home environment. Procurement savings are attained through consolidation of purchasing power and processes which are currently fragmented.
• Potential to free up current inpatient bed capacity and out-patient appointments whilst providing improved patient care.
• Will reduce the workload of General Practitioners as patients' prescriptions and processes to support home delivery will be managed by Secondary Care.
• Reduction in costs of stock management and stockholding overheads.Redirecting clinical resources into direct clinical care as a result of reducing administration across primary and secondary care
• Service model could be used as a basis for other HB strategies

Estimated financial projections

2005/6

2006/7

2007/8

2008/9

Overall project cost

Total-£65k

- backfill of staff and mgt consultancy

Total- £75k -

backfill of staff and mgt consultancy

Total- £180k all recurring - set up of facility

Estimated projected benefits:

Producing better/more outputs for the same inputs - approx £1m recurring savings of which £195k will be cost avoidance. It is anticipated that the full year effect of the savings will be released in 2008/09.

Note this estimate of savings does not include any £ savings associated with time releasing benefits for GP or pharmacy staff

Is a pilot required - see guidance notes

No - pilot already completed for HIV service

Additionally: why is EG funding required

This area of patient care is developing very rapidly throughout the NHS in Scotland. There is an opportunity for GGHB pharmacy and procurement to lead internal various clinical directorates in the establishment of Homecare Service. However, in order for this project to be successful it will require finance investment and the appropriate expertise to ensure effective delivery of objectives. This model can be rolled out to other Boards and agencies.

Clearly, it is important to recognise that many of these treatments are often new, very expensive and "high-tech" that present major challenges to the NHS in terms of funding and it is vital to take all steps to minimise these costs. By implementing homecare arrangements NHSGG can satisfy patent care criteria while gaining best value for money.

For that reason, NHSGG would wish to apply for start-up costs relating to management consultancy, and, the costs of developing and implementing a new Homecare Service.

Is this project complementary in anyway to other EG work

In line with national procurement strategy

Is "stage 2 development funding" requested?

Yes (see attached letter and business case)