HIV Homecare – the HIV Homecare – the London ExperienceLondon Experience

Philip AubreyPhilip AubreyMedicines Procurement Specialist – London & East of Medicines Procurement Specialist – London & East of

EnglandEnglandLPP – P&MM Operational LeadLPP – P&MM Operational Lead

National Homecare Symposium - 15National Homecare Symposium - 15thth January 2009 January 2009

OverviewOverview

Commissioning of HIV services in Commissioning of HIV services in LondonLondon

Background to HIV homecare in Background to HIV homecare in LondonLondon

Tendering for a London HIV Tendering for a London HIV Homecare ServiceHomecare Service

Retender of London HIV Homecare Retender of London HIV Homecare 20082008

Outcome of London HIV Tender 2008Outcome of London HIV Tender 2008

Commissioning of HIV services in Commissioning of HIV services in LondonLondon

The London HIV Consortium manages the The London HIV Consortium manages the overall commissioning and provision of HIV overall commissioning and provision of HIV services across Londonservices across London

London Specialised Commissioning Group London Specialised Commissioning Group (LSCG) manage the commissioning of HIV (LSCG) manage the commissioning of HIV services from the 31 PCTs to the 24 HIV services from the 31 PCTs to the 24 HIV provider trusts across Londonprovider trusts across London

2007/08 budget - £211m (65% on ARVs)2007/08 budget - £211m (65% on ARVs) Growth in activity - 7.6%Growth in activity - 7.6%

Background to HIV homecare in Background to HIV homecare in LondonLondon

In 2004/05In 2004/05 - - the HIV Consortium decided the HIV Consortium decided that London HIV patients should be offered that London HIV patients should be offered the opportunity to receive their the opportunity to receive their antiretroviral therapy through a home antiretroviral therapy through a home supply arrangement. supply arrangement.

This followed previous experience at the This followed previous experience at the Royal Free Hospital who at the time had Royal Free Hospital who at the time had 380 patients on HIV homecare.380 patients on HIV homecare.

Other London trusts with HIV homecare Other London trusts with HIV homecare activity – UCLH, GOS and C&W.activity – UCLH, GOS and C&W.

Background to HIV homecare in Background to HIV homecare in LondonLondon

Drivers:Drivers:• Provides patient choiceProvides patient choice• More convenient for some patientsMore convenient for some patients• Patients can choose between their medicines Patients can choose between their medicines

being delivered by van or via the postbeing delivered by van or via the post• Frees up NHS staff time for other HIV dutiesFrees up NHS staff time for other HIV duties• Removes a burden from already overloaded Removes a burden from already overloaded

hospital pharmacy dispensarieshospital pharmacy dispensaries• Financial benefit as medicines are VAT exemptFinancial benefit as medicines are VAT exempt

Tendering for a London HIV Tendering for a London HIV Homecare ServiceHomecare Service

Agreement of stakeholders on how to construct Agreement of stakeholders on how to construct tendertender

Design of tendering modelDesign of tendering model NHS PaSA to undergo tender on behalf of the NHS PaSA to undergo tender on behalf of the

London HIV ConsortiumLondon HIV Consortium Specification of tender – used NHMC original Specification of tender – used NHMC original

specificationspecification No of patients eligibleNo of patients eligible Homecare market intelligence Homecare market intelligence From Royal Free model 25% of patients on From Royal Free model 25% of patients on

treatment should be eligible for homecaretreatment should be eligible for homecare

StakeholdersStakeholders

CommissionersPatient – Public

Engagement(PPE)

Clinicians

HIVPharmacists

ProcurementPharmacists

NHS PaSA

HIV ConsortiumPrescribing

Advisor

SeniorPharmacyManagers

HIVnurses

LondonHIV

HomecareTender

Design of Tendering Model - 2005Design of Tendering Model - 2005

Framework contractFramework contract Suppliers are invited to price for a van or postal Suppliers are invited to price for a van or postal

delivery depending on the number of patients delivery depending on the number of patients they have on servicethey have on service

Patient bandingsPatient bandings 3 monthly supply of patient medication (4 3 monthly supply of patient medication (4

deliveries per year)deliveries per year) List A – ARVs (pan London contract prices)List A – ARVs (pan London contract prices) List B – miscellaneous (source at lowest cost)List B – miscellaneous (source at lowest cost) Suppliers must provide financial data to LSCG on Suppliers must provide financial data to LSCG on

a monthly basisa monthly basis

London HIV homecare contract - London HIV homecare contract - 20052005

Commenced 1Commenced 1stst July 2005 July 2005 Duration - 2+2Duration - 2+2 Awarded to 4 suppliersAwarded to 4 suppliers Each supplier awarded geographically:Each supplier awarded geographically: HaH – North Central London (except UCLH)HaH – North Central London (except UCLH) Firstplus – North West London (except C&W) Firstplus – North West London (except C&W) HCL – North East LondonHCL – North East London Intecare – South LondonIntecare – South London

Note – Firstplus – terminated contract in Mar 07Note – Firstplus – terminated contract in Mar 07

London HIV homecare contract - London HIV homecare contract - 20052005

Homecare suppliers buy ARVs at list priceHomecare suppliers buy ARVs at list price They then provide manufacturers with They then provide manufacturers with

dispensing datadispensing data Manufacturers reimburse homecare Manufacturers reimburse homecare

suppliers difference between list price and suppliers difference between list price and contract pricecontract price

Provider trusts are allowed to keep 20% Provider trusts are allowed to keep 20% (now increased to 25%) of any savings to (now increased to 25%) of any savings to fund infrastructure costsfund infrastructure costs

Retender of London HIV Homecare Retender of London HIV Homecare 20082008

Similar model to 2005Similar model to 2005 Homecare suppliers invited to price Homecare suppliers invited to price

(van and postal) on patient numbers (van and postal) on patient numbers up to 6000+ in bandings of 500 for 3, up to 6000+ in bandings of 500 for 3, 4, 5 or 6 monthly deliveries4, 5 or 6 monthly deliveries

Evening, weekend and emergency Evening, weekend and emergency delivery prices were also requesteddelivery prices were also requested

Patient numbers on therapy are Patient numbers on therapy are confirmed by the trustsconfirmed by the trusts

Example of pricing by patient Example of pricing by patient bandingbanding

Bidder Patient_Numbers Months

Postal Mon-Sat 3-

monthly

Van normal hours Mon-

Fri

Van non-normal hours (excl Sat/Sun)

Van SatEmergency

courier deliverySunday delivery

charge

Supplier A 1 - 499 Months3

Supplier A 500 - 999 Months3

Supplier A 1,000 - 1,499 Months3

Supplier A 1,500 - 1,999 Months3

Supplier A 2,000 - 2,499 Months3

Supplier A 2,500 - 2,999 Months3

Supplier A 3,000 - 3,499 Months3

Supplier A 3,500 - 3,999 Months3

Supplier A 4,000 - 4,499 Months3

Supplier A 4,500 - 5,999 Months3

Supplier A 5,000 - 5,499 Months3

Supplier A 5,500 - 5,999 Months3

Supplier A 6,000 + Months3

3-MONTHLY PRICING

Retender of London HIV Homecare Retender of London HIV Homecare 20082008

New NHMC specification used for New NHMC specification used for tendertender

Suppliers were requested to supply Suppliers were requested to supply monthly management information and monthly management information and KPI data to PaSAKPI data to PaSA

Pre-tender meeting with all homecare Pre-tender meeting with all homecare suppliers – 8suppliers – 8thth May 2008 May 2008

6 suppliers submitted tenders6 suppliers submitted tenders Shortlisted to 5 after PQQShortlisted to 5 after PQQ

Retender of London HIV Homecare Retender of London HIV Homecare 20082008

Tenders were scored using the eAward Tenders were scored using the eAward system by myself, NHS PaSA and 2 HIV system by myself, NHS PaSA and 2 HIV Pharmacy LeadsPharmacy Leads

Final adjudication – 1Final adjudication – 1stst Aug 2008. Aug 2008. Adjudication panel consisted of:Adjudication panel consisted of:

• Procurement pharmacistsProcurement pharmacists• NHS PaSANHS PaSA• Prescribing Advisor to HIV ConsortiumPrescribing Advisor to HIV Consortium• Patient – Public Engagement representativePatient – Public Engagement representative• CommissionersCommissioners• HIV Pharmacy LeadsHIV Pharmacy Leads

WeightingsWeightings

MeasureMeasure WeightingWeighting

Homecare supplier Homecare supplier infrastructureinfrastructure

2020

Quality AssuranceQuality Assurance 1212

Storage and Storage and distributiondistribution

2020

Customer serviceCustomer service 1818

PricePrice 3030

TotalTotal 100100

Outcome of London HIV Tender Outcome of London HIV Tender 20082008

Awarded the existing 3 homecare Awarded the existing 3 homecare suppliers to the frameworksuppliers to the framework

This was mainly due to higher This was mainly due to higher service charges from the other two service charges from the other two tendererstenderers

New patients in Supplier A trusts will New patients in Supplier A trusts will commence with Supplier Bcommence with Supplier B

Percentage market share of London HIV Percentage market share of London HIV homecare patients by supplierhomecare patients by supplier

66%

20%

14%

Supplier A

Supplier B

Supplier C

Percentage of Patients on HIV Homecare compared to Total Number of Patients on Treatment by Trust

Total number of patients on HIV homecare - 5974 (Jan 2009)

0%

10%

20%

30%

40%

50%

60%

%age of patients onHIV homecare bytrust

Average number ofpatients on HIVhomecare acrossLondon

London HIV Homecare SavingsLondon HIV Homecare Savings

YearYear SavingSaving

2005-20062005-2006 £999,020£999,020

2006-20072006-2007 £1,200,488£1,200,488

2008-20092008-2009 £268,609£268,609

Any Questions?Any Questions?