1. LPP: How to work in
partnership with the LPP
Jasbinder Khambh, Pharmacy & Medicines Use & Procurement Lead for Primary
Care | NHS London Procurement Partnership

2. Managing Medicines
in the NHS – London
Perspective
Jas Khambh
Pharmacy & Medicines Use & Procurement
Operational Lead & Lead for Primary Care, LPP
Tim Root
Strategic Pharmaceutical Lead, LPP

3. Today’s Objectives
•An overview of how medicines are managed in
the NHS (in London)
•An overview of the Medicines Use and
Procurement QIPP Workstreams in London

4. The New Landscape
•Abolition of PCTs & SHAs
•Commissioning power shared between NHS
England (was NHS Commissioning Board) and
GPs
•So we have:
NHS England – direct commissioning &
oversight of CCG commissioning
Clinical commissioning groups – direct
commissioning
Local authorities: social services, public
health services

5. Managing medicines
•National guidance and priorities
• NHS Constitution
• Innovation health and wealth
• NICE – good practice guidance on developing
and updating local formularies (Dec 2012)
•Local guidance & priorities
• Formularies
•Variance across the country
• Decision making groups: stakeholder
engagement, processes
• Criteria for decision making
• Decision outputs

6. Managing the introduction of new medicines –
factors considered
•Patient safety
•Budget impact
•Strength of evidence
• Place in therapy
• Clinical effectiveness
• Cost effectiveness
•Equity of access
•Stakeholder views

7. On the horizon?
• Continuing fiscal constraint
• Value-based pricing
• NHS England contracting for medicines
• Greater consistency about commissioning for high-cost
PbRX medicines

8. Pan-London Management of Medicines through
the QIPP agenda
•LPP
•Built on
• 30 years medicines management & medicines
procurement expertise in acute trusts
• Pharmacy & Medicines Management work of the LPP.
•There are 3 workstreams:
Primary Care
Acute & MH Trusts (Secondary Care)
Cross-sector

9. 9
Pharmacy & Medicines Use & Procurement
Governance Model for London
LPP & Medicines Use and
Procurement Productivity
Steering Group
Ad hoc projects /
Task & finish group
LPP Pharmacy
Medicines
Management Group/
Secondary care
QIPP Sub-Group
LPP Steering Board
Commercial Board /
Productivity PLG at
NHSL
NHS England Trusts and PCTs
QIPP
guidance
Monthly
QIPP
reporting
Subscriptions
Monthly
QIPP
workstream
reporting
High level
comment
on
workstream
Monthly project
reporting against
plan
Monthly project
reporting against
plan
Primary Care QIPP
Sub-Group
Project
initiation,
milestone
and results
reporting
Combined and co-
ordinated LPP and
productivity
reporting

10. NHS London Procurement Partnership – Pharmacy, Medicines Use
& Procurement Workstream
Key Objectives and Priorities for 2013 - 2015
32 CCGS
and
3 CSUs
QIPP
 Promotes & supports across the NHS in London:
 Evidence based choice of medicines
 Safe , cost-effective use of medicines (£)
 Reduced medicines waste (£)
 Recommendations and advice to prescribers and medicines management teams
 Specialist analytics & informatics support, key performance indicators and
dashboards
 Management of primary care rebate schemes (£)
Medicines Optimisation
 Safe use of medicines and improved quality of patient
care:
optimised patient experience & treatment outcomes
 Medicines optimisation as part of routine practice
Continuity & quality of care involving medicines use,
across the
primary/secondary/tertiary/social care interfaces
 Specialist pharmaceutical support for optimisation of
prescribing for complex therapeutic areas such as mental
health, cancer chemotherapy , nutrition and dietetics (£)
Collaboration and sharing of best practice
 London-wide stakeholder engagement and working groups
 Pan-London solutions
 Do once and share : efficient use of limited resources (£)
 Facilitated access to key advice & information at www.lpp.nhs.uk
(£)
 Training and education
 Collaborative working with external stakeholders e.g.
pharmaceutical industry
Procurement of the most cost-effective
medicines for acute & mental health trusts
 Expert knowledge and specialist expertise from medicines
procurement specialists
 Pan-London contracts to secure best value-for-money (£)
 Strategic clinical medicines procurement (£)
 Support for management of expenditure on:
high cost PBR excluded drugs (£)
supply of medicine through Homecare (£)
Patient Access Schemes (£)
Acute and
Mental
Health
Trusts
Note: All of these objectives aim to
improve productivity and quality of
patient care. Objectives marked (£)
can provide significant financial
savings to the local health economy
in London. These savings may be
quantified in terms of return in
investment and against key
performance indicators.

11. Primary Care QIPP Workstream
• Engagement with CCGs/CSUs
• Collaborative approach
• Primary Care QIPP sub-group
• Priority setting
• Medicines Information & Specialist Pharmacy Services
support
• Data collection, analysis & reporting
• Dashboards
• Rebate schemes

12. 2013/14 priorities
• Engagement with new stakeholder groups
• CCGs, CSUs, NHS England
• Quality & Safety
• Cross-sector
• Extend & Refine data presentation
• Split dashboards
• Acute & MH Trusts
• Define® benchmarking tool
• Primary Care
• Financial
• Quality & safety
• Mental Health
• Nutrition

13. Primary Care Clinical Priorities for
2012/13
Cardiovascular
•Renin-angiotensin system drugs
•Statins
•Ezetimibe
Endocrine
•Diabetes
•Osteoporosis
Central Nervous System
•Prescribing in mental health
•Low dose antipsychotics
•Hypnotics
•Venlafaxine
•Pain control
Other Therapeutic areas
•Glucosamine
•Prednisolone
•Wound care
•Specials
•Vitamin D
•Oral nutritional supplements
•Antimicrobials

14. Tools and resources
www.lpp.nhs.uk
• Dashboards
• KPIs and Red Amber Green ratings
• CCG and CSU level (not practice level)
• Benchmarked data including savings / lost
opportunity
• Key messages bulletins with MI
• Supporting information for procurement
• Newsletters for chief executives
• Working groups
• Specialist pharmacist advice & tools to support
implementation
• Events

15. LPP website

16. LPP website

17. Trend graphs for PCTs/Clusters

18. Dashboard Benchmarking
Graphs

19. Secondary care dashboard

20. Final points
• Engagement with the clinical commissioning groups
• Understand new stakeholders & their priorities
•Support CCGs and Trusts to improve performance
• Support local QIPP plans
• Share good practice
• Pan-London approach
• Collaborative working between primary & secondary
care
• Enhance Dashboards
• Collaborative working with community pharmacists
• Collaborative working with the pharmaceutical industry

21. www.lpp.nhs.uk
Jasbinder.khambh@lpp.nhs.uk
Tim.root@chelwest.nhs.uk