for Medicines Procurement Services

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To review how medicines procurement services are currently managed by hospitals in the UK and to comment on potential strategic implications with regards to expertise required to fulfil these roles in future

Prepared by:

14th Oct 2014

Report commissioned by

The Procurement and Distribution Interest Group (PDIG) of the Guild of Healthcare Pharmacists (GHP)

Martin Anderson B.Sc, MRPharmS

Martin Anderson Consulting [email protected] 07731 826671

David Tutcher BPharm, MSc, MBA, MRPharmS Optrapharm Ltd

[email protected] 07733 225655

S u c c e s s i o n P l a n n i n g

for Medicines Procurement Services

To review how medicines procurement services are currently managed by hospitals in the UK and to comment on potential strategic implications with regards to expertise required to fulfil these roles in future

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Table of Contents

Succession Planning for Medicines Procurement Services ... 1

Table of Contents ... 2

1. Executive Summary ... 3

2. Key Recommendations ... 5

3. Background ... 7

3.1 The NHS hospital medicines procurement function ... 8

3.2 Regional Pharmacy Procurement Specialists (RPPSs) ... 13

3.3 Review of Specialist Pharmacy Services in England ... 14

3.4 Why do we need to consider succession planning? ... 15

4. Results and analysis ... 16

4.1 Overall response rate ... 17

4.2 The importance of these roles ... 19

4.3 Age profile ... 21

4.4 Anticipated difficulty in filling vacant posts ... 23

4.5 Dealing with vacancies ... 25

4.6 Staff type and grade in each role ... 26

4.7 Length of Time in role and levels of competency amongst post holders ... 30

4.8 Extent of part-time working ... 34

4.9 Further Analysis ... 35

4.10 ‘Free text’ comments from questionnaires ... 36

5. Recommendations ... 41

6. Acknowledgements ... 44

7. Glossary ... 45

Appendix 1 – Free Text Comments from Questionnaires ... 46

Appendix 2 – Introductory letter from Dennis Lauder/Allan Karr ... 54

Appendix 3 – Project proposal ... 56

Appendix 4 – Terms of Reference ... 61

4.1 Review approach ... 61

4.2 The report ... 62

Appendix 5 – Methodology ... 63

5.1 Letter of introduction ... 63

5.2 Questionnaire design ... 63

Appendix 6 – Further Analysis ... 65

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1. Executive Summary

The Guild of Healthcare Pharmacists Procurement and Distribution Interest Group (GHP PDIG) commissioned an independent review of staffing and management of current medicines procurement services in NHS hospitals, and the arrangements in place to ensure the ongoing provision of these services. The aim was to identify the current and emerging local and strategic personnel issues that will need to be addressed in the coming months to ensure that these important services can continue to be provided to an appropriate standard in the future.

Every UK NHS hospital Chief Pharmacist was contacted and asked a series of questions about each of the key roles involved in medicines procurement in their organisation, including the importance attached to each role, the age of the current workforce and plans to deal with vacancies, amongst others.

The overall response rate was approximately 50% and this report sets out the findings. From the responses it is clear that organisations manage the medicines procurement function in different ways. Some Chief Pharmacists have pro-actively reviewed the provision of medicines procurement services and have identified the necessity for change and much could be gained by a greater sharing of information.

At a local level, the importance placed by Chief Pharmacists on the medicines procurement service in each hospital is clear. In excess of 90% of respondents considered all of the roles to be either ‘crucial’ or ‘highly important’ to the safe and effective running of the Pharmacy Department. This degree of criticality indicates that the profession must ensure that suitably trained and experienced personnel are available to provide this service into the future. However, the findings of the report would suggest that a large number of experienced pharmacists that currently manage and direct local medicines procurement activities may retire in the next 5 years or so. Almost 50% of those that provide the strategic and/or professional management of local medicines procurement activities are over 50 years old. Coupled with the finding that 66% of respondents expected that filling pharmacy procurement posts is likely to be ‘quite difficult’ or ‘very difficult’, this should be of immediate concern.

This report demonstrates an urgent need to begin to consider succession planning in medicines procurement if these critical services are not to fail in the near future. It should be shared with organisations and individuals that can (i) influence the securing of provision of NHS medicines procurement services and (ii) influence the ongoing provision of pre- and post-registration education and training for pharmacy staff, both locally at individual hospital level, regionally and nationally.

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From an analysis of the findings, the report puts forward a number of recommendations for action at the local, regional and national level that will help to ensure the availability of appropriately trained, qualified and experienced personnel in the future. Recommendations largely fall into two groups (i) issues that need to be addressed urgently and in the short term and (ii) issues that need to be addressed in the medium to long term. The full list of recommendations is included in Section 5 of the report, but key recommendations are set out in Section 2 below.

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2. Key Recommendations

Recommendations largely fall into two groups (i) issues that need to be addressed urgently and in the short term and (ii) issues to be addressed in the medium to long term.

(i) Issues to be addressed urgently and in the short term

 As a matter of urgency, the Regional Pharmacy Procurement Specialists (RPPSs) should work with local Chief Pharmacists in their regions to identify the education and training needs of key current (and potential) medicines procurement personnel, and ensure that adequate support is offered to these individuals so that this expertise is retained (Recommendation 8)

 The report should be discussed at (regional) Chief Pharmacists meetings to raise awareness of this topic and identify forthcoming risks so that they can develop business continuity plans (with entries made in local organisation risk registers where deemed necessary) (Recommendation 13)

 Each region should forecast the requirement for medicines procurement personnel in the coming years, and ensure that succession plans are put in place for the key posts, and in particular for Role 1 (Recommendation 7)

(ii) Issues that need to be addressed in the longer term

 RPPSs should use the medicines procurement curriculum in the RPS competency frameworks (when available) as the basis on which to design and provide regional education and training schemes for medicines procurement personnel and collaborate to develop a standard syllabus for a national training course to cover the more advanced training requirements of medicines procurement specialists (Recommendation 22)

 The report should be discussed at (regional) Chief Pharmacists’ meetings to identify where difficulty in filling posts is envisaged, examine the reasons for this and propose ways in which the situation might be mitigated (Recommendation 11)

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 ‘Regional’ groups of Chief Pharmacists should commission a detailed survey of opinions amongst potential medicines procurement specialists to find out how careers in medicines procurement are perceived and identify the barriers which prevent people becoming interested and involved in these roles. This would provide valuable information for planning and help identify how these obstacles can be overcome. (Recommendation 12)

 In England, NHS England should use the two year period during which it is responsible for commissioning Specialist Pharmacy Services to establish a model specification against which specialist services, and in particular medicines procurement services, should be commissioned. This should include medicines procurement service outcomes, governance arrangements and professional expertise of service providers. Other Home Countries should also develop national service specifications for use by their NHS hospitals too (Recommendation 6)

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3. Background

Patients should expect that NHS hospitals have robust and demonstrable systems of governance in place to assure that the treatment they receive is safe and appropriate. This applies to medicines use, from selection and procurement to prescribing and administration.

The NHS hospital medicines procurement service supports the cost effective supply, management and optimisation of medicines use for patient treatment, is essential to safe and effective patient care, and is a mature and highly complex process. The primary purpose of the service should be to support and enable improvements in the safety and outcomes of patient care through the better use of medicines.

Currently, over £5bn per annum is spent on medicines in secondary care and it is vital that timely purchasing decisions are made, along with clinical commitment to change practice as necessary, for services to be both safe and efficient. NHS hospitals need to ensure that best value for money is achieved, and that pressure is maintained on suppliers to reduce costs wherever possible. This is a complex scenario with new clinical evidence emerging, and new medicines being introduced, almost on a daily basis. It is therefore critical that there is long term support for medicines procurement services in a modern NHS, especially when they have to deliver a high quality service and the best value for the patients and the organisations served.

The ‘Review of Specialist Pharmacy Services in England’ (see Section 3.3) sets out why NHS England considers medicines procurement to provide a critical resource for patient safety and the optimal use of medicines. There is a key dependency on excellence in the medicines procurement function for organisations to be able to deliver the RPS Principles of Medicines Optimisation.A

Across the UK there is an existing network of senior pharmacists that have, over many years, developed the local, regional and national ‘medicines procurement’ role into a strategically important one, working across and outside the Pharmacy Department, and providing important insight and advice in improving patient safety. However, for many years, the hospital pharmacy medicines procurement service has perhaps been undervalued. As a consequence many junior hospital pharmacists themselves, partly due to the surge in interest in clinical pharmacy, may have failed to understand how important this role is in providing safe patient care and ensuring value for money.

The second phase of the Modernising Pharmacy Careers Programme produced a report in September 2012 for the Medical Education England Board called ‘Review of post-registration career development: Next steps’B. It stated: “Overall, our conclusion is that career development pathways for pharmacy professionals post-registration are not well defined”.

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It went on to say: “there is currently a lack of structured career pathways needed to enable pharmacists and pharmacy technicians to move from novice to expert and beyond” and “there are supply side shortages in certain areas of the pharmacist workforce, notably in academia, research and technical specialties”.

The report proposed that workforce planning and post-registration education and training commissioning for technical and other speciality pharmacists and pharmacy technicians is undertaken at a national level by Health Education England and builds on pre-registration and undergraduate training.

3.1 The NHS hospital medicines procurement function

The NHS hospital medicines procurement service is one that supports the cost effective supply, management and optimisation of medicines use for patient treatment. The service is essential to safe and effective patient care, and needs to be delivered by senior professional medicines procurement staff that have expert knowledge of medicines, pharmacy services and the necessary systems and processes. These include legal controls applied to medicines (and in particular the regulations made under the Medicines Acts and Misuse of Drugs Act), professional and ethical obligations, patient safety, financial considerations, safe procurement systems and processes, support for clinical colleagues in treatment of patients, security of supply, quality of medicines, supply chain management, process efficiency (minimise wastage and stock holding), obtaining best value for money and achieving cost improvement savings targets. Therefore medicines procurement provides cost savings and patient benefits, through, for example:

 Delivery of medicines procurement activities e.g. sourcing, order placement, invoice query management, rebates, savings support and drug file management

 Medicines shortages management

 Guidance on outsourcing, e.g. Homecare, sourcing and managing unlicensed medicinal products etc.

 Provides examples of medicines whose presentations are judged to pose risks to patient safety

 Strategic advice to policy makers and implementation support for the procurement of medicines for hospitals providing NHS services

 Input to, and coordination of national strategy on medicines procurement

These individuals, therefore, need sufficient experience, skills and knowledge to liaise and influence:

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 NHS hospital Chief Pharmacists

 Commissioners (as appropriate)

 Specialist/formulary pharmacists/clinical leads

 Prescribers, either directly or, for example, presenting information at local/area Prescribing Committee meetings

 Pharmacy procurement and distribution personnel, technical service personnel

 Regional Pharmacy Procurement Specialists

 All types of suppliers

 Financial services

So, across the UK NHS hospitals need to ensure the availability of cost effective, quality assured medicines that meet individual patient needs in appropriate settings as and when required. In addition, new types of commercial contracts are being developed to manage services such as third party OPD services, homecare services, unlicensed medicinal products and cytotoxic dose banding, which all require expert management.

NHS hospitals will carry out these roles in a variety of ways; some will have specific dedicated senior pharmacy staff doing all or most of the role, whilst others will divide the tasks between different staff. In many ways, it does not matter who does the tasks as long as they are done by suitably trained and competent staff, and that individuals communicate effectively across and within departments.

Medicines procurement services are, and will continue to be embedded within NHS hospitals. These ‘providers of care’ need to ensure that those responsible for funding such services (Clinical Commissioning Groups in England, national bodies in other Home Countries) are aware of their importance to the safe treatment of patients, and of the major role they play in helping to reduce operating costs. New NHS England planning guidance is expected shortly, and will reportedly remind providers (and Clinical Commissioning Groups) to focus on the core aspects of improving quality, meeting NHS Constitution commitments and financial sustainability. NHS medicines procurement services demonstrably help in meeting at least two out of these three requirements.

In recognition of the growth of procurement activity in the NHS in England and the need to find £1.5 billion in efficiency savings by the end of 2015-16, the Department of Health has published its Procurement Development ProgrammeC, aimed at increasing expertise as well as efficiency and productivity. The document highlighted the scarcity of skilled procurement professionals in the health sector, and included plans to establish a Centre of Procurement

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Development, incorporating an Academy of Procurement Excellence which will provide a centre for networking, learning and knowledge management.

Whilst medicines procurement is not specifically mentioned in the Programme, there may be value in noting and exploiting certain aspects of it. Amongst the initiatives included in the Programme for instance is the creation of a new national ‘enabling function’ to support leadership development and build better capability throughout the system. Key components of this function will be senior executive ownership, talent management and development, process excellence in strategic sourcing, category management and supply chain management, key supplier management including the management of supply risks, accurate and timely procurement information, mechanisms for sharing knowledge, and the adoption of meaningful and relevant performance measures.

Whilst all of the foregoing will be of interest to medicines procurement professionals, it should be noted that the NHS spend on medicines accounts for a quarter of NHS non-pay expenditure. Due to this enormous financial commitment, the NHS hospital medicines procurement function has evolved continuously since its inception, and indeed has set the pace for introduction of innovative practice in medicines procurement in response to changes in technologies and ways of doing business. It has at its heart the imperative to ensure medicines of the appropriate quality and efficacy are available for the treatment of patients when needed, but it also has to respond to strategic and political pressures. The diagram below describes the hospital medicines procurement landscape in England (there will be similar arrangements in each of the Home Countries). The process has at its centre a network of Regional Pharmacy Procurement Specialists across the whole of the UK (and forming part of the Specialist Pharmacy Services in England) who are crucial in providing expertise, intelligence and mutual support.

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Chief Pharmacists Regional Pharmacy Procurement Specialists Regional Medicines Procurement Strategy Groups NPSG PMSG Commercial Medicines Unit Clinicians, Clinical Networks CCGs/CSUs (commissioning for common conditions and PbR included medicines) NHS England (via Area Teams and Clinical Reference Groups) (Medicines Optimisation

and commissioning for Specialised Conditions)

NICE/NPSA (decisions on use of

medicines)

NHS procurement hubs (support for local tendering and contract

monitoring) CMU

(support through national and Regional tenders)

NHS Hospitals Procurement Specialists in neighbouring regions (support through collaboration) Specialist Pharmacy Service (support from MI, QA etc)

Regional Medicines Procurement

Operational Groups

Local clinical pharmacy specialists (support for procurement

initiative implementation) Department of Health MHRA/EMA (announcements on use and availability of medicines) Pharmacy Procurement staff NHS England

Diagram 1 - Organisational landscape for Hospital Medicines Procurement in England

Within UK NHS hospitals, local medicines procurement activities are well established. The diagram below shows how the major medicines procurement functions link together to form the complete process.

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Diagram 2 –NHS hospitals medicines procurement functions

Two distinct sets of roles are identified – the first are those that are linked to routine stock management functions (coloured in purple). The second, which are the ones that were of interest in this study, are those roles that are performed to anticipate and respond to strategic pressures and external factors related to medicines procurement (coloured in yellow). These roles are described below:

 Role 1 - Strategic/Professional management of local medicine procurement activities – i.e. the post holder involved with the professional oversight of medicine procurement activities, the provision of professional advice, and strategic development of local procurement services

 Role 2 - Operational/Technical leadership of local medicine procurement activities

- i.e. the post holder most involved with the day to day supervision of procurement

staff undertaking basic procurement activities (e.g. raising purchase orders, goods inwards, storage, stock control, stock distribution etc)

 Role 3 - Management of homecare services - i.e. the post holder most involved in the provision of homecare services (e.g. ensuring prescriptions are clinically vetted, orders are placed, problem are resolved etc)

 Role 4 - Provision of medicines usage information - i.e. the post holder most involved in activities associated with the provision of information on medicines used (e.g. extraction and analysis of data from pharmacy IT systems, provision of information and reports etc)

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 Role 5 - Management of influences on the range of medicines stocked - i.e. the post holder most involved in evaluating the impact of factors that may give rise to changes in medicines used in the organisation (e.g. outcomes of tendering exercises, findings of audits and reviews, changes in local and national commissioning decisions, NICE Technical Appraisals etc). NB This is not necessarily the 'formulary pharmacist' post - see Role 6 below

 Role 6 - Management of formulary - i.e. the post holder responsible for overseeing the operation of due processes for managing changes in the list of medicines to be procured and supplied (e.g. response to requests for new products, implementation of Local Prescribing Committee Decisions etc)

3.2 Regional Pharmacy Procurement Specialists (RPPSs)

Against this complex background, it is recognised that a key role is played by the UK-wide network of Regional Pharmacy Procurement Specialists in ensuring that the medicines required for the treatment of patients are available when needed, and are procured in the most efficient ways possible within their regions. The importance attached to this function has been recognised, and, in England, RPPSs are included in the Specialist Pharmacy Services, which comprises a range of services to be commissioned at a national level (see Section 3.3).

This group of highly experienced and qualified specialists provide medicines procurement support and expertise to local organisations, and operate as a collaborative network to address problems and resolve issues so that supplies of medicines are maintained. However, through its relationships with the National Pharmaceutical Supply Group (NPSG), the Pharmaceutical Market Support Group (PMSG), and, in England its engagement with the DH Quality, Innovation, Productivity and Prevention (QIPP) programme, the Commercial Medicines Unit (CMU) identified that NHS medicines procurement performance in hospitals - involving as it does clinical relationships, collaboration between trusts, relationships with commissioners and the identification and pursuit of opportunities - varies by regional NHS Pharmacy Purchasing Group.

CMU therefore provided funding for a project to be undertaken to examine the causes of this variance, and make recommendations that would help regional pharmacy procurement groups in England achieve similar high levels of performance. The study, known as the ‘Promoting Excellence in Hospital Medicines Procurement Project’D was completed in March 2014, and provided:

 A comparison of regional medicines procurement arrangements, highlighting the variations in regional medicines procurement infrastructure in place across England

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 A list of success factors, ranked in order of importance, against which each region was able to assess itself and identify gaps in medicines procurement capability and develop plans to address them

Each region in England was invited to assess procurement capability against the list of success factors in October 2013. Reports were produced for each region showing how they scored against each factor, and comparing local scores to the national average. Based on medicines procurement practice in the regions with the highest success factor scores, a number of recommendations were made in the report including:

 That Chief Pharmacists in a geographic region should agree and implement a local medicines procurement model, fund a small medicines procurement team led by a Regional Pharmacy Procurement Specialist (RPPS) to work on their behalf, agree and support an annual work plan and hold the team accountable for delivery of the plan

 That RPPSs should establish better links with commissioning organisations, taking the requirements of the wider health economy into account when making purchasing decisions, take advantage of the new regional structures to work together across traditional geographic boundaries, and collaborate to develop better IT systems to address weaknesses in data availability and analysis

Each region was then encouraged through NPSG to develop a local action plan to address capability and capacity gaps. It is understood that this work will be used to inform the development of service specifications for regional procurement services.

3.3 Review of Specialist Pharmacy Services in England

In May 2104, Dr Keith Ridge, Chief Pharmaceutical Officer for England, published a Review of Specialist Pharmacy Services in EnglandE. The aim of the review was to consider evidence, analyse options and make recommendations for the future commissioning and sustainable delivery of Specialist Pharmacy Services in England from 2014-15 onwards. The report recognised the long-standing contribution that these services make to patient safety, coupled with the need to retain skills and expertise.

This report states that Specialist Pharmacy Services were introduced into the NHS as part of the NHS reforms of 1974 and consisted of Medicines Information (MI), Quality Assurance (QA) / Quality Control (QC) and Radiopharmacy. Since then, NHS organisational changes and reforms have impacted on the organisation and provision of the separate disciplines in different ways. A stocktake of Specialist Pharmacy Services by the Strategic Health Authority Pharmacy and Prescribing Leads during 2011-12 cited in the report demonstrated that, whilst the core of Specialist Pharmacy Services remained a critical resource for the NHS,

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newer services had emerged under the Specialist Pharmacy Services umbrella to support better medicines use, including medicines safety, evaluation and procurement.

Evidence confirms that Specialist Pharmacy Services provide a critical resource for patient safety and the optimal use of medicines. The span of their activities yields health care benefits for thousands of patients every year and also delivers significant savings for the NHS.

The report also confirms that NHS medicines procurement contracts already yield major financial savings of around £150m nationally per annum (excluding homecare) which are reflected ultimately in the tariffs paid by commissioners, and further plans for savings in medicines procurement are being developed.

The report recommends that the services should not be abstracted from patient care organisations but continue to be provided from trusts. The primary purpose of such services should be to enable improvements in the safety and outcomes of patient care through the better use of medicines. They should support patients, clinicians, commissioners and providers in the delivery of medicines optimisation across the NHS.

Prior to the reorganisation of the NHS in 2013/14, there were major differences in the way these services were organised, funded and provided throughout England. The changes in the structure of the NHS exposed difficulties in accommodating these services within the existing commissioning process. To reduce the risk of losing these services, arrangements have been made for NHS England to commission them centrally for a period of two years. This period will provide an opportunity to establish a model specification within which these services, including medicines procurement, should be defined, their benefits acknowledged and lines of accountability established, so that they can be accommodated within routine commissioning processes in future.

3.4 Why do we need to consider succession planning?

From the foregoing, it can be seen that the medicines procurement function forms an essential component of the pharmacy service in supporting patient care and optimising medicines use. It is clear therefore that there will be a requirement for NHS staff with the necessary knowledge, skills, training and expertise to maintain the hospital medicines procurement function in the future, to uphold current service standards and to develop the service as new opportunities and challenges present themselves.

As well as the requirement for specialists at national and regional level, staff with all the necessary qualities will be required in senior posts at a local level. Attention must therefore be focussed on ensuring a continuous supply of hospital pharmacy staff with the desire and motivation to embark on a career in medicines procurement, and the ambition and

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determination to progress into senior positions.

The changing NHS has created significant pressure on the hospital pharmacy service and its workforce needs. Managers responsible for providing the medicines procurement service will need to ensure that sufficient staff with the required skills and experience, are available if they are to continue to meet the need to provide the most cost-effective medicines in the most efficient way.

Despite the existence and effectiveness of the national and regional medicines procurement structures, medicines procurement forms such an integral part of the hospital pharmacy service that it is not generally regarded as a ‘specialism’. It does not benefit from a recognised career development pathway and struggles to have a recognised national ‘identity’.

In England, commissioning organisations (and hospital managers) may also increasingly be challenging the cost of providing these services, and may choose, through ignorance of the importance of the roles, to have them provided more cheaply by others. It is important that engagement with and support from commissioners, including CCGs, is obtained to highlight the benefits of an effective hospital medicines procurement service to the local health economy.

Also, the current cost pressures in the NHS have seen many workforce changes including a downgrading and reduction of posts. Effective medicines procurement and supply chain management may be at risk unless there is an active management approach to ensuring sufficient expertise is available at local, regional and national level.

The question uppermost in our minds is “where will the people who provide these local, regional and national services come from in future”? The answer to the question must surely be that some of the hospital based pharmacists and technicians currently performing medicines procurement roles will be the people that progress their careers from local to regional and national responsibilities. As the results show (see Section 4) there is an urgent need to begin to consider succession planning in medicines procurement at local level if these critical services are not to fail in the future. Ultimately, a clear career development plan for medicines procurement staff will need to be developed.

4. Results and analysis

An online questionnaire was designed and all NHS hospital Chief Pharmacists were asked to complete it (see Appendix 5 for more details). The results from the questionnaires are set out in the various tables and charts below. At the end of each section, the authors present some brief discussion and analysis of the findings in order to stimulate readers to carefully consider the results and apply their own interpretation based on their own individual

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organisational circumstances, and on their wider understanding of medicines procurement activities at regional/national level. Where appropriate, the authors have also begun to make some recommendations about how these results may be used to encourage further discussion and action.

The on-line questionnaire also featured two optional free text boxes to allow respondents to give brief details of their succession plans, and/or to share thoughts and ideas on succession planning for key medicines procurement functions. These were used by many respondents, and provide a rich source of information, including how hospitals manage and consider changing these functions. A number of comments have been inserted throughout this section to provide a ‘flavour’ of the feedback received and are shown in italics (in blue coloured boxes) to differentiate them from the author’s thoughts. Other comments have been ‘grouped’ in Section 4.10, and all of the comments received are set out in Appendix 1.

4.1 Overall response rate

116 completed forms were received by the closing date of 31st July 2014. It has been difficult to get an accurate figure for the total number of organisations included in the survey due to organisational change and mergers. One estimate (from the NHS Choices websiteF) lists 236 NHS Trusts in England, which combined with information from Scotland, Wales and Northern Ireland means that 263 questionnaires would have been distributed. On this basis, the response rate was 44%, and the breakdown by region is shown in the table below:

Region Trusts/Boards Replies Response rate

(%) Northern Ireland 5 4 80 Scotland 15 8 53 Wales 7 4 57 East Midlands 16 4 25 East of England 24 12 50 London 40 12 30 North East 11 11 100 North West 39 13 33 South Central 16 11 69

South East Coast 17 7 41

South West 24 12 50

West Midlands 28 6 21

York and Humber 21 11 52

Other 1

Total 263 116 44

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However, not all NHS Trusts in England will have an on-site pharmacy and using information held by CMU on hospital purchasing points in England, (which excludes NHS Trusts that do not procure medicines), the number of questionnaires distributed in England may have been as low as 186, which combined with information from Scotland, Wales and Northern Ireland makes a reduced total of 213 questionnaires sent out, lifting the response rate to 54%.

Discussion and Analysis

The authors are very pleased with the overall response rate, estimated to be between 44% and 54%, and which therefore provides a large enough sample on which findings and recommendations can be based with confidence. Responses have been received from all regions, although rates were lower in three regions (West Midlands, East Midlands and London).

It is worth noting that as this is the first time this type of data has been collected, it represents a snapshot of the current situation. If the study is repeated, changes in the way that procurement services are being provided will become apparent. This would be valuable information to assist with identification of trends to inform skill mix analysis and workforce planning.

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4.2 The importance of these roles

In response to the question “In your opinion, how critical is this function to the operation of the Pharmacy Department?” replies are shown in the chart below:

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Role 1 Role 2 Role 3 Role 4 Role 5 Role 6 % or responses

Importance attached to roles

Crucial Highly important Medium importance Low importance

Role 1 - Strategic/Professional management of local medicine procurement activities Role 2 - Operational/Technical leadership of local medicine procurement activities Role 3 - Management of homecare services

Role 4 - Provision of medicines usage information

Role 5 - Management of influences on the range of medicines stocked Role 6 - Management of formulary

Chart 1 – importance attached to roles

The importance placed on the medicines procurement service in each hospital by Chief Pharmacists is clear. In excess of 90% of respondents considered all of the roles to be either ‘crucial’ or ‘highly important’ to the safe and effective running of the pharmacy department. Role 1 (providing strategic/professional management of local medicine procurement activities) and Role 2 (providing operational/technical leadership of local medicine procurement activities) were both rated ‘crucial’ by over 70% of respondents.

This degree of criticality indicates that the profession must ensure that suitably trained and experienced personnel are available to provide this service into the future. The crucial importance attached to Role 1 is worth noting as results from other parts of the questionnaire relating to seniority and maturity of current post holders in this role indicate that there could be a high demand for new staff in the near future.

NHS hospitals must ensure that the expertise to provide medicines procurement functions safely, efficiently and at best value is maintained, and that the service is delivered to the

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required standards. Professional standards for Hospital Pharmacy Services produced by the Royal Pharmaceutical SocietyG should be regarded as the minimum basis for the service. Ideally NHS England should encourage and incentivise commissioning organisations to develop and include specifications for medicines procurement services in contracts with provider organisations. The equivalent authorities in Northern Ireland, Scotland and Wales should similarly ensure support for these functions at national level.

“All functions are considered to be crucial elements of a hospital pharmacy service”. “There is currently no succession planning in place, but we are beginning a process locally to identify high risk specialist posts and develop succession plans.

Procurement will be one of the areas covered”. Free text quotes

Recommendations

1. The findings of this report should be shared with organisations and individuals that can influence the securing of provision of NHS medicines procurement services e.g. NPSG, PMSG, RPS, NHS England, NHS Scotland, NHS Wales and Health & Social Care in Northern Ireland, Chief Executives of NHS hospitals etc.

2. The findings of this report should be shared with organisations that can influence the ongoing provision of pre- and post-registration education and training for pharmacy staff to ensure that all pharmacists and technicians are aware of the importance of the medicines procurement function, have a good understanding of the medicines supply chain and the factors that influence the price of a product at the very minimum.

3. The GPhC should work with universities to ensure teaching about medicines procurement is included at undergraduate level, and with pre-registration training providers to develop this theme during the pre-registration period.

4. The Regional Pharmacy Procurement Specialists should provide regular (e.g. annual) workshops for existing and potential medicines procurement personnel.

5. Ideally, in England, NHS England should encourage and incentivise commissioning organisations to develop and include specifications for medicines procurement services in contracts with provider organisations. The equivalent authorities in Northern Ireland, Scotland and Wales should similarly ensure support for these functions at local level.

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6. In England, NHS England should use the two year period during which it is responsible for commissioning Specialist Pharmacy Services to establish a model specification against which specialist services, and in particular medicines procurement services, should be commissioned. This should include medicines procurement service outcomes, governance arrangements and professional expertise of service providers. Other Home Countries should also develop national service specifications for use by their NHS hospitals too.

4.3 Age profile

In response to the question “What is the approximate age of the current post holder?” replies are shown in the chart below:

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Role 1 Role 2 Role 3 Role 4 Role 5 Role 6 % of responses

Age profile of role holders

< 25 yr 25 - 50 yr > 50 yr

Chart 2 – Age profile of role holders

For succession planning purposes, this is one of the most interesting and informative findings from the survey. There is a very low proportion of workers under 25 years in all posts, and in particular in posts 1, 5 and 6. This probably reflects the complexity attached to these roles and seniority required to undertake them. For most roles the large majority of post holders are in the age range of 25 – 50 years old. There is a big difference between 25 and 50, but this would seem to suggest that many of these people might be in employment for many years to come.

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Approximately 28% of post holders are over 50 years old, and in Role 1, this proportion rises to almost 50%. The data would suggest (and support the expressed views of many in the service), that a large number of experienced pharmacists that currently manage and direct local medicines procurement activities may retire in the next 5 years or so. As the provision of strategic and/or professional management of local medicines procurement activities is regarded as one of the three most important medicines procurement posts in the survey, this finding should be of immediate concern.

Finally, these findings may suggest that career pathways could be blocked by older incumbents, reducing the number of opportunities for younger staff members to advance and progress their careers in medicines procurement. With encouragement and support some of these more experienced people could act as mentors to junior staff members, and perhaps recent retirees could be re-employed on a part time basis to act in a similar capacity.

“Currently under consideration as all key staff members > 50 yrs age”.

“The senior pharmacist for medicines procurement is due to retire in the next few years. We have started succession planning - with our senior technician in

procurement being trained up and developing knowledge and skills needed to take over”.

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Recommendations

7. Each region should forecast the requirement for medicines procurement personnel in the coming years, and ensure that succession plans are put in place for the key posts, and in particular for Role 1.

8. As a matter of urgency, the Regional Pharmacy Procurement Specialists should work with local Chief Pharmacists in their regions to identify the education and training needs of key current (and potential) medicines procurement personnel, and ensure that adequate support is offered to these individuals so that this expertise is retained.

9. Chief Pharmacists, supported by the local RPPSs, should explore ways in which NHS hospitals might collaborate on procurement activities, and cooperate in future to ensure that sufficient people are available (suitably trained and competent) to take on these roles as existing post holders leave or retire.

10. Chief Pharmacists should encourage and support some of the more experienced medicines procurement personnel to act as mentors to junior staff members with an

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interest in medicines procurement, and consider re-employing recent retirees on a part time basis to act in a similar capacity.

4.4 Anticipated difficulty in filling vacant posts

In response to the question “How easy do you think it would be to fill this post if it became vacant?” replies are shown in the chart below:

0% 20% 40% 60% 80% 100% Role 1 Role 2 Role 3 Role 4 Role 5 Role 6 % of responses

Anticipated difficulty in filling vacant roles

very easy fairly easy quite difficult very difficult

Chart 3 – anticipated difficulty in filling vacant roles

Approximately 66% of respondents expected that filling medicines procurement posts was likely to be ‘quite difficult’ or ‘very difficult’. Post 3 was generally felt likely to be the least difficult to fill. The reasons for envisaging difficulty in filling vacant posts were not explored, but presumably relate to concerns over the ability to attract candidates of adequate calibre for each post. This may be attributed to the lack of appeal of procurement posts to candidates, the technical complexity attached to the posts, or the low availability of applicants with the requisite skills, knowledge and experience.

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It would be useful to undertake a further study into how careers in medicines procurement are perceived and identify the barriers which stop people becoming interested and involved in these roles. The survey should extend to current medicines procurement staff to ascertain what drew them towards and retains them within the speciality. The results may provide the basis on which new initiatives to facilitate and promote career progression in medicines procurement can be developed. These may include a formal post-registration qualification scheme to underpin the specialism, and would raise the profile of medicines procurement specialists. Any benefits that may be obtained from the facilities offered by the Centre of Procurement Development or parallel development of similar facilities (e.g. on-line knowledge bases, best practice, training (including mentoring and links to training schemes provided by the Chartered Institute of Purchasing and Supply), development of standards etc) could also be explored, and proposals for the creation of a stronger image and national identity for the medicines procurement speciality considered.

Clearly, where difficulty in filling posts is envisaged, the reasons for this should be examined and ways in which the situation might be mitigated proposed and implemented. In the meantime, business continuity plans should be developed to ensure that the medicines procurement function can continue to be provided whilst vacancies exist. This should be led at a regional level, whilst at local level, entries in the organisation’s risk register to flag up anticipated vacancies due to retirement and potential difficulty in recruiting to such posts may be required.

“Main concern is around replacing the person as in Role 1 - this is a Band 7 pharmacy procurement technician who has expert knowledge of procurement law, pharmacy issues and a good understanding of oncology drugs (for the purposes of procurement). We have other staff who can step in and undertake basic procurement functions but this would not be sufficient longer term”.

“It is extremely difficult to get younger pharmacists interested in procurement issues and it often falls to the Chief Pharmacist”.

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Recommendations

11. The report should be discussed at (regional) Chief Pharmacists’ meetings to identify where difficulty in filling posts is envisaged, examine the reasons for this and propose ways in which the situation might be mitigated.

12. ‘Regional’ groups of Chief Pharmacists should commission a detailed survey of opinions amongst potential medicines procurement specialists to find out how careers in medicines

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interested and involved in these roles. This would provide valuable information for planning and help identify how these obstacles can be overcome.

13. The report should be discussed at (regional) Chief Pharmacists meetings to raise awareness of this topic and identify forthcoming risks so that they can develop business continuity plans (with entries made in local organisation risk registers where deemed necessary).

4.5 Dealing with vacancies

In response to the question “If the post became vacant, would you replace the post holder on a like for like basis?” replies are shown in the chart below:

Dealing with vacancies

same change

Chart 4 – dealing with vacancies

Whenever a job becomes vacant this creates a good opportunity to review the roles and responsibilities of the previous post holder and replace accordingly. As can be seen above, most roles will be filled on a like for like basis, although approximately 20% of respondents intend to make changes when the opportunity arises. Changes are most likely for Role 1 (27%), Role 5 (27%) and Role 6 (29%), which are the roles predominantly undertaken by

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actively reviewed the provision of medicines procurement services and have identified the necessity for change. The reasons for making changes, and the nature of the changes, are not explored in the survey.

“My succession plan is like for like replacement and focusing the pharmacy technicians on the procurement aspects developing them along the CIPS route”. “Scope has changed in recent years and we have redesigned ensuring optimum skill mix is utilised at right place in overall medicines optimisation process. We will need to continually redesign to meet the agenda. Yes there is succession planning in place, but this does not involve replacing like with like”.

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Recommendations

14. Chief Pharmacists should undertake a review of local medicines procurement services and explore the need for organisational change. Where the case is strong, and the potential for benefits is clear, consideration should be given to utilising formal organisational change procedures, rather than waiting for vacancies to arise.

4.6 Staff type and grade in each role

In response to the question “What type of staff member normally undertakes this function?” replies are shown in the chart below:

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Staff type in each role

Pharmacist Technician A&C Other

Chart 5a – Staff type in each role

In response to the question “What is the Agenda for Change band of the staff member that normally undertakes this function?” replies are shown in the chart below:

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AfC Band for each role

Band 5 Band 6 Band 7 Band 8a Band 8b Band 8c Band 8d Band 9

Chart 5b – staff grade in each role

The findings show that Roles 1, 5 and 6 are predominantly undertaken by pharmacists, while Role 2 is predominantly undertaken by pharmacy technicians. Roles 3 and 4 had the greatest use of ‘A&C’ and ‘Other’ staff types (more than 30% non-pharmacist or technician in each case).

Staff banded at 8a, 8b and 8c accounted for the majority of performers of Roles 1 (63%), role 5 (81%) and role 6 (87%). Staff predominantly banded at 5, 6 and 7 performed Roles 2 (88%), role 3 (65%) and role 4 (76%). Interestingly, Role 1 is performed by Band 9 in 7% of cases.

Where respondents indicated ‘Other’ they were asked to provide further information which has been analysed as follows:

For Role 3, 23 (19%) respondents used ‘Other’ and gave the following explanatory notes:

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 No person performing this role in this organisation – 8 respondents

 Role performed by a mixture of people – 5 respondents

 Role performed by Band 3 ATO – 1 respondent

For Role 4, 18 (15%) respondents used ‘Other’ and gave the following explanatory notes:

 Details of person performing role already provided – 5 respondents

 Role performed by Data Analyst – 8 respondents

 Role performed by a mixture of people – 2 respondents

 Role performed by Commercial Manager – 1 respondent

 Role performed by Performance Manager – 1 respondent

 Role outsourced to IT Department - 1 respondent

As can be seen individual organisations seem to manage the medicines procurement function in different ways. The authors recognise that all hospitals are different and the model on which the questionnaire was based (see Diagram 2) may not be applicable in all hospitals. This may have led to different approaches to providing answers. The answer to the question “Why do some hospitals have a Band 6 staff member performing Role 1, whilst others have a Band 9?” will be that this will depend on local circumstances. However, this wide variation in banding should be of interest to all.

As discussed in 4.1 above, the findings from this study provide useful information about the current staffing situation in NHS hospitals. It provides no information on how the situation has evolved, and how it is likely to develop in the future. Further studies will be required to help identify trends in work force changes.

“The procurement team consists of a lead Pharmacy technician (7) supported by a senior technician (6) with clerical support consisting of 2 clerical officers (3). Homecare has a designated manager clerical officer (4) and a specialist PAS

pharmacy technician (0.5 x 5).The service is supported by a Principal Pharmacist (8b) who gives clinical advice and helps if required with any strategic or professional issues”.

“There is one band 8c pharmacist who oversees all the activities, and has a team of A&C staff carrying out the functions, graded band 4 and below, apart from the information role at band 6. This is part of this individual’s wider role as clinical lead

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Free text quotes Recommendations

15. Chief Pharmacists should use the findings of this report to review the skill mix in their own organisations to ensure the appropriate use of personnel in the medicines procurement process. Any proposed changes, however, should take into account the skills and expertise needed in each role, and consider the requirement to maintain these services into the future.

16. Chief Pharmacists should co-operate with requests to submit KPI data so that they can benchmark their hospital against other similar hospitals, and, supported by the local RPPSs, introduce the opportunity for peer review in procurement service provision.

17. The study should be repeated at some point in the future (2 years?) to see how staff types and staff grades in each role are changing, and to identify trends in service provision to inform planning for work force education and training.

4.7 Length of Time in role and levels of competency amongst post holders

In response to the question “Approximately how long has the post holder been in this post?” replies are shown in the chart below:

0% 20% 40% 60% 80% 100% Role 1 Role 2 Role 3 Role 4 Role 5 Role 6 % of responses

Length of time in role

< 1yr 1-5 yr > 5yr

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In response to the question “What is the level of competency in this role of the current post holder?” replies are shown in the chart below:

Level of competence amongst role holders

Novice Partly Trained Fully trained Expert

Chart 6b – Levels of competence amongst role holders

Clearly many people remain in these procurement roles for a long time. On average, over 55% of all post holders have been in post for more than 5 years, possibly indicating high levels of job satisfaction. The highest proportion of long service (over 5 years) is seen in Role 1 (70%), Role 2 (66%) and Role 5 (66%), and these roles unsurprisingly show the lowest number of new starters. The greatest proportion of new starters is seen in Role 3 (homecare services at 18%) and Role 4 (provision of medicines usage information at 16%). For Role 3, these data may reflect the relatively recent introduction of roles for homecare services managers following the implementation of the recommendations in the Hackett reportH. As medicine procurement roles are deemed ‘crucial’ in many cases, a high staff turnover would not be desirable. However, when considering succession planning, this positive aspect needs to be balanced against the age profile of the post holders so that a steady supply of adequately trained and qualified personnel to fill vacant posts is assured.

Turning to competency levels, it is reassuring to discover that in all cases, medicine procurement functions are being undertaken mainly by post holders with recognised skills and ability. Bearing in mind the length of time that staff are in post, it is not surprising that

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There are very low levels of novices in all roles; Role 3 has the lowest proportion of staff classified as ‘fully trained’ and ‘expert’ (57%), perhaps as this role is a relatively recent introduction in many hospitals. It is worth noting that for all roles, a significant proportion of staff are in need of, (and presumably undergoing) training, so that post holders will be able to undertake their roles with greater competence.

The project proposal asked for current medicines procurement service provision to be benchmarked against the RPS Faculty competency framework Levels. The RPS has published two documents, the Foundation Pharmacy Framework (FPF)I and the Advanced Pharmacy FrameworkJ, which together set out four levels of competency, and which map to the drop down response options in the survey as follows:

RPS Competency Framework Level PDIG questionnaire drop-down menu options

Foundation Novice (requires training)

Advanced Level 1 Partly competent (requires some supervision) Advanced Level 2 Fully competent (requires no supervision)

Mastery Expert

Table 2 –Competency Framework levels mapped to questionnaire options

The questionnaire sought the opinions of Chief Pharmacists on the level of competency amongst their staff in medicine procurement roles. Chart 6b (above) shows how the competencies of current medicines procurement staff would be likely to meet the medicines procurement competencies set out in these documents. Note that to fully achieve the RPS competency framework levels, other competencies of a more generalist nature would have to be demonstrated too, through the Faculty assessment process. There is currently no equivalent credentialling process for non-pharmacists.

The Foundation Pharmacy Framework does list some basic procurement competencies, which should be regarded as the minimum level that all pharmacy staff should attain. They are set out below:

 Pharmaceutical - Describes how pharmaceuticals can be sourced, and sources pharmaceuticals in a timely manner

 Resolves supply problems promptly

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 Cost effectiveness - Ensures stock purchased maximises cost effectiveness

The Advanced Pharmacy Framework lists clusters of competencies, one of which is referred to as ‘Expert Practice’. This is where, in the near future, competencies for medicines procurement, as a recognised specialism within the practice of pharmacy, will be set out as a curriculum. It will list knowledge, skills, education and behaviours relating to medicines procurement practice to accompany the framework. This will provide the basis for a post-registration road map to support personal development programmes and a career pathway in medicines procurement. Work has begun on this task, and some competencies have been set out in the RPS publication ‘Medicines Procurement, Expert Professional Practice Curriculum 2014’K The value of linking personal capabilities of post holders to the RPS Competency Framework Levels for medicines procurement needs to set out for Chief Pharmacists, so that they can decide how best to use the facility, and build it into training and assessment processes.

The Chartered Institute of Purchasing and Supply (CIPS) is a body that promotes professionalism and high standards in procurement. Membership of the Chartered Institute of Purchasing and Supply (MCIPS) is the internationally recognised standard for top quality procurement professionals. Pharmacy procurement professionals can, of course, complete the training modules and obtain the necessary qualifications to apply for CIPS membership as part of their personal development plan. However, at present there is no training component that specifically addresses the specialised area of medicines procurement.

“Some of the post holders have been in post for too many years and changes need to be made but they don't necessarily want / like change. This area is ripe for

re-organisation”.

“There is a lack of structured training programmes currently in the region to help develop a pool of staff with an interest in procurement and thus even fewer have a CIPS or equivalent qualification”.

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Recommendations

18. Chief Pharmacists should ensure that staff remain up to date and motivated to improve performance throughout their careers. One way to potentially improve individual motivation and to address the succession planning challenge is to rotate staff at regular intervals in order to make staff aware of different roles and responsibilities within the dept.

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19. Resources should be identified to continue to work with the RPS to develop the medicines procurement curriculum to support the APF.

20. The RPS should work with APTUK to provide assistance in developing a credentialling process for non-pharmacists in medicines procurement roles.

21 Chief Pharmacists are encouraged to make full use of the emerging RPS competency frameworks, and in particular the medicines procurement curriculum (when available), to monitor the progress of staff in training and to inform personal development plans for individuals wishing to pursue careers in medicines procurement.

22. RPPSs should use the medicines procurement curriculum in the RPS competency frameworks (when available) as the basis on which to design and provide regional education and training schemes for medicines procurement personnel (See also recommendation 4) and collaborate to develop a standard syllabus for a national training course to cover the more advanced training requirements of medicines procurement specialists.

4.8 Extent of part-time working

In response to the question “Does this person work in this role on a full (or substantively full) time basis?” replies are shown in the chart below:

Extent of part-time working

full time part time

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The results show that across most of the roles, part-time working is fairly evenly balanced with full-time working; the exception is Role 2 where the majority of post holders (80%) are working on a full time basis. These results may, however, be reflecting the fact that in a large number of cases, particularly in smaller organisations, post holders may have a full time employment commitment, but share their time between two or more medicines procurement functions, or with other hospital pharmacy roles.

“I do not necessarily have one member of staff for each of the above roles. One person may undertake more than one role”.

“Some of the functions listed above do not sit with one person, responsibilities spread between professions and posts”.

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Recommendations

23. Chief Pharmacists should seek to take every advantage of the popularity of part-time working arrangements amongst medicines procurement staff and should provide some level of flexibility when considering how best to maintain medicines procurement services when filling vacant posts.

4.9 Further Analysis

Respondents to the questionnaire were asked to categorise their organisation by organisation type, geographical location, number of pharmacy staff, and annual expenditure on medicines. This provides the opportunity to examine the responses from organisations from each category, and compare the findings with organisations in different categories.

In general, there was not a huge difference in views from around the country, nor from hospitals of different types and sizes. The most noteworthy differences are listed below: