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1 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 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 Prepared by: Report produced by 14 th Oct 2014 Martin Anderson B.Sc, MRPharmS Martin Anderson Consulting David Tutcher BPharm, MSc, MBA, MRPharmS Optrapharm Ltd Report commissioned by The Procurement and Distribution Interest Group (PDIG) of the Guild of Healthcare Pharmacists (GHP) October 2014

2 Table of Contents Succession Planning for Medicines Procurement Services... 1 Table of Contents Executive Summary Key Recommendations Background The NHS hospital medicines procurement function Regional Pharmacy Procurement Specialists (RPPSs) Review of Specialist Pharmacy Services in England Why do we need to consider succession planning? Results and analysis Overall response rate The importance of these roles Age profile Anticipated difficulty in filling vacant posts Dealing with vacancies Staff type and grade in each role Length of Time in role and levels of competency amongst post holders Extent of part-time working Further Analysis Free text comments from questionnaires Recommendations Acknowledgements Glossary Appendix 1 Free Text Comments from Questionnaires Appendix 2 Introductory letter from Dennis Lauder/Allan Karr Appendix 3 Project proposal Appendix 4 Terms of Reference Review approach The report Appendix 5 Methodology Letter of introduction Questionnaire design Appendix 6 Further Analysis Appendix 7 The final version of the questionnaire Appendix 8 References

3 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. 3

4 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. 4

5 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) 5

6 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) 6

7 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 postregistration career development: Next steps B. It stated: Overall, our conclusion is that career development pathways for pharmacy professionals post-registration are not well defined. 7

8 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: 8

9 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 , the Department of Health has published its Procurement Development Programme C, 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 9

10 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. 10

11 Department of Health NHS England CMU (support through national and Regional tenders) Commercial Medicines Unit MHRA/EMA (announcements on use and availability of medicines) PMSG NPSG Procurement Specialists in neighbouring regions (support through collaboration) NICE/NPSA (decisions on use of medicines) Specialist Pharmacy Service (support from MI, QA etc) Regional Pharmacy Procurement Specialists NHS England (via Area Teams and Clinical Reference Groups) (Medicines Optimisation and commissioning for Specialised Conditions) NHS procurement hubs (support for local tendering and contract monitoring) Regional Medicines Procurement Operational Groups Regional Medicines Procurement Strategy Groups CCGs/CSUs (commissioning for common conditions and PbR included medicines) Local clinical pharmacy specialists (support for procurement initiative implementation) Pharmacy Procurement staff Chief Pharmacists Clinicians, Clinical Networks NHS Hospitals 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. 11

12 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) 12

13 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 13

14 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 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 England E. 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 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 cited in the report demonstrated that, whilst the core of Specialist Pharmacy Services remained a critical resource for the NHS, 14

15 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 15

16 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 16

17 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 Overall response rate 116 completed forms were received by the closing date of 31 st July 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 website F ) 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 Scotland Wales East Midlands East of England London North East North West South Central South East Coast South West West Midlands York and Humber Other 1 Total Table 1 - Questionnaire response rates by region 17

18 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. 18

19 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: Importance attached to roles Role 6 Role 5 Role 4 Role 3 Role 2 Role 1 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% % or responses 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 Discussion and Analysis 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 19

20 required standards. Professional standards for Hospital Pharmacy Services produced by the Royal Pharmaceutical Society G 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. 20

21 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: Age profile of role holders Role 6 Role 5 Role 4 Role 3 Role 2 Role 1 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% % of responses < 25 yr yr > 50 yr 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 2 Age profile of role holders Discussion and Analysis 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 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. 21

22 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. Free text quotes 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 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 22

23 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: Anticipated difficulty in filling vacant roles Role 6 Role 5 Role 4 Role 3 Role 2 Role 1 0% 20% 40% 60% 80% 100% % of responses very easy fairly easy quite difficult very difficult 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 3 anticipated difficulty in filling vacant roles Discussion and Analysis 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. 23

24 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. Free text quotes 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 procurement are perceived and identify the barriers which prevent people becoming 24

25 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 Role 6 Role 5 Role 4 Role 3 Role 2 Role 1 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% % of responses same change 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 4 dealing with vacancies Discussion and Analysis 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 pharmacists (See Chart 5a below). This implies that some Chief Pharmacists have pro- 25

26 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. Free text quotes 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: 26

27 Staff type in each role Role 6 Role 5 Role 4 Role 3 Role 2 Role 1 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% % of responses Pharmacist Technician A&C Other 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 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: 27

28 AfC Band for each role Role 6 Role 5 Role 4 Role 3 Role 2 Role 1 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% % of responses Band 5 Band 6 Band 7 Band 8a Band 8b Band 8c Band 8d Band 9 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 5b staff grade in each role Discussion and Analysis 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: Details of person performing role already provided 9 respondents 28

29 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 pharmacist. 29

30 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: Length of time in role Role 6 Role 5 Role 4 Role 3 Role 2 Role 1 0% 20% 40% 60% 80% 100% % of responses < 1yr 1-5 yr > 5yr 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 6a Length of time in role 30

31 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 Role 6 Role 5 Role 4 Role 3 Role 2 Role 1 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% % of responses Novice Partly Trained Fully trained Expert 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 6b Levels of competence amongst role holders Discussion and Analysis 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 report H. 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 most staff are deemed to be either expert or fully trained (average of 79% for all posts). 31

32 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 Framework J, 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 Foundation Advanced Level 1 Advanced Level 2 Mastery PDIG questionnaire drop-down menu options Novice (requires training) Partly competent (requires some supervision) Fully competent (requires no supervision) 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 Ensures stock is managed 32

33 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 postregistration 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 reorganisation. 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. Free text quotes 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. 33

34 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 Role 6 Role 5 Role 4 Role 3 Role 2 Role 1 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% % of responses full time part time 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 7 extent of part-time working 34

35 Discussion and Analysis 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. Free text quotes 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: 35

36 Bigger organisations (more than 100 wte) had a greater proportion of post holders classed as expert Most regions have approximately 25% of experts, except Northern Ireland which has 75% Organisations with a medicines budget of over 75m rated all posts as crucial or highly important (with the exception of Post 3) and responders are less pessimistic about the difficulty in replacing post holders There is above average use of pharmacists in the medicines procurement process in Northern Ireland There is above average use of technicians in the medicines procurement process in two English regions (Midlands/East of England, and South of England) Scotland has the greatest number of medicines procurement staff approaching retirement with over half above 50 years old Most difficulty in replacing post holders is anticipated in Northern Ireland (73%), London (73%) and Wales (71%) More details of the further analysis carried out are given in Appendix Free text comments from questionnaires 66 respondents out of a total of 116 (57%) took the opportunity to submit free text comments on succession planning. The comments received provide an invaluable insight to the realities faced by Chief Pharmacists, and by examining the free text comments in more detail, a number of themes have appeared, as follows: a) Of the respondents that provided information on succession planning, only 4 organisations (6%) confirmed they had formal succession plans in place for medicines procurement positions. A further 15 organisations (23%) had partially addressed succession planning. The vast majority of respondents (59%) had no plans in place with the remainder (12%) not stating their position clearly. It should be noted, however, that respondents were not asked a specific question in the questionnaire about whether they had succession plans in place. The findings are shown in the chart below: 36

37 r e s p o n s e s Organisations with succession plans % 0 Not stated None Partial Full Chart 8 organisations with succession plans Nowhere near enough thought given to succession planning. Far too busy firefighting the problems of today, this week, this month... No plans. Make it up as we go along! :-) Free text quotes b) A small number of respondents stated that high workload levels and inability to release staff from their current roles prevented the introduction of formal succession planning. Some respondents also noted the futility of succession planning due to staff movement and promotion: In our trust succession planning for procurement is very difficult due to recruitment controls and the Trusts difficult financial position means we are running the pharmacy with fewer pharmacists than is ideal. Therefore there is no opportunity to give junior pharmacists experience in procurement as they are all needed at ward level to ensure patient safety. We had no succession planning in place because the staff establishment has been trimmed as tightly as possible and simply does not allow succession planning for any of the senior roles. Very short-sighted in my opinion but the finances simply don't stack up in the short term. Free text quotes 37

38 c) Many respondents stated that they are currently restructuring (or have recently restructured) the procurement function. Whilst this may have been done proactively, in some cases this appears to be a common response to dealing with vacancies as they arise, with posts morphed to suit local needs. This accords with the finding of the questionnaire that approximately 20% of respondents would not replace a post that has become vacant on a like-for-like basis, and might be regarded positively as an alternative survival tactic to formal succession planning: Recently brought together into one post medicines procurement / commissioning / formulary and APC / medicines savings. Includes lead for Homecare, purchasing/invoicing and contract management etc. Separated out medicines stores and distribution including stock management, goods in, ward and clinic top ups etc managed by team that includes ward and dispensary based technical services. Created data analyst post crucial. We are in the process of restructuring. There will be further restructuring as other post holders retire e.g. Current 8c who covers section 1 activities. Free text quotes d) Some organisations had ring fenced the procurement function and created a procurement team that provided cover for absence and allowed junior staff members to develop the knowledge, skills and experience necessary for promotion into vacant positions: The procurement pharmacist post is managed by a Band 8b principal pharmacist and chief pharmacist. Working with the current procurement pharmacist the department is building up a systematic approach to procurement issues. In addition other pharmacists whose work impacts or is impacted by the procurement pharmacist (e.g. the formulary pharmacist and lead satellite pharmacist) are closely involved in the decisions the post holder makes. Should the procurement post become vacant, these posts (assisted by the Chief and Principal) would be supporting the procurement function until a successor appointed and trained 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) 38

39 who gives clinical advice and helps if required with any strategic or professional issues. Free text quotes e) Several respondents noted the apparent lack of appeal to younger staff members of a career in medicines procurement, noting their greater enthusiasm for clinical pharmacy roles: Incorporating the procurement function in training and development for junior grades to ensure there is exposure to the importance of this role in underpinning good patient care. For some reason I don t think this area is appealing to many and may not be sufficiently well valued by pharmacy staff. Free text quotes f) Although the questionnaire made no reference to regional support, many respondents acknowledge the important role provided by Regional Pharmacy Procurement Specialists in providing support and assistance for local pharmacy procurement staff: Having the regional procurement collaborative is essential to help us use an achievable investment to maximise savings and control. I would highly value continuation after the initial commitment. In terms of procurement we work closely with the regional hub which provides excellent support to augment the post holder. Free text quotes g) Whilst organisations can take steps to minimise the disruption caused by vacancies, a number of respondents felt that support at local, regional or national level was required to help ensure a good supply of suitably qualified staff for future for succession planning. The support suggested included the provision (or availability) of external training sessions and course for pharmacy procurement staff, provided by 39

40 for example, Regional Pharmacy Procurement Specialists, Pharmacy computer system suppliers etc. 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. I think procurement has not been "sexy" within pharmacy for too long and we will suffer the consequences of not developing accredited training programmes in the near future as our work force moves towards retirement. Incorporating the procurement function in training and development for junior grades to ensure there is exposure to the importance of this role in underpinning good patient care. Free text quotes h) There may be opportunities for neighbouring organisations to collaborate on medicines procurement functions, with some suggesting that centralisation or rationalisation of functions may be possible to reduce duplication: Currently looking at centralising/rationalising some procurement functions, which may impact on the people at an operational/strategic level. These functions are crucial but in some cases have meant that it is crucial that Pharmacy carries out the activity but this does not necessarily have to be onsite e.g. Could have some strategic advice given by Pharmacist / Expert technicians at regional type or sector wide roles, rather than necessarily have someone fulltime on site (depending on the size of the organisation). Free text quotes 40

41 5. Recommendations No Recommendation Rationale To be actioned by 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. Section 4.2 PDIG 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. 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. 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. Section 4.2 Section 4.2 Section 4.2 Section 4.2 Section 4.2 Section 4.3 PDIG GPhC RPPSs NHS England, NHS Scotland, NHS Wales, H&SC in Northern Ireland NHS England, NHS Scotland, NHS Wales, H&SC in Northern Ireland RPPSs / Chief Pharmacists 8 As a matter of urgency, the Regional Pharmacy Section RPPSs / Chief 41

42 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 interest in medicines procurement, and consider re-employing recent retirees on a part time basis to act in a similar capacity. 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 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. 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). 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 wait for vacancies to arise 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. 4.3 Pharmacists Section 4.3 Section 4.3 Section 4.4 Section 4.4 Section 4.4 Section 4.5 Section 4.6 Chief Pharmacists / RPPSs Chief Pharmacists Chief Pharmacists Chief Pharmacists Chief Pharmacists Chief Pharmacists Chief Pharmacists 42

43 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. 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. 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 and collaborate to develop a standard syllabus for a national training course to cover the more advanced training requirements of medicines procurement specialists. 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. Section 4.6 Section 4.6 Section 4.7 Section 4.7 Section 4.7 Section 4.7 Section 4.7 Section 4.8 Chief Pharmacists / RPPSs PDIG Chief Pharmacists PDIG / NPSG RPS / APTUK Chief Pharmacists RPPSs / postregistration training providers Chief Pharmacists 43

44 6. Acknowledgements We wish to express our gratitude to all the people with whom we met or spoke for giving their time and for their open responses to our questions, including: PDIG committee and the Succession Planning PDIG Sub-committee UK wide Regional Pharmacy Procurement Specialists Chief Pharmacists that helped with drafting questionnaires Chief Pharmacists that responded to the questionnaires Gail Fleming (Health Education Kent, Surrey and Sussex) Hannah Wilton (RPS Faculty Development Lead) Finally we wish to thank GHP PDIG for commissioning this piece of work. 44

45 7. Glossary Term A&C APF APTUK ATO CCG CIPS CMU CSU DGH DTC EP epma FPF FT GHP GPhC H&SC IT KPI MI NICE NPSG OPD PAS PbR PDIG PMSG QA QIPP RPPS(s) RPS SLA TAG wte Meaning Administration and Clerical Advanced Pharmacy Framework Association of Pharmacy Technicians, UK Assistant Technical Officer Clinical Commissioning Group Chartered Institute of Purchasing and Supply Commercial Medicines Unit, part of Department of Health Commissioning Support Unit District General Hospital Drugs and Therapeutics Committee Electronic Prescribing electronic Prescribing and Medicines Administration System Foundation Pharmacy Framework Foundation Trust Guild of Healthcare Pharmacists General Pharmaceutical Council Health & Social Care Information Technology Key Performance Indicators Medicines Information (Specialist Pharmacy Service) National Institute for Health and Care Excellence National Pharmaceutical Supply Group Outpatients Department Patient Administration System Payment by Results Procurement and Distribution Interest Group (Part of GHP) Pharmaceutical Market Support Group Quality Assurance (part of Specialist Pharmacy Service) Quality, Innovation, Productivity and Prevention programme Regional Pharmacy Procurement Specialist(s) Royal Pharmaceutical Society Service Level Agreement Technology Assessment Group (part of NICE) Whole Time Equivalent 45

46 Appendix 1 Free Text Comments from Questionnaires The on-line questionnaire 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. Respondents were invited to write none if no succession planning is currently in place and given the opportunity to provide any comments that may be needed to clarify any responses given. Comments below have been grouped to give a flavour of the nature of the responses received. 1. Positive Responses Is Succession Planning In Place / Underway? Ideas and Opportunities (i) Strategic Views (ii) Succession Planning in Hand / No Current Need (iii) Staff Rotation (iv) Consolidation (v) Outsourcing 2. No Succession Planning In Place / Underway Problems and Difficulties (i) Organisational Problems/Failure (ii) Have They Given Up? (iii) Succession Planning / Medicines Procurement Undervalued? (iv) Changing Roles 3. All Hospitals are Different - Everybody Manages Somehow! What Lessons can be Learned? 4. Comments on Regional Procurement Services 1. Positive Responses Is Succession Planning In Place / Underway? Ideas and Opportunities (i) Strategic Views - There should be senior pharmacist oversight of strategic procurement functions, decision making relating to managed entry of new medicines including clinical trials, risk and economic assessment and assurance of compliance with national mandates such as NICE TAGs. Technicians can play an important role in operational leadership of procurement functions and support formulary management. There is a need for 'formulary and DTC Pharmacist' roles to have an understanding of contracting and tendering to spread expertise. Medicines Information services are well place to support the management of shortages and recalls which further spreads procurement expertise. Chief Pharmacists are accountable for homecare services and can delegate specific authority to designated pharmacist and technician staff to ensure compliance with national governance and procurement standards. - The procurement pharmacist post is managed by a Band 8b principal pharmacist and chief pharmacist. Working with the current procurement pharmacist the department is 46

47 building up a systematic approach to procurement issues. In addition other pharmacists whose work impacts or is impacted by the procurement pharmacist (e.g. the formulary pharmacist and lead satellite pharmacist) are closely involved in the decisions the post holder makes. Should the procurement post become vacant, these posts (assisted by the Chief and Principal) would be supporting the procurement function until a successor appointed and trained. - Further and improved training and support on pharmacy systems in-house and through SLA with systems owner should occur e.g. JAC offer a one-day course in systems management/report writing but due to the complexities of the system it is not particularly helpful - further support should be offered at reasonable cost (often can be expensive!) to the Trusts using the system. - Incorporating the procurement function in training and development for junior grades to ensure there is exposure to the importance of this role in underpinning good patient care. Focus for more Clinical roles in the recent past tends to undermine the importance of maintaining pharmaceutical expertise applied to procurement. Technician roles in this area are key to maintaining Pharmacy professional oversight of this function. We need a united national approach to maintaining pharmaceutical professional expertise in this area. - 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. - 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. - 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) would gives clinical advice and helps if required with any strategic or professional issues. - For 8a Team Leader for stores and distribution we have tried a number of staff in a deputy role - none have been up to the mark. On third attempt but would probably restructure if my 8A left as again current deputy would not be able to fulfil the range of activities. Starting technician and band 7 rotations into medicines management which includes formulary homecare purchasing decisions etc. (ii) Succession Planning in Hand / No Current Need - Band 5 Technician been identified as the successor to the senior technician and is being trained up to take on this role. - We now have employed a band 7 pharmacist to work with the band 8c to address some of the succession planning issues but need to get this up to an 8a over the next few years. - No succession plans as yet as staff have a good few years to go. 47

48 - There is succession planning for technician procurement operational, although CIPS training would be required. - We are in the process of restructuring. There will be further restructuring as other post holders retire e.g. Current 8c who covers section 1 activities. - We do have band 6 techs in place so that they can cover the band 7s (procurement lead and IT/EP lead) on a daily basis. They do need further development if it is specifically intended that they are appointed to future vacant roles. - Procurement Lead Technician and Pharmacy IT systems manager and Data Analyst both recently appointed. Young team and they are still finding their feet. Thus, succession planning has taken a back seat to getting the current team up and running. - Consultation in place and will create band 7 for role succession. - Our Band 7 purchasing manager is currently mentoring a Band 4 technician for the purpose of succession planning. - We are trying to train a pool of technicians who can undertake the purchasing function. - I see homecare being technician led with pharmacist input as required. In terms of succession planning the current model works well and I have no plans to change this going forward. - My succession plan is like for like replacement and focusing the pharmacy technicians on the procurement aspects developing them along the CIPS route. - Currently under consideration as all key staff members > 50 yrs age. - 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. - We have just had approval for a high cost drugs pharmacist which will be the procurement succession plan hopefully, however, procurement is now wider than it was and is becoming an increased requirement to be business support, so this is part of our discussions now on how we plan ahead. In terms of formulary we are working this into our governance structures in order to provide training but this remains a difficult role to replace alongside procurement due to the experience of the individuals involved. Procurement manages homecare at the moment and formulary manager is a separate role. - A workforce planning exercise is underway and scheduled for completion in October. - Following the retirement of a Principal Pharmacist (8b) in 2011the team was restructured and functions well. (iii) Staff Rotation - If the merger was not happening, the succession plan would need to be different - exposing all rotational staff to procurement and distribution functions (including homecare) is important to allow individuals opportunity to appreciate all aspects of the department functions, so that as posts become vacant there is a broad understanding (if not full experience) of work in the procurement section. - We have clear succession planning in place for technical functions including an effective and supportive deputy structure. We are looking to introduce 6 month rotations for 48

49 our senior pharmacy technician workforce so that they can gain the experience and expertise. - Procurement should form part of technician/ato/pharmacist rotations. (iv) Consolidation - As the Trust is about to undergo an 'acquisition' by a Trust in a different regional purchasing group there is potential opportunity for centralising the purchasing and distribution functions across the two sites, and to review the staffing needed for all aspects described in the questionnaire. All functions are considered crucial elements of a hospital pharmacy service, but there is scope for consolidation of some posts. - Lots of duplication across Trusts. Needs to be greater collaboration. - Better regional 'sharing' of skills, maybe shared posts (??) could be investigated. - Recently brought together into one post medicines procurement / commissioning / formulary and APC / medicines savings. Includes lead for Homecare, purchasing/invoicing and contract management etc. Separated out medicines stores and distribution including stock mgt. goods in, ward and clinic top ups etc - managed by team that includes ward and dispensary based technical services. Created data analyst post crucial. - Significant overlap between procurement, Pharmacy IT, homecare, contract management roles so developing team of staff focussed on business aspects. - Currently looking at centralising/rationalising some procurement functions, which may impact on the people at an operational/strategic level. - Undergone a significant amount of service and skill mix review over past months with impending retirements of 2 key post holders so already have done quite a lot of succession planning. Next stage would be to consider benefits of shared services/functions with neighbouring trusts especially in hard to recruit areas. (v) Outsourcing - These functions crucial but in some cases have meant that it is crucial that Pharmacy carries out the activity but this does not necessarily have to be onsite e.g. Could have some strategic advice given by Pharmacist / Expert technicians at regional type or sector wide roles, rather than necessarily have someone fulltime on site (depending on the size of the organisation). - Drug expenditure reports are produced by the business intelligence staff within the organisation. We do not directly employ them. - We are a small community trust pharmacy establishment (1.8wte). We have a SLA with local acute trusts and community pharmacy for procurement. Governance formulary etc. managed in house, sometimes in conjunction with the wider health economy. - Procurement of medicines contracted out to Lloydspharmacy. Trust IT services support production of reports for medicines usage information. 49

50 2. No Succession Planning In Place / Underway Problems and Difficulties (i) Organisational Problems/Failure - My department is a small DGH/Community FT which has not had a Chief Pharmacist for 12 years. As a result coming into post there was a B5 technician running procurement with virtually no professional input, so as I had done this role in previous posts I have picked that function up along with the management of influences on the range of medicines stocked. My Head of Clinical Pharmacy picks up the formulary role. The IT support is only newly established so the post holder is still finding her feet. - 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 but as some of the post holders have been through one re-organisation recently I am holding off at present! There are no plan as such just ideas in mine and others minds... - Trust in process of transformation so plans will be redrawn. No immediate successors lined up for any post except homecare technician. - 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. I think procurement has not been "sexy" within pharmacy for too long and we will suffer the consequences of not developing accredited training programmes in the near future as our work force moves towards retirement. - In our trust succession planning for procurement is very difficult due to recruitment controls and the Trusts difficult financial position we are running the pharmacy with fewer pharmacists than is ideal. Therefore there is no opportunity to give junior pharmacists experience in procurement as they are all needed at ward level to ensure patient safety. - None - most of the roles described above are bit parts of a larger job. We are a relatively small department that has been restricted in development over several years and do not have the luxury of being able to develop potential successors. - There is no succession planning in place all efforts at the moment are towards restructuring to deliver a fit for purpose structure to properly resource the posts necessary for procurement. - We had no succession planning in place because the staff establishment has been trimmed as tight as possible and simply does not allow succession planning for any of the senior roles. Very short-sighted in my opinion but the finances simply don't stack up in the short term. - No capacity in current structure of a small DGH to have a succession plan. (ii) Have They Given Up? - No planning as such. - No plans. Make it up as we go along! :-) - Nowhere near enough thought given to succession planning. Far too busy firefighting the problems of today, this week, this month... - None for this crucial role. 50

51 (iii) Succession Planning / Medicines Procurement Undervalued? - For some reason I don t think this area is appealing to many and may not be sufficiently well valued by pharmacy staff. - It is extremely difficult to get younger pharmacists interested in procurement issues and it often falls to the Chief Pharmacist. - Succession planning in procurement and prescribing support is challenging. - Succession planning is only just starting to get the 'air time' it needs. (iv) Changing Roles - We have been trying to recruit a junior technician to support the band 6 tech in stores/procurement for the last 9 months with no success. Now reviewing position and considering opening up the position to a general procurement person. Formulary pharmacist has to date been supported by formulary technician and struggling to recruit to the technician position. The formulary technician would support the implementation of changes in contracts etc so maximising contract changes etc. A lot of the responsibilities listed above have morphed over the years into different posts depending on people s expertise and interests as well as the demands of the overall pharmacy service. - Main concern is around replacing the person as in Question 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. - Our most difficult role to fill in this area is the trust technical procurement lead. We have had for people on post in the past 6 years. The first three were pharmacists and did a pretty poor job and left. We then decided to allow technicians to apply and our latest post holder is a technician and she has been excellent. - Technician lead currently in post expected to retire in coming years. Training other technicians on some elements but unclear if staff will be around at retirement as good technicians shortage and move onto higher bands. - I have no succession plans in place - Chief pharmacist has been in post for 4 weeks. 3. All Hospitals are Different - Everybody Manages Somehow! What Lessons can be Learned? - We have a lead pharmacist and lead technician managing most of the services in this questionnaire therefore I am not sure it gives you the level of granularity you need. - Our Procurement team in one band 8c procurement/it pharmacist (assistant director of pharmacy), one band 5 pharmacy technician and part time of the Director of Pharmacy's post (band 8d). - Difficult to respond directly to these questions as many of the functions are shared across teams. Clinical Pharmacists work in cost efficiency groups to influence procurement practice. Strategic Direction of Procurement activities is a key responsibility for the Director of Pharmacy. Operational responsibility and responsibility for Homecare Services is the same person. One of our senior clinical pharmacists who has a procurement interest co-ordinates the activity of colleague 51

52 clinical pharmacists and provides procurement leadership as a sessional responsibility. We have a team of data analysts working across primary and secondary care whose function is to extract data and prepare reports for clinical analysis by clinical pharmacists who are integrated in to clinical teams and management structures and they can use these reports to provide professional advice to their team. - I am the Principal Pharmacist, Patient Services and Procurement. As such I have to juggle these two roles and on any given day priorities will change but my aim is to cover both aspects 50/50. There is also a Band 6 procurement technician who predominately deals with stock management functions but is responsible for running reports which I then analyse. - I do not necessarily have one member of staff for each of the above roles. One person may undertake more than one role. - Our Homecare services are overseen by the lead technician for procurement but the JAC programme and daily management is actually the responsibility of a Band 3 ATO/clerical support - solely employed for Homecare. - This is a difficult questionnaire to answer for a small mental health and community services trust as it is based on acute trust requirements. Three pharmacy staff (chief pharmacist, pharmacist team manager and technician team manager) undertake some of these roles on an ongoing basis, we do not have the resources or need for people in specific posts. We do, however, make full use of the regional procurement specialist as we do not have the expertise within the organisation. - Some of the functions listed above do not sit with one person, responsibilities spread between professions and posts. - Question 5 is not a specific individual but a role undertaken by Team leaders /directorate leads. - The person referred to in sections 2 and 3 are the same person all part of her responsibilities, the same applies to sections 5 and 6 i.e. same person. - Many roles identified above are shared over several individuals at that grade, thus we have widespread coverage of issues. - Many of the functions are supervised by the Chief Pharmacist although specialist clinical pharmacists are also involved. - For Q5 - the Chief Pharmacist, Procurement Pharmacist and D+T Pharmacist each have an input to the different aspects of this function. - Some of the above roles cannot be attributed to a single role e.g. drug usage- my procurement tech knows about tender outcomes, my formulary pharmacist about NICE appraisals. - The roles described in section 1, section 4, section 5 and section 6 are performed by one person who is a full-time employee but shares their time amongst these roles as well as overseeing medicines information, the high cost drugs pharmacist, the medication safety pharmacist and the epma team. The current post-holder is described above but is leaving the trust. We have appointed an internal candidate who would be described as a novice in these roles. We advertised externally and were very disappointed in the number and overall quality of the applicants for such a high banded role. Although happy with the potential of the internal candidate he/she did not have any significant competition for the job which leads me to conclude that filling these roles is quite to very difficult. 52

53 - There is one band 8c pharmacist who oversees all the activities listed above, 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 individuals wider role as clinical lead pharmacist. - 8b role takes on majority of the pharmacist roles identified above. - So, to summarise, the following people are involved in all of the functions listed above: Chief Pharmacist (8d), Clinical effectiveness Pharmacist (8b), Purchasing technician (MTO 7) and homecare technician (MTO5). - I take a very keen interest in the purchasing side and the homecare as Chief Pharmacist. 4. Comments on Regional Procurement Services - This region has suffered in recent years with the absence of a regional procurement strategic lead (although guidance was actually provided it was not a recognised role). We have now managed to secure funding for this and have a person in post guiding the region, with the remit of developing training for procurement pharmacists/pharmacy technician and succession planning. Locally we do not have a procurement pharmacist lead leaving procurement to be a functional role rather than one which feeds and supports an informed clinical agenda. If this is to remain a technical role we need to develop technicians with different personal skill sets. - Having the regional procurement collaborative is essential to help us use an achievable investment to maximise savings and control. I would highly value continuation after the initial commitment. - We do not undertake other procurement functions locally; these are done on a regional basis. - In terms of procurement we work closely with the regional hub which provides excellent support to augment the post holder. - We have had a collective loss of procurement knowledge/expertise from the region in recent years and have only just started to do something about it e.g. formally appoint a regional procurement pharmacist. - In addition we work with the regional procurement team who provide much of the strategic expertise working with Directors of Pharmacy. - Small mental health and community services trust.we do, however, make full use of the regional procurement specialist as we do not have the expertise within the organisation. - We mainly purchase rather than undertake procurement decisions, which are mainly carried out by regional procurement services. 53

54 Appendix 2 Introductory letter from Dennis Lauder/Allan Karr Dear Chief Pharmacist 19 May 2014 Re: Medicines Procurement Services Succession Planning Project - to review how medicines procurement services are currently managed by NHS hospitals and to consider the potential strategic implications with regards to expertise required to fulfil these roles in future 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. NHS hospitals should ensure the availability of cost effective, quality assured medicines that meet individual patient needs in appropriate settings when required. In addition, new types of 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. Currently, over 5bn per annum is spent on medicines in secondary care. It is vital that timely purchasing decisions are made together with clinical commitment to change practice as necessary. We must also ensure that best prices are paid and pressure is maintained on suppliers to reduce costs wherever possible. The Guild of Healthcare Pharmacists, Procurement and Distribution Interest Group (GHP PDIG) have commissioned an independent review of the management and staffing arrangements for current medicines procurement services in NHS hospitals. This review has arisen out of discussions within the National Pharmaceutical Supplies Group (NPSG) and as such has their support together with wider support from NHS medicines procurement groups. We are pleased to inform you that David Tutcher (former hospital chief pharmacist and project lead for the CMU funded Promoting Excellence in Hospital Medicine Procurement project) together with Martin Anderson (former hospital chief pharmacist and ABPI Director 54

55 of NHS Policy and Partnerships) have been commissioned to undertake this review. Over the next few weeks they will be sending you an on-line questionnaire which we would like you to complete and return to them. They also intend to conduct a small number of face to face or telephone interviews so they may be contacting you to arrange a suitable time to telephone or visit to seek evidence to further inform their report. We hope that this report will be valuable to you and would encourage you or the most appropriate member of your team to actively take part. Please note that any data gathered and information provided will be anonymised in the report and remain confidential unless your explicit authorisation for disclosure is given. It is intended that the report will be submitted to the GHP PDIG committee and then PMSG/NPSG for consideration in September and that a presentation of the findings will be provided to the biannual PDIG conference on November 6 th in Birmingham. Should you wish to discuss this matter please feel free to contact us by or telephone as below. We look forward to your participation in this review. Yours faithfully Allan Karr Chairman, PDIG Business Distribution Centre Hospitals Foundations Trust Dennis Lauder Chairman, PMSG and PDIG Pharmacy and Committee and Chief Pharmacist UCL Heatherwood and Wexham Park Hospitals, NHS Foundation Trust 55

56 Appendix 3 Project proposal Project Proposal NPSG - Succession Planning for Medicines Procurement Services and Medicines Assurance Final Draft for Discussion Background For many years, the hospital pharmacy medicines assurance functions, procurement and QA services have perhaps been undervalued. As a consequence many hospital pharmacists themselves, partly due to the surge in interest in clinical pharmacy may fail to understand the complexity and criticality of the roles. Although this paper sets out a proposal for beginning the succession planning process for the medicines procurement services, the pharmacy QA service plays an essential role in medicines procurement, and this service has similar medium to long term problems in ensuring a supply of suitably trained and competent people to provide the service into the future. The project could perhaps be expanded to take into account the procurement (and / or wider) aspects of QA services, with input from QA specialists, should this be so desired. Why do we need to consider succession planning? The changing NHS has created significant dynamics in the hospital pharmacy service and its changing workforce needs. One service in particular, the medicines assurance procurement service, will need to ensure that sufficient staff with the required skills and experience are available if they are to continue meet the need to provide the most cost-effective medicines in the most efficient way. Currently, approx 4bn per annum is spent on medicines in secondary care, hence it is vital that timely purchasing decisions are made, with clinical commitment to change practice as necessary, to ensure that best prices are paid, and 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. Also, new types of contracts are being developed to manage services such as third party OPD services, homecare services and cytotoxic dose banding which will require expert management. It is therefore critical that there is support for the right medicines procurement service for a modern NHS, especially when it has to deliver the best value for the patients and the organisation that it serves. There is an existing network of senior pharmacists that, over many years, have developed the medicines assurance procurement role into a strategically important one, working across and outside the pharmacy department, and providing important insight and advice in improving patient safety. Examples of how this is achieved include managing shortages and also improving efficiency (via QIPP) by lowering acquisition costs e.g. by working collaboratively with other Trusts (and at regional and national levels as appropriate) to 56

57 negotiate lower prices from suppliers. We propose to adopt the phrase medicines assurance procurement service to capture the essence of these roles. Medicines Assurance Role Procurement Services Patients should expect that NHS Trusts 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 medicines assurance role is one that supports directorate level clinical pharmacists in the cost effective supply and management of medicines and ensures that pharmacy support staff are able to respond appropriately. Effective Trust should ensure the availability of cost effective, quality assured medicines that meet individual patient needs in appropriate settings when required. The service needs to be delivered by senior professional procurement staff that have expert knowledge of medicines, pharmacy services and the required systems and processes. These individuals need sufficient experience, skills and knowledge to liaise and influence: i) NHS Trust chief pharmacists j) commissioners k) directorate/formulary pharmacists/clinical leads l) pharmacy procurement and distribution personnel, technical service personnel m) regional pharmacy procurement specialists n) all types of suppliers o) financial services It is envisaged that all Trusts will carry out these roles in a variety of ways; some will have specific dedicated senior pharmacy staff doing all /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 experienced staff, and that individuals communicate effectively across and within departments. The future of this strategically important medicines assurance procurement function is under threat due to many of the existing regional staff in these roles are approaching retirement There does not appear to great interest from junior staff in succeeding them. Commissioners (and hospital managers) may 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, or indeed, not at all. Also, the recent demands in the NHS have seen many workforce changes including a downgrading and reduction of posts. Effective procurement and supply chain management may be at risk unless there is an active management approach to ensuring sufficient 57

58 expertise is available at local, regional and national level. For example, it is recognised that currently there is a strong network of regional procurement specialists but the concern is where these people will come from in future once they retire or change careers. A succession planning process will need to be implemented. In many Trusts the important procurement and distribution role is carried out to a high standard by technical, administrative and clerical staff, however, this role does not incorporate the wider strategic medicines assurance roles that senior pharmacists embrace. The Succession Planning Process Ultimately, the effectiveness of a succession planning process will be dependent upon the perceived attractiveness of the particular role. Some of this will, of course, be determined by pay, but will also be influenced by other factors. Currently, many pharmacists and technicians are heavily influenced by the satisfaction of being directly involved with patients and associated clinical services in particular and are therefore able to attract staff in large numbers. However, medicines assurance roles (both procurement and QA services) deliver important patient (and organisational) benefits and will hopefully become more attractive to junior pharmacists, that is if they are sufficiently well recognised and promoted by the profession overall and also in particular by individual Trusts. What is the demand for procurement services? In order to begin to raise awareness at local level of these vital roles, we are proposing to develop a questionnaire aimed at Chief Pharmacists to ask them who, in their local organisations, are currently responsible for these important functions and to begin to tease out from them how they plan to maintain these services into the future. The questionnaires will be analysed and a report written, with recommendations, and made available to contributing Trusts and circulated to various groups e.g. NPSG and PMSG for future action. The report will benchmark current service provision against competency frameworks and identify gaps, both current and emerging. An action plan will then be developed to close these gaps and to try and develop processes or structures that will ensure that more new personnel are attracted to these important roles. 58

59 Recommendations: Creating a National Image: Despite the effectiveness of the national and regional procurement structures and individuals, medicines procurement does not appear to have a recognised national identity. In order for effective succession planning to be achieved the role of medicines procurement will need to be defined by national standards and recognised by national groups and professional bodies (RPS) and enhanced further through a proactive marketing plan that will involves a wide variety of communications tools. Marketing the role in a positive manner will ensure that more healthcare professionals will identify this critical part of the profession and will then endeavour to pursue a career in medicines assurance procurement services. The creation of a national image requires a greater understand of current views and expectations for key stakeholders which can be obtained from market research. The Project Outline A project team (one/two people) will be engaged to work which would take into account the background papers including: 1) CMU (David Tutcher/Elizabeth Arkell s) work 2) Review of sample job descriptions 3) Draft a letter and questionnaire to Trust Chief Pharmacists, setting out; (i) the aims and objectives of the survey (ii) ask them to rate how important they see each of these procurement functions (iii) identify who, within their own organisation, is responsible for delivering these functions. 4) Draft a similar questionnaire to PMSG members and send out with a covering letter. 5) Analyse the survey results and write an independent report for distribution to participating Trust Chief Pharmacists (and the PMSG/PMSG/PDIG committees), so that they are better informed and able to audit and benchmark their own organisations so as to ensure that the required roles are carried out (by suitable trained and qualified staff). The report should also be written in a suitable style and made available to clinical pharmacy leads and other pharmacy staff so as to encourage them to consider developing their careers into these roles. Phase 1: To identify the core competencies and any technical competency required for medicines assurance procurement services and determine current supply and anticipated future demand at a local Trust level. The aim is to build on the CMU funded (David Tutcher/Elizabeth Arkell s) work, which has explored success factors for regional purchasing groups to ensure that in future NHS Trusts 59

60 are able to continue to deliver the strategically important Medicines Assurance roles through linking into their regional specialist procurement pharmacist. Phase 2: To be determined by the outcomes of Phase 1, but it is hoped that recommendations will be actioned with the support of PMSG and NPSG members. This could include a promotional action plan informed by the outcomes of the survey, which will show the gaps in current (and potentially) future service provision. Martin Anderson/Margaret Dolan/Dennis Lauder/Allan Karr 12 September

61 Appendix 4 Terms of Reference 4.1 Review approach A project proposal had initially been developed (Appendix 3) by the PDIG succession planning steering group (Dennis Lauder, Margaret Dolan, Danny Palmer, Jarred Livesey and Martin Anderson). The proposal envisaged a two phase approach with phase one being to identify the core competencies and any technical competency required for medicines procurement services and determine current supply and anticipated future demand at a local Trust level. Phase 2 will be determined by the outcomes of Phase 1, but it is hoped that recommendations will be actioned with the support of PMSG, NPSG, RPS and other relevant organisations. The aim was to build on the CMU funded Promoting Excellence in Hospital Medicine Procurement project, (section 3.2) which had explored success factors for regional purchasing groups to ensure that in future NHS Trusts in England are able to continue to deliver the strategically important Medicines Assurance roles through linking into their regional specialist procurement pharmacist. The brief was therefore to begin to raise awareness across the UK at a local level of the vital medicines procurement roles, by developing a questionnaire aimed at Chief Pharmacists asking them who, in their local organisations, are currently responsible for these important functions and to begin to tease out from them how they plan to maintain these services into the future. The questionnaires will be analysed and a report written, with recommendations, and made available to contributing NHS hospitals and circulated to various groups e.g. NPSG and PMSG and identify gaps, both current and emerging. An action plan will then be developed to close these gaps and to try and develop processes or structures that will ensure that more new personnel are attracted into these important roles. A project team (Martin Anderson and David Tutcher) was subsequently appointed and asked to: (i) Review and take into account the CMU funded Promoting Excellence in Hospital Medicine Procurement project (ii) Review a sample of current medicine procurement job descriptions (iii) Develop a questionnaire for Chief Pharmacists asking them to rate how important they see each of these procurement functions and identify who, within their own organisations, is responsible for delivering them 61

62 (iv) Draft a letter to hospital Chief Pharmacists, setting out the aims and objectives of the project (v) Analyse the questionnaire results and write an independent report for the PDIG committee for onward distribution to the NPSG and PMSG committees. Copies will be made available to participating NHS hospital Chief Pharmacists so that they are better informed and able to audit and benchmark their own organisations to ensure that the required roles are carried out by suitably trained and qualified staff. The report should also be written in a suitable style and hopefully made available to clinical pharmacy leads and other pharmacy staff so as to encourage them to consider developing their careers in these roles. The PDIG succession planning steering group confirmed the outline proposal at a meeting held on 11 March The report The report has been written by Martin Anderson and David Tutcher who have been commissioned by PDIG to undertake this review. The content of the report will be both factual and, based on findings, interpretational at the author s discretion. It will include conclusions and may include recommendations for further work. A presentation based on the report will be made to the PDIG Symposium in November

63 Appendix 5 Methodology 5.1 Letter of introduction A letter from Dennis Lauder and Allan Karr (see Appendix 2), was sent to all Chief Pharmacists to introduce the project and the project leads. It explained that the Guild of Healthcare Pharmacists, Procurement and Distribution Interest Group (GHP PDIG) had commissioned an independent review of the management and staffing arrangements for current medicines procurement services in NHS hospitals. The review had arisen out of discussions within the National Pharmaceutical Supplies Group (NPSG) and as such has their support together with wider support from NHS medicines procurement groups. It confirmed that David Tutcher (former hospital chief pharmacist and project lead for the CMU funded Promoting Excellence in Hospital Medicines Procurement project) together with Martin Anderson (former hospital chief pharmacist and ABPI Director of NHS Policy and Partnerships) had been commissioned to undertake the review. 5.2 Questionnaire design A questionnaire was developed on the basis of an understanding of current hospital medicines procurement processes (see Diagram 2). The questionnaire was directed at Chief Pharmacists in NHS hospitals. The focus of the questions was on advanced procurement functions (as distinct from stock management functions ) as post holders in these roles are most likely to go on to follow a career in medicines procurement and ultimately aspire to hold senior procurement positions at regional and national level. The questionnaire contained brief descriptive notes for each of the above roles to assist Chief Pharmacists identify the most appropriate individual post holders in their organisations for consistency of response. Following a number of pilots, the final version of the questionnaire is attached at Appendix 7. The first four questions in the questionnaire sought information about the organisation in which the responder worked. This was to enable analysis of responses by sub-sample and included questions covering organisation type, medicines budget, pharmacy department staffing levels and geographical situation. A number of questions were then asked about each of the roles above as follows; The Importance attached to each role to obtain the views of Chief Pharmacists on the significance of each role in providing the hospital pharmacy service The type and grade of post holders performing each of the roles in order to establish a nation-wide skill mix picture 63

64 The time in post and level of competency of current post holders in order to obtain an indication of levels of experience, staff turnover and levels of expertise amongst current post holders. This information will also provide a direct mapping to the RPS Competency Framework Levels The age of the current workforce in order to derive an estimate of the levels of maturity amongst current post holders, and in particular to see whether preparations need to be made for retirement of senior post holders The nature of working arrangements to ascertain the extent to which part-time working needs to be accommodated in succession planning The plans to deal with vacancies to see whether there are pre-mediated intentions to take the opportunity to make changes when the post is refilled The anticipated ease with which posts can be filled as clearly, where difficulties are anticipated, some form of succession planning should be given a high priority Finally, free text boxes were provided so that Chief Pharmacists could provide supporting information for their responses, and submit information on local succession planning arrangements should they wish to. One of the imperatives throughout the design process was that the questionnaire would be easy and quick for busy Chief Pharmacists to complete, so that response rates could be maximised. The on-line form was generated using Adobe FormsCentral Plus, which had simple to use editing tools. This allowed the questionnaire to be developed iteratively, and attractively and professionally presented to responders. The questionnaire went through a number of revisions following comments from the PDIG succession planning steering group and was tested on a number of Chief Pharmacists before release to make sure that terminology was easily understood etc. In June the UK wide hospital pharmacy Regional Pharmacy Procurement Specialists where then asked to forward an electronic link to an on-line questionnaire to all Chief Pharmacists, asking them to complete the questionnaires by 21 st July. Reminders were issued on 7 th July and 18 July and in order to gather even more responses the closing date was extended to 31 st July. A covering explained that the questionnaires would be anonymous and responders were asked to note that any data gathered and information provided will be anonymised in the report and remain confidential unless their explicit authorisation for disclosure is given. 64

65 Appendix 6 Further Analysis (i) Organisations with more than 100 wte in the pharmacy (a total of 47 responses) A greater proportion of post holders were classed as expert (average across all posts of 33% versus average of 25% in the full sample) Slightly fewer part-time workers (average across all posts of 42% versus average of 48% in the full sample) (ii) Organisations with a drugs budget of above 75m (11 responses) With the exception of Post 3, no posts are rated lower than crucial or highly important unlike the national average where 90% of respondents regarded all posts as crucial or highly important Skill mix is slightly different as there are noticeably fewer pharmacists in posts 1 and 5 compared to the national average Grades of post holders are generally higher less use of Bands 5 to 7, in favour of Bands 8a c; no involvement of Band 9 in the medicines procurement process Staff turnover is lower (fewer post holders have been in post for less than one year) A greater proportion of post holders are classed as expert (average across all posts of 50% versus average of 25% in the full sample) There are fewer post holders working on a part-time basis (average across all posts of only 25% versus average of 48% in the full sample) Organisational structure is more stable as more posts will be replaced on a like for like basis (average across all posts of 94% versus and average of 77% in the full sample) Responders are less pessimistic about the difficulty in replacing post holders (iii) Geographical differences Very little regional variation here all regions have similar views on importance of the posts ie 90 to 98% of respondents saying all posts are crucial or highly important 65

66 Above average use of pharmacists in Northern Ireland; above average use of technicians in England (Midlands and East), England (South) Maximum use of other in Northern Ireland appears to be the disproportionately high use of Band 8c posts across the procurement functions in Northern Ireland Most regions have approx 25% of experts except Northern Ireland which has 75% Northern Ireland has over 90% of post holders in posts for more than 5 years, and the fewest (0%) people in post for less than 1 year London has the fewest (42%) post holders in post for more than 5 years Scotland has the greatest number of procurement staff approaching retirement with over half above 50 years old Very few young people in any region reflecting the occupation of posts by older post holders and the seniority of the positions included in the questionnaire Wales has the lowest number of full time staff across the procurement function Highest number of full timers in Northern Ireland and Scotland Northern Ireland and London least likely to make changes when people leave 40% of responders in Wales will make changes when vacancies arise Most difficulty anticipated in Northern Ireland (73%), London (73%) and Wales (71%) choosing quite or very difficult across all roles Least difficulty in England (North) (49%) and Scotland (44%) scoring at very or fairly easy Appendix 7 The final version of the questionnaire 66

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