Meetings

Hospital manfacturing — a collaborative approach

Risk assessment of hospital pharmacy manufacturing was discussed at the annual symposium of the Guild of Healthcare Pharmacists' compounding interest group. Olumide Cole reports

Hospital manufacturing will be more patient-focused

A change in culture will be necessary if a national strategic plan for hospital pharmacy manufacturing is to be successful. This was according to Dr Vic Standing, who is a member of the board responsible for implementing the recommendations of the advisory group on risk assessment of NHS manufacturing units. The board was set up by the Department of Health.

The board has the remit of developing a plan for restructuring NHS manufacturing into a national service (similar to medicines information) and overseeing its implementation. A timescale of two years is probably necessary to meet the stated objectives, according to Dr Standing.

One aspect of the culture change that is required is a move away from using trading accounts in monitoring the performance of manufacturing units. Dr Standing believes that the use of trading accounts, with its focus on financial viability, is not conducive to the process of risk assessment as it does not fit in with clinical governance and an evidence-based approach. He said that it was only to be expected that a unit would continue to provide services that will boost its accounting position. Capital allocation from the central government to the various units may be necessary to encourage change.

Agenda for implementation board

1. Explore scope for rationalisation of product ranges

2. Hospital manufacturing should reflect wider changes in the NHS, that is, re-engineering of hospital pharmaceutical services to become more patient-focused

3. Examine the feasibility of developing a secure website for NHS manufacturing units to share information on product and service availability

4. Have in place strong accounting principles to underpin the viability of pharmacy manufacturing units (is there a need for capital allocation from the central government?)

5. Consider new ways of providing patients with unlicensed medicines

Another essential change in culture is the need to share information. Dr Standing pointed out that "integration, not competition" is required. The board will consider the feasibility of developing a secure website for NHS pharmacy manufacturing units to share information on products and service availability. Currently, advertising specific products is contrary to Medicines Control Agency MAL Guidance Note 14.

It is possible that a more patient-focused approach to hospital manufacturing would be adopted, in line with the wider changes in the NHS relating to the re-engineering of hospital pharmacy services. This could lead to a rationalisation of the number of manufacturing sites.

Dr Standing believes that there is no contradiction between the rationalisation of services and the need to expand the workforce in technical services. This is because a more patient-focused approach would involve the re-use of existing capacity. For example, this could mean an increase in the level of certain services, such as centralised intravenous additive services and cytotoxic reconstitution.

There would still be the need for unlicensed medicines, although new ways of providing patients with such medicines should be explored, according to Dr Standing. He stressed that rationalisation is not being driven simply out of the desire to see a certain limited number of manufacturing units.

In line with the Department of Health publication "Building a safer NHS for patients", the board would prefer not to see any items being dispensed extemporaneously in hospitals. Rather, such items should be formulated into products that can be produced in licensed manufacturing units. This would be quite challenging as it is difficult to change prescribing habits.