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Peter Sharott is director, London, Eastern & South
East Specialist Pharmacy Services and chairman of the Pharmaceutical
Market Support Group |
Pharmaceuticals cost the NHS in England
approximately £2.2bn per year |
SUMMARY
Procurement of pharmaceutical products in the NHS is often described
as the “jewel in the crown” compared with procurement of
other product groups. This is recognition of the long-standing partnership
between specialist procurement pharmacists, national and local pharmaceutical
procurement groups (PPGs) and the NHS Purchasing and Supply Agency (NHS
PASA), which has delivered cost-effective market management of generic
and branded medicines for many years.
In common with other health care
products and services, pharmaceutical contracting, purchasing and supply
are subject to increasing demands to reduce prices and produce efficiencies
in the supply chain. However, the procurement of pharmaceuticals also
has a number of unique characteristics which require a high level of
professional and clinical input. The overriding priority is to ensure
that medicines are always available to meet the clinical needs of patients.
Particular emphasis needs to be placed on critical medicines where no
acceptable clinical alternatives are available and, therefore, patients
may be put at risk if they do not receive them. The NHS aims to purchase
only medicines of the highest
quality, that are appropriately packaged and labelled and safe to handle
by health care staff and patients.
The contracting, procurement and supply of generic medicines is essentially
a technical and commercial process, which requires specialist pharmaceutical
input at a national level, but limited clinical involvement. On the other
hand, branded medicines generally fall within therapeutic groups where
clinicians decide which drugs should be available on trust formularies.
Opportunities to achieve therapeutic rationalisation have to be managed
at a local level through clinical engagement and consultation with trust
and area prescribing committees and clinical networks. In a wider context,
rationalisation and globalisation of the pharmaceutical industry and
the generic medicines manufacturers have increasingly led to major product
shortages, the consequences of which need to be managed effectively at
both a national and local level. Recent examples include shortages of
diamorphine injection caused by withdrawal of a manufacturer’s
licence, and intravenous human immunoglobulins, caused by insufficient
production capacity to meet increasing global demand.
Market management, achieving a balance between the pressures to achieve
cost savings and maintaining a continuous and reliable supply chain,
needs to be given the highest priority when proposing changes to the
current arrangements. Over the past few years, wide-ranging reviews and
changes to the NHS structures for contracting, procurement and supply
chain management for all commodities have posed challenges to the arrangements
for pharmaceuticals. This article describes how these changes impact
on pharmacy and the challenges that have been addressed.
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Hospital Pharmacist