Pharmaceutical Adviser Services

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A decision made (14.02.06) to approve a contract with InPAx for the provision of Pharmaceutical Advisory Services.

Subject:	Pharmaceutical Adviser Services- Contract Renewal
Decision Reference:	MD-S-2006-0019	Exempt clause(s):	Contract Exempt
Type of Report: (oral or written)	Written	Person Giving Report (if oral):	N/a
Telephone or e-mail Meeting?	N/a	Report File ref:	2/2/4/8 (1140) & (1141)
Written report – Title	Pharmaceutical Adviser Services- Contract Renewal
Written report – Author (name and job title)	Janice Waddell, Policy Principal
Decision(s): To approve a contract with InPAx for the provision of Pharmaceutical Advisory Services to encourage more efficient and effective management of medicines in the primary care sector.
Reason(s) for decision: The Department needs independent pharmaceutical advice both to fulfil the constitution of the Pharmaceutical Benefit Advisory Committee and to promote the cost-effective use of prescription medicines funded by the Health Fund. For the past 5 years Paul McManus has successfully provided this support. In response to the PWC report to increase support to local prescribers, Mr McManus has submitted a proposal for an extended and more inclusive service to meet the needs of the Department and to further reduce the cost of subsidising medicines to the general public by working directly with prescribers and pharmacists.
Action required: The Minister is asked to approve and sign the contract with InPAx for the provision of Pharmaceutical Advisory Services.
Signature: (Minister/ Assistant Minister)	Date of Decision:

Pharmaceutical Adviser Services - contract renewal

Pharmaceutical Adviser Services

1. SUMMARY

The Department needs independent pharmaceutical advice both to fulfil the constitution of the Pharmaceutical Benefit Advisory Committee and to promote the cost-effective use of prescription medicines funded by the Health Fund. For the past 5 years, this support has been successfully provided on a restricted basis by Paul McManus, an experienced adviser with links to the NHS and academic practice. In response to the recent PWC report on pharmaceutical services in Jersey, which recommends an increase in support to local prescribers, Mr McManus has submitted a proposal for an extended, and more inclusive service to meet the needs of the Department. This service will include local pharmacists meeting and working directly with local prescribers to promote quality and cost-effective prescribing while maintaining links with, and support from, a network of independent advisers in the NHS led by Mr McManus. As the responsible officer directed under Financial Direction 51 (Engagement and use of consultants, January 2006) I recommend this proposal to the Minister.

2. BACKGROUND

The Health Insurance (Jersey) Law 1967 requires the Social Security Deartment to include an independent adviser in the membership of the Pharmaceutical Benefit Advisory Committee (PBAC). For the past 5 years, this role has been fulfilled by Paul McManus, who has worked part-time to support local prescribers. With support from Mr McManus, the Department has managed an increase in the range of medicines available in primary care to local patients, while reducing expenditure in some high cost areas. For example, changes in the choice of drugs used to treat stomach acid-related conditions reduced annual expenditure by around £250,000 and the arrangements put in place continue to attract annual discount payments for the Department of around £70,000.

Around £11miilion is spent by the Department on prescriptions medicines dispensed in primary care in Jersey. Advice and support for local prescribers on the choice and appropriate use of these medicines is essential if the Department is to get good value for this money. In its report on pharmaceutical services in Jersey, PWC acknowledged the successes in this area but strongly recommended greater investment in medicines management services, now standard resources in the NHS, to meet increasing clinical and financial pressures of new medicines and disease management strategies. The Employment and Social Security Committee reviewed the full recommendations of the Review at its meeting on 22 July 2005. A paper produced by the Policy Principal (2/2/6/1 (1137)) noted the possibility of extending the pharmaceutical adviser services. The Committee was advised that it would be possible to recruit local pharmacists to undertake work on a sessional basis if supported by Mr McManus and agreed this route (it is noted that this is not recorded in the Committee minutes).

Over the past 5 years, Mr McManus has become a respected and trusted source of independent, expert advice and information for health professionals and the Department. In recent months, he has worked with the Department and local health professionals to develop a single island formulary, uniting prescribing decisions across primary and secondary health care services, and embarked on initiatives, including practice prescribing budgets and quality indicators, to increase financial and clinical accountability among GPs for their prescribing.

3. Responses to Financial Direction no. 51 (Engagement and use of consultants, January 2006)

A contract for consultancy services from InPAx, an independent prescribing advisory service led by Mr McManus, and the Social Security Department has been proposed.

Item 5.3

The specialist skills provided by InPAx are not available in-house and an independent opinion is essential for the Department to meet its obligations for financial governance, with regard to the Health Fund, as well as its statutory requirement as part of the Pharmaceutical Benefit Advisory Committee.

Item 5.4

The expense of hiring an external consultant is more than justified by the reductions in expenditure and improvement in quality achieved through their engagement with local prescribers. Based on the submitted proposal, the cost of contracting with InPAx will be less than 0.5% of the Department’s current expenditure on prescription medicines.

Item 5.15

In view of the current work being undertaken by Mr McManus, which requires credibility with all local stakeholders, it would be beneficial for him to continue this work with the additional support of his team of experienced NHS advisers and local support.

4. COST COMPARISON to In-HOUSE approach

To deliver the service in-house would require recruitment to a full-time position. The cost has assumed that a local candidate would have to undertake further study to attain a relevant clinical qualification to provide a quality pharmaceutical advice service. The minimum qualification would be Diploma level which is a two-year course. The MSc is a total of four years. The National Prescribing Centre (NPC) conference and workshops would be the minimum attendance required to ensure networking with other advisers and understanding of innovations and best practice.

Recruitment of pharmacist (Grade 12) including pension costs £60,320

Diploma/MSc Medicines management (£2000 p/a) £ 2,000

NPC conference & workshops 5 days @ £250 £ 1,250

Data Analysis ½ day/week for administrator (grade 6) £ 3,070

Travel and subsistence for courses etc £ 3,000

Dr Duerden’s workshops 4 £ 3,500

Total annual expenditure for 235 days (excluding holidays) £73,140

The contract with InPAx is for 133 days at a cost of £52, 580 (excluding holiday or sickness pay). It is marginally more expensive than recruiting in-house, however, the confidence of practitioners in the present service should not be under-estimated and to dispense with that and then recruit someone, potentially new to the Island, or without in-depth experience of the issues in community prescribing could jeopardise the Department’s standing and the work of the PACT User Group and the PBAC.

It is therefore, considered prudent to expand upon the existing service incrementally.

5. RECOMMENDATION

The Minister is asked to approve the contract with InPAx for the provision of Pharmaceutical Advisory Services.