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Pharmaceutical Services Negotiating Committee

Background information on PharmOutcomes

At the LPC Conference in November 2010, PSNC announced the development of a web-based platform to support community pharmacy contractors and their staff in the delivery of services and the management of payment claims, and commissioners in the management of community pharmacy services.

The platform, PharmOutcomes (formerly known as PharmaBase), was developed during 2010 following an initial trial of a proof of concept.


A bit of context and history...

Why was PharmOutcomes developed?

Community pharmacists recognise the need to demonstrate the value of the services they provide in order to prevent decommissioning and to support the development of new services. The previous Government clearly stated the importance of collating an evidence base for pharmacy services in the Pharmacy in England White Paper published in 2008. The current Government's White Paper Equity and Excellence: Liberating the NHS is even clearer that all healthcare providers must be able to demonstrate their value to the new NHS; failure to do so will result in services being decommissioned.

Against this policy background, PSNC decided in early 2009 to examine the available software to support delivery of pharmacy services and the collation of data at a national level that could be used to develop an evidence base for different services. An extensive review of existing software in the UK and internationally was undertaken and it was concluded that none of the available options met the current and expected future needs of pharmacy contractors and therefore a new system would need to be developed.

PharmOutcomes was developed to fill this identified gap in the market and to allow community pharmacy to take control of building its own evidence base. The political and economic climate and recent radical changes in NHS structures and commissioning processes made it an ideal time for pharmacy to deliver its own solution to easing the challenges of commissioning and management of locally commissioned and new national services.

The challenges with locally commissioned services

Delivery of locally commissioned community pharmacy services has generally used locally developed paperwork which varies from commissioner to commissioner. This lack of consistency adds costs for contractors, causes complications for locums working across different areas and could get worse in the future, as the expanded number of commissioners engage with community pharmacies.

A paper submission to the commissioner provides no confidence to the pharmacy contractor that the payment claim is received by the commissioner. Paper based systems have tended to lead to slow processing of claims by commissioners. Once a payment claim is processed by the commissioner, it can be difficult for the contractor to verify the accuracy of the payment or to determine the appropriate VAT status of the payment; both these circumstances can result in a reduction in overall contractor margin.

Poor data capture at commissioner level can also mean evaluation of services is difficult to undertake; over time the lack of a robust service evaluation can put a service at risk of decommissioning.

Some commissioners have developed their own software to support local service delivery and invoicing, or they have bought commercial software products. These developments have generally been viewed by LPCs and contractors to support the needs of the commissioner in preference to addressing the support needs of the pharmacy contractor or pharmacy staff member. The use of different software products across the country results in a lack of consistency that adds operational costs for pharmacy contractors and complicates information governance procedures. Some locally used software products may not be compatible with contractors' IT systems, but refusal or inability to use the chosen software may exclude a pharmacy contractor from service provision. Clinical support may not be delivered by all software providers and access to management data for pharmacy use is not always part of the software vendor's focus or service offering.

Provision of support for nationally commissioned services

Where it is possible to make the business case for the introduction of a new national service, community pharmacy contractors must be in the best possible position to deliver the service in an efficient and effective manner. The experience of implementing the MUR service provides a good example of some of the challenges that can occur. The use of a paper based system for service administration and recording of outcomes can lead to delays in effective implementation of the service and can reduce pharmacy income generation from the service.

The development of IT support for a new service has historically relied on PMR vendors or other software companies to prioritise development, but even where this occurs, variable software can add complexity to service delivery for the workforce and clinical support may not be delivered by all software providers. Additionally where there is a lack of centralised data, this makes it difficult for PSNC to undertake an evaluation of the service in order to prevent de-commissioning.

The PharmOutcomes vision

This context and historical perspective is what informed PSNC's decision in 2010 to develop PharmOutcomes in order: 

To provide a national IT system to support the efficient commissioning, delivery, invoicing and analysis of pharmacy services.

PSNC's aim was to provide pharmacy contractors with a system that works for independents and chains alike. The system allows pharmacy to control its own data and develop support for service delivery that meets the immediate needs of pharmacy and commissioners. Alongside this it provides a source of data to demonstrate service outcomes in order to protect existing services and develop new opportunities in the future; see PSNC's evaluation of the PharmOutcomes NMS data as an example of this.

The aim is to make it easy for service commissioners to commission and administer pharmacy services, so that community pharmacy becomes the first choice when they want to deliver a new service in primary care.


Who operates PharmOutcomes?

The first version of PharmOutcomes was operated by Health Information Exchange Ltd (HIE), which is a limited company whose shares are held in trust for PSNC. The creation of HIE and the development of PharmOutcomes was undertaken by PSNC for NHS pharmacy contractors, and any net revenues will be used for their benefit.

The HIE Board - originally the membership of the Board was agreed by PSNC. It currently comprises: Barry Andrews (Chair), Peter Cattee, Mark Collins, Andy Murdock, Mark Burdon, Sue Sharpe and Alastair Buxton. Board members receive the PSNC day allowance and travel expenses only; Sue Sharpe and Alastair Buxton receive no payments. The members of the Board were appointed for their skills and experience, and the trust they have from other members of PSNC.

In 2012 PSNC and the HIE board agreed to work in partnership with Pinnacle Health Partnership LLP to launch a new improved PharmOutcomes platform to provide support for locally commissioned services and contractor assessment of compliance with the CPCF requirements (the Contract Workbook module). This new PharmOutcomes system is operated by Pinnacle Health Partnership and was launched at the start of April 2013.

The new improved platform addresses the shortcomings of the previous platform identified in feedback received from LPCs, contractors and commissioners. It is a more flexible system which can support an extensive range of local services.


Finance

The initial development of PharmOutcomes was funded from PSNC's reserves and ongoing operation and development costs in 2011/12 and 2012/13 were funded via a hypothecated levy charged to LPCs. The audited accounts of HIE can be accessed via the links below:

Health Information Exchange Ltd accounts 11th Aug 2010 to 31st March 2011

Health Information Exchange Ltd accounts 1st April 2011 to 31st March 2012

From 2013/14 the partnership agreed between HIE/PSNC and Pinnacle Health Partnership LLP means that no hypothecated levy will be charged to LPCs. Instead 'commissioners' pay for the use of the platform by pharmacies. Local commissioners will normally be local authorities and clinical commissioning groups. Some LPCs have also decided to act as a commissioner for the platform in order to make it easier for their local pharmacy contractors to provide services commissioned by, for example, the local authority. A pharmacy or groups of pharmacies may also wish to pay for access to specific modules, for example to support the provision of a private ‘flu vaccination service.

If you would like to learn more about how you could use PharmOutcomes to manage a community pharmacy service contact your LPC or email info@phpartnership.com.

The partnership agreed between HIE and Pinnacle Health Partnership LLP includes an agreement on revenue sharing which should result in income to HIE, which will ultimately be to the benefit of PSNC.


Background to the decision to develop a new improved PharmOutcomes platform

At the LPC Secretaries and Chairs meeting in July 2012 PSNC talked to the LPCs present about its current thinking on the future of PharmOutcomes, in particular the approach to funding the platform. At that point the view of HIE was that levy funding still seemed the most appropriate approach for 2013/14. At the meeting there was a lengthy discussion on PharmOutcomes and PSNC/HIE also received more feedback directly from LPCs following the event.

In September 2012 PSNC sought the views of LPCs on the future development of PharmOutcomes via a survey; 103 individual responses, representing the views of 57 LPCs were received. As a consequence of all this feedback PSNC/HIE concluded that its original plan of levy funding for 2013/14 was not going to be the best option to pursue and as a consequence of this it started to explore other options.

The consideration of other options for the platform and discussions with a number of potential partners with whom HIE could work was undertaken following the LPC Secretaries and Chairs meeting. After exploring a wide range of options PSNC and HIE agreed to work in partnership with Pinnacle Health LLP to provide support for locally commissioned services and contractor assessment of compliance with CPCF requirements (the Contract Workbook module) via a new improved PharmOutcomes platform.

PSNC/HIE believes this partnership is the most appropriate way in which it can continue to seek to achieve the two main aims that were at the centre of the project from the very beginning:

  • to capture the evidence of community pharmacy’s benefit for patients; and
  • to ease the burden of record keeping, service management and financial tracking for services provided by community pharmacies.

The new improved PharmOutcomes system has been developed to address the shortcomings of the current platform identified in the feedback received from LPCs, contractors and commissioners. In summary the new system:

  • doesn’t require an LPC hypothecated levy;
  • allows for local tailoring of services but also provides national templates for common services;
  • allows real-time performance management of services; and
  • remains ‘By Pharmacy, For Pharmacy’.

Frequently Asked Questions

What process was followed to select Pinnacle Health LLP as PSNC/HIE's partner in the provision of the new PharmOutcomes system? Following discussions at the LPC Secretaries and Chairs meeting and subsequent direct feedback from LPCs, PSNC/HIE concluded that levy funding was not an option going forward, so we considered other options for the platform. This included shutting it down, as PSNC could not continue to resource the platform unless all LPCs were willing to pay a levy.

PSNC/HIE explored a wide range of other options and held detailed discussions with a number of potential partners. We assessed the partnership opportunities that may be possible with all organisations of whom we were aware are operating in the market for provision of IT support for locally commissioned community pharmacy services.

The HIE board recognised the need for a rigorous approach to selecting a partner. The assessment looked at a range of criteria to determine whether the potential partner would fit with the goals of HIE/PSNC, including the strength of their product offering, feedback from current users of the system, ability to scale up support and reputation in the market.

How did you manage potential conflicts of interest? Before the commencement of the process there was a recognition by PSNC/HIE of the potential for conflicts of interest to arise which would need to be managed appropriately.  During the review of the different partnership opportunities, it was recognised that one potential partner included an organisation in which a member of PSNC had a close interest.

PSNC's Review and Audit Panel, which has the responsibility for governance and oversight of PSNC's operations, was consulted on the implications of developing a commercial relationship with an organisationin which a member of PSNC had a close interest, and looked at the process leading to the selection. The Review and Audit Panel decided, after careful consideration, that the proposed partnership with Pinnacle Health LLP was acceptable, and it will keep this under review.

Following this decision on governance grounds, which meant that there were no obstacles to appointing HIE’s preferred partner, a decision had to be taken by the full Committee of PSNC.  The PSNC Committee was advised of the interest of the Committee member in Pinnacle Health LLP, and voted to proceed, with no dissenters. The Committee member with an interest in Pinnacle Health LLP was absent for this part of the PSNC meeting.

HIE will continue to oversee the work of PharmOutcomes and the partnership working with Pinnacle Health LLP on behalf of PSNC.

Was there a tendering process? As LPC funding was not going to be an option we had to look for partnership arrangements and this was not something that could sensibly be undertaken via a tendering process.

Why were LPCs not consulted on the selection of the partner organisation to work with PSNC/HIE? It would not be practical for LPCs to be consulted on this matter in a timely manner, as part of the negotiations that preceded reaching an agreement between PSNC/HIE and Pinnacle Health LLP. PSNC’s regional reps act as the formal link to LPCs and bring with them to PSNC meetings an understanding of the views and concerns of LPCs in their region. They draw upon this knowledge when they are making decisions at the PSNC meetings.   

LPCs have already committed a large amount of money to the development of PharmOutcomes via the hypothecated levy. How will the remainder of that money will be spent? The development of the PharmOutcomes platform was largely funded by PSNC from its limited reserves.  During 2011/12 and 2012/13 levy funding from LPCs was used to fund the provision of the former PharmOutcomes platform. A significant amount of the costs relate to the provision of the NMS module, which was made available to all contractors to support provision of a service for which up to £110m of funding has been negotiated for contractors.

The PharmOutcomes NMS data which has been evaluated for PSNC and was published in December 2012 is the only evidence on effectiveness of the service which was available to inform the DH/NHS England decision on extending the service beyond March 2013.

The HIE accounts are published above, so LPCs and pharmacy contractors can have visibility on how the levy funding was spent.

 

 


PharmOutcomes is a registered trademark of Health Information Exchange Ltd.

Health Information Exchange Ltd. Registered in England and Wales; Company number 7343096. Registered Office: Da Vinci House, Basing View, Basingstoke, Hampshire, RG21 4EQ