The Carter review, published on 5 February 2016, indicated that substantial cost savings can be made across hospitals and hospital pharmacy services. As part of the ongoing work of the review, the NHS has used benchmarking exercises to compare hospital services and identify potential efficiency savings.
The identified savings for the Hospital Pharmacy Medicines Optimisation (HoPMOp) project are £800m by 2020. In the three years leading up to then, the NHS will spend £23bn on medicines (conservatively based on a 15% annual increase), so £800m represents a saving of around 3.4%
NHS benchmarking supports providers in delivering optimal services within resource-constrained environments, while also allowing commissioners to achieve the best balance from available commissioning resources. NHS benchmarking provides a rich source of data about services provided by individual trusts, such as procurement and workforce, and allows comparisons to be made between trusts. It provides context to support differences in service provision across similar trusts and allows individual trusts to look at their own services and identify unintended and unwarranted variations in order to make efficiency savings. Ultimately, it is up to each trust to establish whether some variations are appropriate because not all trusts are the same.
Benchmarking has allowed trusts in England to share best practice, which in turn has realised savings. Examples include the £8m that is saved per year on the procurement of soluble prednisolone (
The Pharmaceutical Journal 2016;296:360) and annual savings of £55m that could be achieved if everyone moved to a biosimilar formulation of infliximab. These are large system-wide savings; others include savings realised through dose banding, vial sharing and specialised commissioning policy changes.
Lord Carter proposed a ‘Hospital Pharmacy Transformation Programme’ (HPTP) to ensure trusts implement his recommendations. Trusts have been asked to send their initial HPTP structures to the Department of Health (DH) by the end of October 2016, with final approval by April 2017. Some trusts, like mine, have already set up their structures. Carter suggests that trust boards have a nominated director to take responsibility for the development of HPTP plans alongside the chief pharmacist who is then mandated to implement the changes identified. Each trust will agree its own HPTP structures based on its size, structure and scope of work. NHS Improvement (NHSi) will manage the performance of trusts, driving organisations to adopt transformational change; the HPTPs will be required to apply local, regional and national scrutiny, as well as challenge individual services since there is overwhelming evidence of some organisations not adopting legal, professional or NHS-required practice.
In my trust I am responsible for the development of the pharmacy workforce, which has involved using the NHS benchmarking data to identify the numbers of pharmacists, pharmacy technicians and other staff and comparing them to similar sized trusts. In my hospital I am the lead for the workforce stream of our HPTP Board, my vision for this is to use the Royal Pharmaceutical Society (RPS) frameworks for pre-foundation, foundation and Faculty and to have the RPS professional development roadmap underpinning our workforce development. My position on the English Pharmacy Board (EPB) has allowed me provide a strategic link as a hospital pharmacist and employer to help inform the work of the EPB as we review and develop the future roles of pharmacists and pharmacy technicians, in accordance with the Carter requirements and the NHS England ‘Five year forward view’.
As part of the HoPMOp project there are already several short life working groups on eCommerce, pharmacy systems, production and biosimilars, with plans for others, such as the potential role of clinical pharmacy technicians.
This type of root and branch review of the workforce allows gaps in professional development to be identified and then filled, ensuring there is an adaptable workforce that is fit to work across and along patient pathways. This will involve challenging the current service provision and networking with other trusts to share and learn from each other while respecting that no trust is the same in terms of service provision.
The Carter review is one of the most important recent developments that will affect hospital pharmacy. The main challenge is to get people to start thinking about change and transformation.
 Department of Health. Productivity in NHS hospitals: Lord Carter’s review. 5 February 2016. Pg. 30. Available at: https://www.gov.uk/government/publications/productivity-in-nhs-hospitals