Advanced Wound Care: How a just in time total purchase system can improve services

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Summary Overview

The NHS faces unprecedented challenges, fuelled by a growing and ageing population and exacerbated by increasing financial pressures. The NHS is required to find £22 billion of efficiency savings to limit pressures on services, reduce wasteful practices, and focus on shifting the entire system towards a greater focus on preventative care.

NHS SBS is uniquely placed to help the NHS address some of these challenges. Through engagement with clinical networks, a key area identified with high wastage and inefficiencies on which to focus was wound care. Together, we set about supporting new ways of working with an innovative Procurement Solution.

Project

The Problem
The NHS spends approximately £5.3 billion on wound care per year, accounting for around 5% of the overall NHS budget. At least 2.2 million wounds are treated in the UK on an annual basis with some 200,000 patients having a chronic wound. Wounds impose a substantial economic health burden on the NHS, equivalent to that of obesity, and the figures are set to increase due to the ageing population and the number of surgeries. Despite this, nurse numbers in community settings where the majority of wound care management is practiced are declining year on year.

The Approach
An estimated 85% of wound care costs are related to nursing and home visits rather than the dressing itself. With this in mind, NHS Shared Business Services (NHS SBS) has developed and manages a framework agreement focussed around helping the NHS reduce the nursing time required to manage wound care in the community by providing a wide choice of high quality dressings to clinicians via a just in time delivery model. The approach to the market was to develop two linked framework agreements – one for product and a second for delivery of that product to a non-acute setting.

Each supplier on the framework agreement has undergone a rigorous evaluation process, focusing on quality and cost. Users of the framework agreements not only have access to these fully approved delivery providers, but also to the NHS SBS product framework which contains a wide choice of dressings, bandages and scar/burns products. Each product on this framework has been clinically approved by a dedicated clinical stakeholder group, enabling clinicians to feel secure in their own local formulary choice.

The Solution
Under the Total Purchase system, wound care products are ordered via an online portal, aimed at taking the repetitveness away of the GP writing the patient a repeat prescription when it is not necessarily required. This means that dressing are issued for the patient at point of need for use; only by that patient.

The framework agreement allows for supplier engagement and direct award so it is entirely up to the user to decide which products, delivery supplier and ordering portal to award.

A formulary (clinically approved list) is developed and uploaded to the portal. A formularly effectively restricts choice through stringent evaluation and a multi disciplinary team approach ensuring highest quality standards are met and cost control of type and size product being ordered. They are devised specifically to meet the patients requirements and clinicians can proactively order products, without GP intervention, safe in the knowledge that they will be delivered within 24, 48 or 72 hours as required.

As a result, formulary compliance is increased and stock holding at bases can be proactively managed with minimum and maximum levels. The system also reduces product wastage caused by short expiry dates and addresses the sustainability agenda as one box of dressings can be used for multiple patients rather than just one if the box was GP prescribed for a patient. It also provides a more timely method of obtaining wound care items as neither the clinician nor the patient has to wait for a prescription to go through the system and be dispensed; enabling the clinician to be truly autonomous in their practice.

Due to the sometimes complex nature of implementing a just-in-time total purchase system, NHS SBS has provided additional implementation resource to this framework agreement.

Since its launch, the framework agreement has been supported by a Category Team, an Implementation Manager and a Senior Clinical Advisor, each offering a vast wealth of experience in the NHS. Together, the team has been able to provide first-hand support to NHS organisations who wanted to implement this system under the framework. The collaborative teamwork between Procurement and Clinical has been integral to the framework’s success.

The Senior Clinical Advisor at NHS SBS, Sue Mason, has been a champion of this framework for many years as she utilised it herself when she led a Tissue Viability team in Staffordshire and Stoke-on-Trent and saw first-hand the benefits that it can bring to the NHS. Sue’s experience and expertise has also inspired the widening of the scope for the framework renewal which is due in 2021.

Stakeholder engagement with clinicians, medicines management and the wider wound care landscape (including the National Wound Care Strategy, The Tissue Viability Society, the ABHI, the SDMA and a vast range of wound care manufacturers and providers), has been ongoing since the project conception. We have adapted the approach based on stakeholder preference, with regular forums taking place to enable input on the approach and process. Taking on board feedback from the stakeholders NHS SBS has proactively widened the scope of the framework renewal to include Lymphoedema, Advanced Wound Care Therapies, Wound Care Dressing Packs, Diagnostic & Digital solutions and Higher Education. This innovative whole market approach will ensure that clinicians are able to efficiently procure all their wound care needs via one route enabling them to direct more of their time and resource back to patient care.

The Benefits
One of the major benefits of the total purchase system is that it allows Medicines Management and Tissue Viability Leads to obtain more control and visibility over their wound care spend by utilising the reporting tools which are embedded within the online ordering portals. The live data reports can be used to highlight high areas of spend and help budget holders to make informed decisions when trying to achieve further cost savings. The online ordering platform providers also offer free of charge audits to help show users where they can gain further efficiency savings if desired.

Due to the evidenced cost and efficiency savings which can be achieved by adopting a just-in-time total purchase system under the NHS SBS framework agreement, uptake of the framework has increased significantly since its launch in in 2017. To date, there are 34 NHS customers with a scheduled pipeline expected to contract before the end of 2020.

In 2019, the framework had an annual spend of approximately £13.4m and in 2020 YTD there has been spend of approximately £15.9m. The framework is forecast to achieve a throughput of £27 million for the full year. This is a percentage growth increase of 101% in two years. Potential savings are anticipated to be £2m, potentially more, where the online portal is used and a formularly approached adopted. The framework has already seen customers achieve large savings; one customer reported that their CCG saved £400k in the first six months of implementation (approximately 8% of their total spend) which has allowed them to put more clinical resource back into the NHS and patient care.

A large number of CCGs and Community Healthcare Trusts are now contracting with one of the three delivery providers under the framework, who have provided various testimonials:

“The service was able to reduce wound care costs through the reduction of avoidable waste that is inherent in the FP10 supply system. This also released nursing capacity previously spent ‘chasing’ prescriptions – the released capacity for the service was 1 hour per day, per qualified nurse. Patients also expressed a benefit in their houses not being over stocked and the correct dressing and treatment being more efficient.” Treacey Kelly, Matron of Community Nursing, Newcastle Hospitals Community Health Trust on behalf of Newcastle Gateshead CCG.

“The support provided by NWOS has facilitated the provision of a just in time, responsive and efficient system that ensures maximal Formulary compliance, greater visibility and robust governance in the supply and use of wound care products. NWOS are a trusted and reliable partner and the timeliness of their supply is fundamental to minimising avoidable waste that is inherent in other supply arrangements.” Neil Frankland, NECS Medicines Optimisation Pharmacist, working with North Tyneside CCG.

“We have worked collaboratively with SBS with this project and their support has been invaluable. Sue Mason heads up the wound care side of things at SBS and is a great resource to tap into, she has been integral in assisting with the implementation and review of the scheme. Sue is a TVN by background so she understands it from both sides and in her previous TVN role she implemented a successful non-prescription service in her area.” Julie Mullings, Community Matron Tissue Viability & Infection Prevention, Manchester University NHS Foundation Trust.

“Oxfordshire Clinical Commissioning Group has enjoyed utilising the SBS Framework for the provision of wound care products across over 190 sites including all District Nurse, Practice Nurse and Nursing Homes. The main benefit to the Framework was the simplicity in signing up, removing the time and cost associated in running a procurement exercise and the option to freely use any one of the three providers in the knowledge that the main pricing structure is standardised. We have benefited from the advice and expertise provided by Carolyn Lawton and her team throughout our time using the Framework and we look forward to continuing to work with Carolyn.” Ross Burton, Medicines Optimisation Pharmacist, Oxfordshire Clinical Commissioning Group.

 

 

 

Finalist : 2020 HCSA Procurement Excellence Award  and  Winner: 2020 HCSA Procurement Excellence Award

 

Name: Ayshea Domun
Job Title: Innovation Researcher
Organisation: NHS Shared Business Services

For further information:
Email: Ayshea.domun@nhs.net