The Carter Review

Carter Review includes specific recommendations for NHS hospital pharmacies

The final recommendations of Lord Carter’s review on improving productivity and performance of the NHS in England set out a blueprint for the ‘model hospital’, and includes challenging improvements for pharmacy departments to address. With the NHS bill for medicines standing at £6.7 billion, improvements in medicines management will deliver significant savings, reduced errors and improved patient care.

One of the main aims is to allow pharmacists and pharmacy technicians to spend more time on front-line, patient-facing activities to improve medicines optimisation. By April 2017, each NHS Trust should have undertaken a Hospital Pharmacy Transformation Programme (HPTP) to develop plans to increase pharmacist prescribers, electronic prescribing and administration, accurate cost coding of medicines, and consolidate stock holding by April 2020.

Underpinning this, the review sets out some clear recommendations for hospital pharmacies. Primarily, each Trust should nominate a main board director to work with the Chief Pharmacist in making the changes, leading to 80% of NHS pharmacist resource to focus on medicines optimisation, governance and safety.

Other recommendations include moving prescribing and administration to electronic systems and ensuring the coding of medicines is accurately recorded within NHS reference costs. NHS Improvement will publish the top ten medicines with cost saving opportunities each month and NHS drug prices should be benchmarked to ensure competitiveness.

Focusing on the medicines optimisation role will be a difficult transition for most Trusts, with upheaval from outsourcing or reconfiguration within pharmacy departments. NHS hospital management should look to how the independent sector has already delivered the improvements required. There is already a long-term trend towards outsourcing pharmacy services, which is a recommendation of the Carter Report.

Currently, in NHS hospital pharmacies, 55% of pharmacy staff time is spent on infrastructure services, including the procurement and supply of medicines. This compares to 5% in the independent hospitals we work with. Utilising non-pharmacy staff or outsourcing the supply of medication could free up the time of the hospital’s pharmacy staff to focus on clinical activities.

In particular, buying and distributing medicines can be done more efficiently by non-pharmacy staff, freeing up clinical pharmacy staff to focus on promoting the best use of medication and improving medicines management.

Medicines stock holding is a key area of focus and varies between 11 and 36 days for Trusts, with 20 days being the average, compared to 18 days in many independent hospitals, based on our experience. If all NHS hospitals achieve the 20 days stock holding target, this alone could save £200 million.

The NHS faces significant challenges to improve productivity and performance. If all hospitals achieve the current average cost of medicines per patient, the NHS could save £800 million and improve patient care. The recommended practises are being put in place in NHS hospitals.

Ashtons has already implemented Carter’s recommendations and works with independent hospitals to maintain and improve medicine management standards. If you would like more information on the Carter Review, please click here.