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A guide for Commissioning Consortia Boards

An organisational competency framework to ensure the effective delivery of medicines management functions and responsibilities

A guide for Commissioning Consortia Boards

July 2011 Version 1.1

A guide for Commissioning Consortia Boards

Acknowledgements
Author Project lead Production Published by: Website: Cathy Picton Gill Harvey Head of Medicines Management Stephen Beer Web and Publications Officer Merissa Bellew Web and Publications Manager National Prescribing Centre Ground Floor Building 2000 Vortex Court Enterprise Way Wavertree Technology Park Liverpool L13 1FB Tel No: 0151 295 8691 Fax No. 0151 220 4334 www.npc.nhs.uk

About the National Prescribing Centre (NPC)

The NPC is an NHS organisation formed in 1996 and funded by the Department of Health. In April 2011 the NPC integrated into the National Institute for Health and Clinical Excellence (NICE). The NPC and NICE already has a history of close working and this integration will add further strength to achieve the NPC aim, which is:

About the author

Catherine Picton is a pharmacist with a wide range of experience in healthcare delivery and management. She can be contacted by email at catherinepicton@t-online.de

to support the NHS, and those working for it, to improve quality, safety and value for money, in the use of medicines for the benefit of patients and the public.
The NPC work programme is designed to support the specific needs of commissioners, providers and individuals with an involvement in prescribing and medicines use. In order to improve the flexibility, accessibility and timeliness of its support, the NPC provides key NHS audiences with a range of choices for accessing outputs. This includes making use of opportunities provided by electronic learning environments, as well as more traditional approaches. Additional materials to complement this guidance are available through the NPC website: www.npc.nhs.uk

National Institute for Health & Clinical Excellence 2011

A guide for Commissioning Consortia Boards

Foreword
I am pleased to introduce you to this Organisational Competency Framework covering the skills and competencies needed by commissioning consortia in order to fulfil the Boards responsibilities for medicines management. Why is medicines management so important? The prescription of a medicine is the most frequent therapeutic intervention in primary care; most self care is supported by direct access to a medicine and in hospital settings the use of specialised medicines has transformed the treatment of many diseases. To put it another way, we would not have the health services we have today without access to modern medicines. Great progress has been made in improving the quality and cost effectiveness of prescribing in the 20 years since the Improving Prescribing Scheme was introduced - we have much to celebrate but much more to do. We must now build on the successes of the Improving Prescribing Scheme and embrace the idea that getting medicines use right or optimising the use of medicines has the potential to not just improve outcomes for our patients but, in many cases, to support us in redesigning care pathways in ways which reduce overall system costs. We have no alternative but to seek both these goals if we are to meet the needs of patients within the resources which will be available to us in the future. Alongside these opportunities we must also recognise the financial risk - around 14% of consortia budgets will pay for medicines, not just those directly prescribed but also many of the medicines used in hospital. So the task ahead is much more than just controlling prescribing costs, it is about realising the full benefits that optimal medicines use can deliver for our patients and for our Health Service. Given this context it must be apparent that every commissioning consortium will require access to the skills and competencies needed to optimise the use of medicines and to ensure that the expected patient outcomes and pathway redesigns are delivered. This Skills and Competency Framework and Self Assessment Tool, which has been co-produced with colleagues from consortia, PCTs, the National Prescribing Centre and DH, is designed to assist Consortia Boards to assure themselves that this is the case. I hope you will find it helpful and would welcome feedback to gill.harvey@nice.org.uk

Peter Rowe National QIPP Lead for Medicines Use and Procurement Department of Health Richmond House - Room 207 79 Whitehall SW1A 2NS Email: Peter.Rowe@dh.gsi.gov.uk PA: Jackie.Pennant@dh.gsi.gov.uk

A guide for Commissioning Consortia Boards

HOW CAN THIS DOCUMENT HELP CONSORTIA BOARDS?

Recent research shows that 3-4% of UK hospital admissions are a result of avoidable medicine related illness.And between eleven and thirty percent of these admissions result from patients not using their medicines as recommended by the prescriber.1
In secondary care, about 60% of medicines expenditure is on high cost medicines excluded from the national payment by results (PbR) tariff.3 These medicines require active management to ensure best value for patients and the NHS.
Appendix 1 contains a quick diagnostic tool based on the competency framework. Boards can use the diagnostic to determine where they are currently. A comprehensive list of key medicines management functions which underpinned the development of this framework is downloadable as a Word file. Boards can use this to give them a detailed overview of the functions currently delivered in the NHS. Commissioning Consortia must have medicines management expertise to optimise medicines usage and improve patient outcomes in all the services that they commission on behalf of their patients. This resource provides Commissioning Consortia Boards with a framework of competencies that a Consortium needs to have, or have access to, to ensure the effective delivery of medicines management functions. The framework is based on a comprehensive resource2 already used by PCTs and SHAs in transition planning. Although Consortium structures will vary across England, all Consortia Boards must have a thorough understanding of these competencies when they form their organisations. Consortia Boards should use this framework, initially in conjunction with an experienced PCT Head of Medicines Management or SHA pharmacy lead to: help define medicines management needs in any emerging Consortium and, where appropriate, federations of Consortia assist with recruitment and the development of service specifications for medicines management services (or the recruitment of individuals) with the appropriate competencies identify gaps in Consortium knowledge and skills, and highlight training and development requirements Over time the framework can then be used to review Consortium performance in delivering management functions and responsibilities.

ARE THERE ANY OTHER SUPPORTING RESOURCES?

A guide for Commissioning Consortia Boards

COMPETENCY FRAMEWORK FOR COMMISSIONING CONSORTIA

This framework defines the competencies necessary to deliver effective medicines management services and outcomes for patients. The framework contains six competencies that Consortia need to develop (illustrated in figure 1). Each competency has an overarching statement, which gives an overview of what the competency is about, and numbered supporting statements. The statements are indicators which would demonstrate that a Consortium is demonstrating that competency. The six competencies and their indicators can be found in the table on pages 6-7. All the competencies and indicators in this framework relate specifically to the delivery of medicines management functions.

1 Has a strategic overview 2 Establishes effective partnerships

A Commissioning Consortium delivering effective medicines management

6 Supports and develops people

5 Has medicines expertise 4 Provides medicines oversight

3 Commissions services that optimise the use of medicines

Figure 1: Overview of the six organisational competencies

A guide for Commissioning Consortia Boards

1. HAS A STRATEGIC OVERVIEW
The Consortium has leadership and a clearly communicated strategy for optimising the use and management of medicines in a health economy 1. Has a clear leadership role for medicines management linked to senior colleagues in all partner organisations and provider services 2. Fulfils the requirements of the NHS Constitution with regard to patients access to medicines 3. Has clear and accessible processes for prioritising investment in healthcare interventions and services that involve medicines 4. Gives the public and patients the opportunity to help shape services and local systems that use medicines, in the context of using NHS resources most effectively 5. Effectively manages the entry of new medicines, or new indications for existing medicines, into the health and social care economy 6. Has systems that comply with statutory regulations, and can stand up to legal challenge 7. Delivers the Quality, Innovation, Productivity and Prevention (QIPP) agenda in relation to prescribing, medicines usage and procurement 8. Has robust mechanisms for managing the risks associated with medicines (clinical, safety, financial, and reputational) 9. Has a consistent approach to medicines across services, whether commissioned directly by GP Consortia or by other organisations supporting GP Consortia 10. Knows how medicines are priced, funding allocated, how the financial flows through the NHS are structured, and how this impacts on budgets across the health and social care economy 11. Supports national policy development and implementation regarding medicines, and unplanned emerging issues

2. ESTABLISHES EFFECTIVE PARTNERSHIPS

The Consortium links with local, regional and national partner organisations to ensure a coordinated approach to medicines usage across health and social care 12. Partners and plans effectively with Local Authorities, other GP Consortia and the NHS Commissioning Board 13. Engages fully with local Health and Well Being Boards, Healthwatch bodies, patient participation groups and community partners 14. Understands the structure and functions of all agencies/services contributing to health improvement, and the impact on patients and their medicines as they move through care interfaces 15. With partner organisations, uses local decisionmaking groups to make evidence-informed decisions about the effective use of medicines 16. Works with other Consortia to identify where collaboration and decision-making on a wider footprint may be appropriate 17. Works with all stakeholders to ensure the safe transfer of medicines and information when patients cross interfaces of care 18. Understands, develops and works with local contractor services to optimise medicines usage, for example, dispensing practices, community pharmacy, dentistry and ophthalmology services, and appliance contractors 19. Has governance processes in place, and codes of conduct that set out how consortia commission or interact with commercial bodies (in relation to medicines), and monitors them 20. Gives proper consideration to working in partnership with commercial organisations (such as pharmaceutical companies) to improve outcomes for patients

3. COMMISSIONS SERVICES THAT OPTIMISE THE USE OF MEDICINES

When commissioning services or redesigning pathways, the Consortium recognises the potential that optimising medicines usage has to improve patient outcomes and increase productivity 21. Establishes and maintains a full understanding of current and future health needs, and service requirements involving medicines 22. Where there is discretion to commission locally enhanced services involving medicines, does this equitably based on patient need 23. Understands what patients want, and need, from services involving/using medicines 24. Involves medicines management expertise at the start of, and throughout, the development of commissioning specifications and services (or changes to existing services) 25. Ensures that the Commissioning Outcomes Framework, indicators and commissioning guidelines (developed by NICE for the National Commissioning Board) inform the commissioning, and management of services using medicines 26. Ensures that service specifications support providers to engage with patients to help them obtain the most benefit from their medicines, minimise the risk of harm and minimise medicines wastage

A guide for Commissioning Consortia Boards

4. PROVIDES MEDICINES OVERSIGHT
The Consortium Board provides oversight, governance and assurance of safe, effective and affordable medicines usage in provider services 27. Identifies and accesses prescribing data and interprets it in order to plan for, monitor, audit and manage medicines usage and expenditure 28. Challenges inappropriate variation in practice in medicines use and shares and promotes good practice 29. Has integrated clinical and corporate governance, providing assurance of control and safety in the use of medicines (for example through policies, training and audit) 30. Encourages and supports reporting of, and shared learning from, serious incidents and near misses 31. Ensures the safe management of controlled drugs in line with regulations 32. Identifies, and has mechanisms for the management of, unsafe or poor practice, and shares the learning from any investigations 33. Monitors medicines usage, using quality markers and key performance indicators and feeds back to providers 34. Shares and routinely benchmarks medicinesrelated performance against other commissioners or service providers

5. HAS MEDICINES EXPERTISE

The consortium has access to the full range of skills, expertise and knowledge necessary to deliver the safe, legal and effective use of medicines across the healthcare economy in order to improve patients outcomes 35. Understands the legislation and systems governing the purchasing, prescribing, administration, supply and disposal of medicines, and their impact on how services can be developed and delivered 36. Accesses and interprets horizon scanning information for new medicines to identify future trends in medicines usage; for example, to forecast budget expenditure, redesign services or develop commissioning agreements 37. Has the skills necessary to access and utilise quality summaries of evidence to help shape and inform local decision-making processes 38. Knows how to interpret, and where appropriate challenge, the evidence-base underpinning the use of medicines 39. Recognises the need to access clinical knowledge and skills, where it is needed 40. Has appropriate pharmaceutical knowledge, knows how to assess pharmaceutical need, and understands pharmaceutical public health 41. Has an overview of the implications of IT developments on service delivery relating to medicines through, for example, electronic prescription services , electronic transmission of prescriptions and GP clinical systems 42. Understands the structure and functions of the NHS, how they are evolving and their implications for service delivery 43. Understands the role and functions of NICE, the NHS Commissioning Board, Monitor and the Care Quality Commission (CQC) in relation to GP Consortia and the cost effective use of resources, with a focus on medicines

6. SUPPORTS AND DEVELOPS PEOPLE

The Consortium ensures that people working in medicines management roles are competent, and supports and develops individuals working for the Consortium 44. Ensures clear professional and managerial accountability within the organisation for all medicines management roles and responsibilities 45. Recruits and retains, or accesses, the appropriate skill mix which takes account of emerging roles and organisations 46. Understands how health and social care professionals working with medicines are trained, their skill base and how their competence is maintained and developed 47. Contributes to future workforce planning and development initiatives 48. Supports and helps develop clinical and professional leadership networks for medicines management

Care Quality Commission investigations into failing services continue to highlight poor medicines management services as a contributory factor in some cases.4, 5

A guide for Commissioning Consortia Boards

Useful links
Accountable Officer for Controlled Drugs: Under the Department of Healths legislation governing controlled drugs, all NHS trusts and independent (private or voluntary) hospitals that are designated bodies must appoint an accountable officer to be responsible for the safe management and use of controlled drugs in their organisation. (Care Quality Commission: www.cqc.org.uk) Area Prescribing Committees (APC): An area prescribing and medicines management committee (APC) is a strategic local group whose members are clinicians, providers and commissioners working together to ensure that patients have safe and consistent access to medicines in the context of care pathways which cross multiple providers. See Managing medicines across a health community: A fitness for purpose framework for area prescribing and medicines management committees (NPC 2009) Better Care Better Value (BCBV) indicators: Aimed primarily at commissioners and acute hospital providers, BCBV indicators reveal the potential to make significant cash or resource savings whilst improving quality Care Quality Commission (CQC): the independent regulator of health and social care in England www.cqc.org.uk CfWI (Centre for Workforce Intelligence): The CfWI is the new national authority on workforce planning and development providing advice and information to the NHS and social care system Commissioning Outcomes Framework: A set of overarching indicators that will frame the NHS Commissioning Boards responsibilities (see below for NHS Commissioning Board) CQUIN: the Commissioning for Quality and Innovation (CQUIN) payment framework, which makes a proportion of providers income conditional on quality and innovation ePACT: ePACT is a service for pharmaceutical and prescribing advisors which allows on-line analysis of the previous sixty months prescribing data held on NHS Prescription Services Prescribing Database Framework for Joint Working with the Pharmaceutical Industry Beyond Sponsorship: A toolkit designed to help the NHS meet the challenges of a rapidly evolving health service by providing practical advice and tools that support joint working projects with the pharmaceutical industry GMS QOF: General Medical Services Quality & Outcomes Framework GP Commissioning Consortia: as defined in the Department of Health White Paper Equity and excellence: liberating the NHS, these are consortia of GP practices, working with other health and care professionals, and in partnership with local communities and local authorities, to commission the great majority of NHS services for their patients HealthWatch England: an independent consumer champion within the Care Quality Commission Individual Funding Request (IFR): An IFR is a request to a PCT to fund healthcare for an individual who falls outside the range of services and treatments that the PCT has agreed to commission. Supporting rational local decision-making about medicines (and treatments). A handbook of good practice guidance (NPC, 2009) Joint Strategic Needs Assessment (JSNA): a process that identifies current and future health and wellbeing needs in light of existing services, and informs future service planning taking into account evidence of effectiveness Local decision-making (LDM) programme: NPCs programme of ongoing support for local NHS organisations (http://www.npc.nhs.uk/ local_decision_making) linked to the NHS Constitution Medicines Management: A system of processes and behaviours that determines how medicines are used by patients and by the NHS. (Modernising Medicines Management, NPC 2002) Medical Education England (MEE): MEE is an Independent Advisory Non-Departmental Public Body with a remit for medicine, dentistry, pharmacy and healthcare science Monitor: The independent regulator established in January 2004 to authorise and regulate NHS foundation trusts. www.monitor-nhsft.gov.uk

A guide for Commissioning Consortia Boards

References
NHS Constitution rights: You have the right to drugs and treatments that have been recommended by NICE for use in the NHS, if your doctor says they are clinically appropriate for you. You have the right to expect local decisions on funding of other drugs and treatments to be made rationally following a proper consideration of the evidence. If the local NHS decides not to fund a drug or treatment you and your doctor feel would be right for you, they will explain that decision to you. Implementation of this right is supported by NPCs local decision-making (LDM) programme see earlier. NHS Constitution NICE: National Institute for Health and Clinical Excellence www.nice.org.uk NHS Commissioning Board: as defined in the Department of Health White Paper Equity and excellence: liberating the NHS, the NHS Commissioning Board is the proposed entity that will have the responsibility for holding consortia to account and for allocating and accounting for NHS resources Payment by Results (PbR): the tariff based hospital payment system that has transformed the way funding flows around the NHS in England; see A simple guide to Payment by Results Department of Health, September 2010. (See also, What you need to know about prescribing, the drugs bill and medicines management: A guide for all NHS managers. NPC December 2008) Patient Group Direction (PGD): a written instruction for the supply and/or administration of a licensed medicine (or medicines) in an identified clinical situation, signed by a doctor or dentist and a pharmacist. It applies to groups of patients who may not be individually identified before presenting for treatment. (NPC, Patient Group Directions, a practical guide and framework of competencies for all professionals using patient group directions, December 2009) QIPP agenda for medicines: Part of a broad spectrum of initiatives being developed by DH as a rounded package of Quality, Innovation, Productivity, and Prevention (QIPP) activities. The supporting document, Key therapeutic topics 2010/11 Medicines management options for local implementation (NPC 2010) focuses on medicines use and their procurement 1. National Institute for Health and Clinical Excellence (2009) costing statement: Medicines adherence: involving patients in decision about prescribed mecdicines and supporting adherence. http://guidance.nice.org.uk/CG76/costingstatement/pdf/english 2. National Prescribing Centre (2010). Ensuring the delivery of prescribing, medicines management and pharmacy functions in primary and community care. An organisational competency framework and key functions checklist. Working document. http://www.npc.nhs.uk/qipp/resources/competency_framework. pdf 3. NPC (2008). What you need to know about prescribing, the drugs bill and medicines management. http://www.npc.nhs.uk/resources/nhs_guide_for_managers.pdf 4. Healthcare commission. Investigation into Staffordshire Ambulance Service NHS Trust. April 2008. www.jrcalc.org.uk/hcr0408.pdf 5. Care Quality Commission (2010). Investigation into the mental health care for older people provided by Devon Partnership NHS Trust. www.cqc.org.uk/_db/_documents/20100614_Devon_ Partnership_NHS_Trust_investigation_Full_report_Final.pdf

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le

Appendix 1 Diagnostic spider web tool for Consortia Boards

What is this diagnostic exercise for? This self-assessment exercise is intended to be undertaken by Consortia Boards to help them to diagnose their readiness to deliver the full range of medicines management competencies expected from them. Undertaking this exercise will enable Consortia Boards to identify the areas that they are already able to deliver, as well as those they need to develop. How to Complete the Diagnosis Exercise Listed on the following page is a series of tables containing statements about the six medicines management competencies outlined earlier in this document. Consider each statement in turn for each of the six competencies, and circle the one that you think most closely reflects your level of organisational competency. When you have completed all six competencies, plot the level (1 5), against the relevant competency on the spiders web. From the resulting graph you will easily be able to see which competencies you need to develop to enable you to deliver your medicines management responsibilities.

1. Has a strategic overview

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Rating Scale:

4. Provides medicines oversight

5:  Our Commissioning Consortia Board has the strategies, structures and processes in place to enable it to deliver its medicine management functions fully 4:  Our Commissioning Consortia Board has almost developed its strategies, structures and processes to enable it to deliver its medicines management functions 3:  Our Commissioning Consortia Board has started to develop its strategies, structures and processes for the delivery of its medicines management functions at a basic level 2:  Our Commissioning Consortia Board has met to discuss its responsibility for medicines management functions but as yet has not defined its strategy, structures or processes 1:  Our Commissioning Consortia Board is not yet supporting the delivery of its medicines management functions

tha 3. t o Com pti mi miss se the ions use serv of ices me dic ine s

5. Ha sm ic ed xp se ine i ert se

A guide for Commissioning Consortia Boards

1. Has a strategic overview
5. We have designated board level lead for medicines management, and a clear strategy and action plan for optimising medicines use across our health economy. We have the medicines management resource through which it can be delivered in place and have started work 4. We have a board level lead for medicines management and are in the process of developing a strategy and action plan. We have some medicines management resource 3. We have a board level lead for medicines management and have started to develop a strategy but have not defined our resource or taken action 2. We have a lead for medicines management but no defined strategy 1. We have no strategy or designated leadership for medicines management

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2. Establishes effective partnerships

5. We have identified all our partner organisations, made contact, set up effective communication processes and are working on areas of joint interest 4. We have identified all our partner organisations, made contact, set up communication processes and have started joint working in some areas 3. We have identified all our partner organisations, made contact with most, and set up some communication processes but have yet to start significant joint working 2. We have identified most of our partner organisations, are making contacts and developing ideas for joint working 1. We have started to identify all our key partner organisations and are planning to make contact

3.  Commissions services that optimise the use of medicines

5. We have a good understanding of the needs and service requirements of our patients with regard to their medicines, all our contract specifications set out our expectations for optimal use of medicines 4. We have a good understanding of the needs and service requirements of our patients with regard to their medicines, we are reviewing our contract specifications to set out our expectations for the optimal use of medicines 3. We are developing an understanding of the needs and service requirements of our patients with regard to their medicines and are going to review our contract specifications 2. We understand the importance of considering the needs and service requirements of our patients with regard to their medicines and the need to review contract specifications 1. We do not specifically look at patients needs around medicines and do not routinely include medicines issues in contracts

4. Provides medicines oversight

5. The Board is aware of its obligations to provide governance, oversight and assurance of safe effective and affordable medicines usage. We routinely review all relevant data to monitor performance and ensure the provision of feedback to provider services 4. The Board is aware of its obligations to provide governance, oversight and assurance of safe effective and affordable medicines usage. We are in the process of developing our review and feedback systems 3. The Board is aware of its obligations to provide governance, oversight and assurance of safe effective and affordable medicines usage. We recognise the need to take action 2. We are aware that there are gaps in our understanding and are taking steps to develop processes to meet our obligations 1. We are unclear about our obligations around governance, oversight and assurance of medicines usage

5. Has medicines expertise

5. We understand the need for and have access to the full range of skills, expertise and knowledge necessary to ensure the safe, legal and effective use of medicines for our population 4. We understand the need for and have access to most of the skills, expertise and knowledge necessary to ensure the safe, legal and effective use of medicines for our population 3. We understand the need for and have limited access to the skills, expertise and knowledge necessary to ensure the safe, legal and effective use of medicines for our population 2. We accept the need for specific expertise but havent yet considered how it can be accessed 1. We are unclear about the full range of expertise required and have no provision to access specific medicines expertise

6. Supports and develops people

5. We have processes to ensure that people who are working with, or for us, in medicines management are competent, and we support and develops individuals to carry out their roles effectively 4. We have processes to ensure that people who are working with, or for us, in medicines management are competent and we are developing our support systems 3. We know what competencies are required and are beginning to develop our systems and processes to ensure that people working for us are competent and supported in their role 2. We need to understand the full range of competencies and develop our processes before we can develop the necessary support systems 1. We have no processes or support to ensure professionals are competent in medicines management

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A guide for Commissioning Consortia Boards

Appendix 2: Development process

The organisational competency framework in this document is based on the framework published in the working resource document: Ensuring the delivery of prescribing, medicines
management and pharmacy functions in primary and community care. An organisational competency framework and key functions checklist.2

This comprehensive document contained a detailed key functions list which underpinned the development of the competencies that commissioning organisations in the NHS would require moving forward. The document was published in November 2010 as a working resource for Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs) to assist with transition planning as they hand over their responsibilities to Commissioning Consortia and the National Commissioning Board. Anecdotal evidence suggests that this document has been heavily used by the NHS. As Commissioning Consortia began to form it was recognised that Consortia needed a version of the competency framework specifically aimed at their Boards. A small steering group was given the task of developing that resource which was user tested with GPs and medicines management leads. The framework in this document has been refined to take account of changes to the commissioning landscape since November 2010 and has been designed to be a relatively short, practical tool to engage Consortia Board members in discussions about how best to deliver on their medicines management functions.

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Appendix 3: Acknowledgements
Steering group Ryszard Gill Clive Jill Jonathan Lelly Catherine Steve Carol Janice Peter Bietzk Harvey Jackson Loader Mason Oboh Picton Pike Roberts Steele Rowe General Practitioner Head of Medicines Management Chief Executive Associate Director Medicines Management National Clinical Director for Primary Care and Community Pharmacy Consultant Pharmacist, Care of the Elderly Commissioned Project Lead General Practitioner Pharmacy lead Deputy Chief Pharmacist, Croydon PCT National QIPP Lead for Medicines Use and Procurement West Essex PCT National Prescribing Centre National Prescribing Centre NHS South West Department of Health NHS Lambeth For National Prescribing Centre Coastal West Sussex GP Commissioning Federation East of England NHS NHS Croydon Department of Health

User testing groups Rachel Rebecca Helen John Steve Peter Julie Andy Andrea Ainger Birchall Burgess Hickey Hulme Johnstone Landale Lee Loudon Principal Pharmacist Pharmacy Adviser GP Prescribing Lead South Manchester Lead Pharmacist Medicines Governance Assistant Director of Medicines Management General Manager Head of Medicines Management General Practitioner Head of Medicines Management NHS North Yorkshire NHS Western Cheshire South Manchester PBC Western Cheshire PCT NHS Derbyshire County Liverpool Healthcare Calderdale PCT NHS Wirral NHS Cumbria

Coastal West Sussex Commissioning Federation tested a draft version of this document in a half day workshop with their medicines management team, consortia chair and GP prescribing lead. Representation from the three Wirral Commissioning Consortia tested a later draft of the document in a meeting with the NHS Wirral Head of Medicines Management

Ground Floor, Building 2000, Vortex Court, Enterprise Way, Wavertree Technology Park, Liverpool L13 1FB Tel: 0151 295 8671 www.npc.nhs.uk National Institute for Health & Clinical Excellence 2011