Logo: NHS East of England Collaborative Procurement Hub

Contracting of Homecare Medicines Services

Terminology

All homecare medicines services provided for the NHS must be covered by an appropriate contract in order to comply with the RPS Professional Standards.

In relation to pharmacy homecare medicines services contract terminology is often misunderstood and on occasion misused. The following information is provided specifically in relation to the context of the homecare medicines services market in England.

Homecare service contracts are formed in a number of parts:

Contract:

A legally binding document between two parties detailing the responsibilities and obligations of each for the successful delivery of the specified products / services.

Service Level Agreement:

A Service Level Agreement (SLA) can form the entirety or part of the contract defined as above.

Service Specification:

A detailed list of the contracting authority’s requirements in relation to the contracted service and/or products. The Commercial Medicines Unit has developed a standard homecare service specification. This can be found on the Royal Pharmaceutical Society website.

Commercial Offer / Pricing Schedule:

Commercial information relating to costs associated with delivering each and all aspects of the service specification.

Tender Response:

Supplier’s responses to questions asked during an OJEU tender process in relation to compliance and specific methodology of delivery of the service specification.

Terms and Conditions:

Terms to be met by both parties to allow successful provision of the service specification. Services provided to the NHS should be aligned to the NHS Standard Terms and Conditions for the Supply of Goods and Provision of Services.

Pharma Funded vs NHS Funded

There are both similarities and differences between contracting of homecare services funded by pharma companies and those funded from within the NHS. Differences stem from the introduction of a third party (Pharma Company) to the equation as well as compliance with NHS terms and conditions and public contract regulations 2015.

Contracting of NHS Funded Homecare Services under a Framework Agreement

The East of England NHS Collaborative Procurement Hub (EoECPH) has established a homecare framework agreement for member trusts. The framework agreement comprises of four elements listed above (service specification, commercial offer, tender response and terms & Conditions) however it is not a contract in it’s own right.

The EoECPH has provided member trusts with a template Service Level Agreement (SLA) for direct call off which references the overarching framework agreement. When completed this SLA and all elements of the framework agreement form the contract between the trust and the selected homecare provider.

Unless stated otherwise, the duration of the contract will be aligned to the term of the framework agreement.

Contracting of Pharma Funded Homecare Services

First, a contract is established between a pharma company and a preferred homecare provider to deliver a specified product and associated homecare services to NHS and private patients. A Pharma Company may choose to select multiple preferred homecare providers. Historically sight of these documents within the NHS is very difficult due to the nature of the commercial agreement.

Current practice is for the preferred homecare provider to approach the NHS with a Service Level Agreement (SLA) document prior to service implementation.

This SLA does not sit directly under either the pharma-homecare provider contract or an NHS framework agreement and is therefore a standalone contract in it’s own right. Therefore this contract must contain the elements above (Service specification, pricing schedule and terms and conditions) usually. Note: Tender response is not applicable in this scenario due to lack of formal procurement process

As a standalone contract, consideration should be given to the term (duration) and termination as well as the overall terms and conditions’ alignment with the NHS Standards.

 

Hub Logo - homecare

Contracting of Homecare Medicines Services in the East of England

NHS Funded Homecare Medicines Services

Dispense and Deliver Homecare Framework Agreement

A framework agreement for homecare medicines services was first established in the East of England on 1st February 2010 and re-tendered in March 2014, covering the most common dispense and deliver variation of homecare. Five homecare providers are awarded to this framework agreement:

  • Alcura UK Limited
  • Evolution Homecare Limited
  • Fresenius Medical Care
  • Healthcare at Home Limited
  • Polarspeed Distribution Limited


For EoECPH member trusts with a pharmacy login, further information about this framework can be found using the “Pharmacy Contracts Search”. If you work for a member organisation and would like a pharmacy login, please contact joe.bassett@eoecph.nhs.uk

Home Delivery of Intravenous and Subcutaneous Immunoglobulin

The EoECPH established a framework agreement for home delivery and associated nursing services for intravenous and subcutaneous Immunoglobulin in August 2014 on behalf of the NHS Commercial Alliance. Three providers are awarded to this framework agreement: 

  • Alcura UK Limited
  • Bupa Home Healthcare Limited
  • Healthcare at Home Limited


For EoECPH member trusts with a pharmacy login, further information about this framework can be found using the “Pharmacy Contracts Search”. If you work for a member organisation and would like a pharmacy login, please contact joe.bassett@eoecph.nhs.uk

Bespoke Homecare Service Procurement

The EoECPH is able to provide bespoke procurement of specialised homecare areas for individual or select collectives of NHS trusts on a case by case basis.

Most recently we have supported Papworth Hospital NHS Foundation Trust to procure a compounded Intravenous antibiotics service.

If there is a particular homecare service, not covered by existing frameworks, that you would like the EoECPH to consider tendering on either a regional or bespoke basis please contact joe.bassett@eoecph.nhs.uk

Pharma Funded

Challenges Relating to Contracting of Pharma Funded Homecare Services

The existing processes around contracting of pharma funded homecare services were established many years ago and since then we have seen a rapid expansion of the market along with the publication of professional standards and national guidance by the Royal Pharmaceutical Society. Examples of challenges surrounding implementation of these services include:

  • No sight of contract between pharma and homecare provider.
  • Terms and Conditions proprietary to the homecare provider and often not aligned to NHS standard terms and conditions.
  • SLA (Service Level Agreement) often not recognised by NHS as an independent, legally binding contract.
  • SLA between NHS and homecare provider often inappropriately linked to the contract between pharma and homecare provider.
  • SLAs reviewed and negotiated locally leading to wide variation both regionally and nationally.
  • SLAs are seen as a barrier to service implementation or as only a requirement for compliance with professional standards as opposed to a vital tool to effectively manage a homecare service.
  • Homecare provider selection process does not reflect requirements under relevant procurement law and legislation.
  • Legal responsibilities and obligations of the pharma company are not clearly identified within the NHS – homecare provider SLA.

Review of NHS Contracting of Pharma Funded Homecare Medicines Services

The acute trust chief pharmacists within the East of England have collectively identified contracting of pharma funded homecare services as a key area in which they require support. This is largely due to significant burden the review process for SLAs applies to the limited available resource within the trust. The EoECPH are currently working on three projects aimed toward supporting this requirement.

East of England Whole Cycle Review

The EoECPH is approaching this project as a review of the whole contracting process with the principle of open collaboration toward an appropriate outcome that is agreeable to all stakeholders, reflects stakeholder’s legal responsibilities in relation to procurement legislation and minimises administrative burden through standardisation.

A multidisciplinary stakeholder group has been identified following a preliminary event attended by over 60 delegates in which four alternative models were reviewed and one selected as the preferred. The EoECPH has been tasked to produce a procurement strategy based on this preferred model for future consultation with the group.

National Workstream

The EoECPH also continues to support the work of the National Homecare Medicines Committee which is currently aimed at producing a standardised template SLA to form the basis of future NHS – homecare provider contracts as well as a standard memorandum of understanding to be signed by the pharma company reflecting their responsibilities.

Bespoke Review of Specific Homecare Provider Service Level Agreements

Recognising that the above projects are longer term solutions to a problem currently facing trusts on a regular basis, the EoECPH has agreed to review specific SLAs on a bespoke, ad hoc basis to support local trusts when initiating new services in the short term. To maximise the benefit of this work, comments / concerns identified during review of SLA documents will be made available on the EoECPH website for member trusts to utilise.

Member trusts with a pharmacy login can find reviewed SLAs here.

If you are an EoECPH member and would like a pharmacy login please contact joe.bassett@eoecph.nhs.uk

This does not replace any requirement for local review and approval of contract documents as per hospital policy and is instead the views of an individual for consideration during this process.

This bespoke process is time consuming and would not be sustainable if applied to all SLAs for all trusts. Volume of requests will be reviewed regularly and consultation with the sourcing group for an alternative solution may be sought if required.

 


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[Information on these pages is representative of the EoECPH homecare team only]