Proactive approach to excluded drug queries

The Royal Wolverhampton NHS Trust, Midlands, Acute

The problem

Processing and reporting the Trust’s drugs is a time consuming piece of work each month for the Finance and Pharmacy teams. It needs to be extracted at patient level from the Pharmacy system, processed to flag each patient line of drug issue to be claimable through the NHS Payment Scheme according to the High Cost Drugs rules, and assigned to commissioners with respective drug and patient details. This enables the Trust to claim funding for drugs, however commissioners are challenging the charges for data quality and Blueteq approval.

The challenges

The data must be as accurate as possible and provided in a timely manner for internal finance ledger purposes to record income and prepare for reporting to commissioners later in the month. However, the drug data from the Pharmacy system is insufficient to meet the reporting requirements of commissioners, and a high majority of drugs require Blueteq approval, which is a commissioner assurance process for patient needs.

Historically, there had been instances where drugs were issued to patients without completing the necessary Blueteq approval forms or follow-up forms before dispensing. To ensure these key elements are addressed efficiently, we needed a process to accurately provide the drug details required by commissioners and proactively resolve any data or Blueteq approval issues before reporting to commissioners. Handling queries reactively would create a greater workload, requiring us to interact with various services, amend data, and then report the findings back to commissioners within the required timeframe.

Additionally, a high proportion of the Trust’s cancer drugs fund (CDF) drugs are manufactured in the Trust’s aseptic lab, and therefore the data from our core report is insufficient for the CDF data set. This puts the income for these drugs at risk, as NHS England CDF commissioners have adopted a policy of no payment without the required Blueteq approval and associated data to validate the charges.

What were/are the outputs?

There has been a significant reduction in CDF drug queries and faster payment processing for these drugs. The Finance team has saved time by amending the datasets and responding to services and commissioners more efficiently. Improved data compliance statistics have also been reported to the Trust from NHS England.

What were/are the outcomes?

Improved confidence in the data has been observed from both the Trust and commissioner’s perspective. As a result, commissioners have even turned off some of the standard queries in their process, and this improvement continues to grow as we refine the process further. The proactive and prompt monthly reports sent to services have enabled them to efficiently resolve issues, leading to better future outcomes.

The joint engagement of Finance and Pharmacy staff has resulted in a better understanding of changes in drug spend. As for CDF queries, the Trust recently ranked at the top of the league for the lowest proportion of drug queries in the region. Additionally, the Trust consistently maintains above 98% validated spend, which is an excellent achievement.

The Innovation

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What the peer-reviewers said

“The biggest strength of this innovation is the engagement of operational colleagues and is proving to solve this problem.”

“This innovation demonstrates how proactive engagement with pharmacy can improve income collection and save time.”

“The innovation has resulted in substantial time savings and increased confidence in data quality for the trust and commissioners, making it an efficient solution for other NHS areas.”

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