It is well documented that the NHS possesses the greatest purchasing power of any business in the UK. Yet the procurement function has traditionally not been able to turn this status to true advantage – supply chain inefficiencies are widespread due to the sheer size and scale of the procurement operation, and trusts buying independently of each other has led to inconsistencies between the amount they sometimes spend on purchasing the same products.
At a healthcare conference we held in June this year Rob Knott, national director for NHS procurement development at the Department of Health (DH), spoke about the lack of focus on this area on board agendas. He said: “Assurity of supply; risk; are our patients being given the right products at the right time; are some products not arriving so we’ve had to cancel operations, and so on – [the lack of focus] is not discussed at board level, and yet it’s one of the most critical things to look at in the organisation.”
Even so, the recognition that the hospital-wide procurement process needs to be reformed is long-standing, but leveraging capability – even that already widely used in other sectors – at the centre of possible solutions has not often been the approach taken.
The challenging situation in which the NHS now finds itself has accelerated this need however. DH published the eProcurement Strategy in May 2014, which estimated that trusts can save £1.5bn by the end of 2015‑16 through taking a cohesive approach to procurement based on global GS1 standards, national framework and local delivery.
In addition, after the initial investment has been made to support this shift, the cost savings will build and build over subsequent years.
Standards & technology
GS1 standards were mandated for use in NHS hospitals by the eProcurement Strategy. So what is the actual purpose of them – what do they do?
The simplest answer is that they uniquely identify ‘things’. The term has to be loose, as these things range from people (patients, care givers) and places (shelves, draws, wards, even bed locations) through to products (such as medicines, devices, surgical instruments) and items (such as medical records).
These ‘things’ are coded with identifying numbers that are globally unique. This ensures that when suppliers, buyers or clinicians share information on that item, they can be certain that there will be no conflicts with other items and that supporting supply chain processes can operate efficiently.
Once identified, the patient care pathway can also be fully tracked ensuring the right patient, receives the right treatment at the right time with the right product without ambiguity. This is of particular importance in a hospital context, as it prevents avoidable mistakes such as when patients receive the wrong medicine and enables effective recalls should they become necessary.
Identification standards are only part of the solution – having them in place massively increases operational efficiencies, but the eProcurement Strategy also ensures that supporting systems are deployed to help trusts get maximum benefit from standardisation.
There are a number of new services being introduced to support the identification of people, places, products and assets as well as the integration of systems across the entire NHS.
Shared product information
The first of these is the use Product Information Management (PIM) catalogue being fed from a GS1-compliant ‘datapool’, which forms part of the Global Data Synchronisation Network (GDSN) – using this platform, trusts are able to access a shared repository of supplier managed accurate data on the items procured for use in the NHS.
It also includes all the information about a product necessary to perform business transactions, which is synchronised in a standardised way between suppliers and buyers to make the trading process transparent and efficient for all parties involved.
The GDSN network already contains almost one million products registered for the healthcare sector, mainly medical devices following the US Food and Drug Administration’s rule on unique device identification.
The benefits to ensuring relevant parties are using shared, high quality data include improved availability of healthcare items in hospitals, reduced procurement costs, lowering risk of errors and never events and increased supply chain efficiency.
Locating stock efficiently
As mentioned above, GS1 standards do not just provide unique identification for items – they can actually be applied to a wide range of different ‘things’.
This includes locations such as shelves, wards or beds, which can be identified using a GS1 identifier called a Global Location Number (GLN). GLNs are specifically used to uniquely identify, deliver and store locations as well as electronic invoice and order points.
The eProcurement Strategy sets out the requirement for the deployment of a central GLN registry. This registry will enable unambiguous identification for both the physical locations of where to deliver goods and the destination of all business messages necessary between trading partners (such as purchase orders, advance delivery notifications, proof of delivery, invoices and remittance advice).
If a PIM and datapool enables unequivocal identification of the products and services a hospital purchases (or what we might think of as the ‘what’ of procurement), then this registry covers the ‘where’.
The combination of these solutions enables trusts to operate far more efficiently through access to accurate procurement data, good catalogue management and a consistent identification system to allow stock and equipment to be located quickly. Overall these support the roll-out of a fully integrated purchase-to-pay and product management process that substantially reduce the processing/management overhead.
GS1 and patient care
All efficiencies made in the supply chain ultimately result in increased potential for improvements in patient care.
Being able to know unequivocally what something is – and where – seems like such a fundamental and obvious point that it is easy to overlook just how important it is in ensuring everything else functions effectively.
For example – a joint survey with Nursing Times in 2010 found that nurses spend on average one hour in every eight-hour shift searching for missing stock or patient records.
It is clear to see how consistent identification and tracking of items would free up time that could be refocused on caring for patients.
Electronic health records also have an important role to play in enhancing current processes, enabling automated completion at all stages of patient engagement in theatre, clinic and pharmacy, and providing verification for medicines and devices at the point of use.
They can even form part of a system for automating stock replenishments where necessary in line with forecast requirements.
The quality of the data within these records is a key factor in how effective they – and indeed all internal processes – are able to be.
There are always challenges associated with widespread change, particularly where new technologies are introduced, and how this change is managed will be an important factor in determining its success.
All trusts are now required to appoint a GS1 lead to help develop and oversee a GS1 standards adoption plan by 2015.
The National Information Board also published the Personalised Health and Care Strategy 2020 in November – this paper sets out a framework for enabling England to become a global leader in the provision of digital health and care services that improve patient safety and transparency.
We fully support the proposal set out in this paper to embrace GS1 standards and, building upon the approach set out in the eProcurement Strategy, we believe the foundations will be in place to develop an exemplar world-class healthcare service.
Change may present challenges, but the potential benefits of implementing these solutions successfully – and consequences of not implementing this essential evolution – are far more significant.