A homecare medicines delivery service can be described as a service that delivers ongoing medicine supplies and, where necessary, associated care, initiated by the hospital prescriber, direct to the patient’s home with their consent. The purpose of the homecare medicines service is to improve patient care and choice of their clinical treatment. ^[1]

Homecare services are provided to over 200,000 patients in the UK representing £1.5 billion of the £4 billion spent on hospital medicines. The sector has grown rapidly and continues to develop and expand to meet patient demands and NHS cost containment targets ^[1].

^{[1] Royal Pharmaceutical Society – Professional Standards for Homecare Services in England.}

Types of Homecare Medicines Services

Homecare medicines services can be categorised in a number of ways, below are two examples:

Funding Routes

Funding for a homecare medicines service typically falls to two entities, the NHS or a product manufacturer (pharma).  Services may be funded privately in very rare circumstances. 

Manufacturer Pharma Funded Homecare Medicines Services

What are manufacturer pharma funded homecare services?

Manufacturer pharma funded homecare services (also known as pharma schemes) are homecare medicines services for which one or more homecare providers are commissioned by the marketing authorisation holder of a drug (manufacturer) to provide a homecare service to patients.

For the majority of manufacturer funded homecare services, the NHS is liable only for the cost of the medicine.  The service and consumable product costs are funded by the pharma company.  Where a pharma funded homecare medicines service is available for a medicine, it typically becomes the preferred supply route. Therefore, pharma manufacturer funded homecare services form the majority of all homecare services provided by NHS trusts across the country, by both patient volume and expenditure.

Manufacturers often establish manufacturer funded homecare medicines services with the aim of improving the patient experience, achieving consistent national product accessibility and collecting more granular product usage data (compared to traditional wholesale supply routes). Unlike data collected through these traditional routes, the data collected by manufacturers through manufacturer funded homecare medicines services includes details of anonymised patient demographics, therapeutic adverse event / reaction data.

To find out more about how the EoECPH supports trusts to implement and manage pharma funded homecare services please see the Contracting of Homecare Medicines Services page.

What manufacturer pharma funded homecare services are available?

The East of England NHS Collaborative Procurement Hub (EoECPH) originally collated a list of available manufacturer funded homecare medicines services for the benefit of its members.  We are pleased that this list has since been adopted by the National Homecare Medicines Committee and is maintained by colleagues in the East Midlands Pharmacy Collaborative on their behalf.  Data is provided quarterly by the homecare medicines services providers.

Not accurate? If you have information to update or correct the content of this list please contact pharmacy@eoecph.nhs.uk.

NHS Funded Homecare Medicines Services

NHS funded homecare services operate on a traditional outsourced service model whereby both product and service costs are payable by the clinical referring centre.

NHS funded homecare medicines services can be procured at national, regional and local level. The Commercial Medicines Unit undertakes national procurement of homecare medicines services for speciality areas such as home parenteral nutrition and enzyme replacement therapy (ERT). Regional procurement hubs like EoECPH procure on behalf of clinical referring centres within a geographical region, most commonly using framework agreements to provide a route to market for member organisations.  On occasion a clinical referring centre may procure a local contract for niche and, typically, complex bespoke local requirements. The EoECPH is positioned to support these local procurements as required.

To find out more about how NHS funded services are procured in the East of England please see the Contracting of Homecare Medicines Services page.

Homecare Medicines Service Design

Homecare medicines services can be designed to satisy a variety of different requirements to meet the needs of the patient and the clinical referring centre.  The following categories are defined within the RPS Professional Standards for Homecare Services.

Low tech homecare service

Activities include

• self-administration of oral therapy or medicinal products for external use only excluding oral oncology
• products are licensed medicines or uncomplicated medical devices
• product storage conditions are 15-25 C and/or 2-8 C suitable for storage in the patient’s own fridge
• self-administration of medicines is usually in accordance with the Summary of Product Characteristics, occasional off-label use
• homecare team members are expected to identify and report obvious misuse of medicines and noncompliance
   

Mid tech homecare service

Activities include

• products that are unlicensed medicines
• therapy that requires significant clinical support or diagnostic testing such as blood level monitoring as part of the homecare service e.g. oral oncology
• patient training and competency assessment relating to self-administration
• self-administration needing basic aseptic technique and standard ancillaries e.g. pre-filled syringes
• medications with special storage requirements
• provision of refrigeration equipment
• compliance and/or concordance programmes including specified interventions
   

High tech homecare service

Activities include

• intravenous infusion
• self-administration needing advanced aseptic technique and / or portable equipment / specialist ancillaries
• products that are compounded aseptic medicines
• administration by healthcare professional
• clinical decisions taken within approved clinical protocol with escalation of out-of-limit findings to the clinically responsible person
   

Complex homecare service

Activities include

• provision of bespoke homecare solutions for individual patients not covered by national standards
• permanent or semi-permanent adaptation of the home environment required as part of the service
• permanent or semi-permanent installation of equipment in the home
• clinical responsibility delegated to a third party
• clinical trials including homecare services

 

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