The Cheshire and Merseyside Commissioning Policy 2014/15 St Helens Council Overview and Scrutiny Committee September 11 th 2017 Dr Ruth Hunter
Topics to be covered today • What is the Commissioning Policy? Why do we have it? • • How does it work? • Why are we reviewing the policy? • How have we conducted the review and where are we up to? • What engagement are we doing?
What is the Commissioning Policy Terminology The policy contains guidance about procedures* which are not routinely undertaken in the NHS and also refers to medicines or equipment which is not commonly prescribed in the NHS. Policy covers a wide range of specialties and sets out the criteria for patients having these procedures and how they must be met. Examples of clinical specialties the policy Examples of procedures in the policy covers Ear, nose and throat Knee replacement surgery Orthopaedics Removal of tonsils – tonsillectomy Dermatology Continuous Glucose Monitoring Systems for Continuous Glucose Monitoring in Type 1 Diabetes Mellitus Ophthalmology Surgery or laser treatment for short sightedness or long sightedness * The presentation will use the term procedures for simplicity
Why do we have the policy? Ensuring that public money is used to give the most health gain possible for all the population Not all the procedures work equally well for all • people • Problem would have solved itself without any intervention anyway • Very expensive and may not always give the desired result • Procedure is recommended by NICE** in limited circumstances • Little evidence of efficacy, limited research done **NICE – National Institute for Health and Clinical Excellence
Terminology • The policy sets out criteria that must be met for the patient to have the procedure • Some of the procedures which are in the policy are called procedures of low clinical priority (PLCPs) ‐ there are 2 routes which can be considered for PLCPs • Some of the procedures in the policy are called not routinely commissioned procedures (NRCs) – there is only one route to use for an NRC
Example ‐ Criteria for knee replacement – a PLCP • Funding for total knee replacement surgery is available if the following criteria are met: • 1. Patients with BMI <40. • AND • 2. Patient complains of moderate joint pain AND moderate to severe functional limitations that has a substantial impact on quality of life, despite the use of non ‐ surgical treatments such as adequate doses of NSAID analgesia, weight control treatments and physical therapies • AND • 3. Has radiological features of severe disease • OR • 4. Has radiological features of moderate disease with limited mobility or instability of the knee joint • Clinician can go ahead with the replacement if the above criteria are met
What if the criteria are not met? • Clinician submits an Individual Funding Request – IFR • IFR details why the patient’s case is exceptional • Panel considers the application – is this case truly exceptional • Makes a decision • Informs referrer eg GP or consultant • Informs patient • There is an appeal process • The CCG’s IFR process is run by Midlands and Lancashire CSU This process is also used for all NRCs in the commissioning policy
Cost of PLCPs and NRCs 16/17 PLCP NRC Number in 16/17 4,824 1,288 Cost in 16/17 9,221,578 1,818,094
Commissioning policy review – why now? Current policy Method – a 5 phase review • 3 year policy needs updating • CCG signed up for first 3 phases • Is the policy all up to date • Phase 1 and 2 almost completed • Confusing and hard to follow • Phase 3 beginning • Updated guidance on procedures eg from NICE • Lacks clarity • Contradictory
The The eng engagement pr process ocess • 18 of the 53 reviewed policies have been RAG rated red and therefore require some level of engagement • Back pain – 17 policies reviewed, in line with NICE guidance • For each red policy, an engagement level has been assigned, taking into consideration the equality impact assessments and the extent to which cohorts of the public may be affected. Please see below how levels are defined. Engagement Description Level 1 Survey posted online and offline with no target 2 Survey posted online and offline, targeted at specific cohorts of people through social media and support groups/charities 3 Survey posted online and offline, targeted at specific cohorts of people through social media and support groups/charities with additional face to face targeted engagement 10
Engagement methodology continued • Engagement Audiences include; • Clinicians ‐ through out the policy review process so far, clinicians have been consulted where required in their expert fields. Clinicians will also have the opportunity to provide feedback during the pre ‐ engagement period. • Public – public engagement will be targeted through social media and groups/charities for those policies which require it (detailed policy plans available upon request). A survey will be available for public to feedback on policy changes. Information will be provided online on each CCG website as well as leaflets and poster in GP surgeries and providers and some events. • Internal/Staff ‐ Existing channels of staff communication both in primary and secondary care will be utilized including staff forums, staff intranet and staff newsletters • Stakeholders – key stakeholders including Local Authorities, Voluntary Sector Organisations and patient support groups, will be provided with the detailed paper outlining engagement. 11
Engagement materials and channels • Survey – Online, Hard copy available at on request from some GP practice, over the phone (0121 612 3806) or your local CCG • Dedicated website landing pages on each CCG site, outlining the current policies out for engagement and the purpose of the project • Voluntary organisations/patient support groups/stakeholders such as MPs, councillors engagements – face to face meetings and phone calls • Targeted engagement for Level 2 and 3 engagement policies e.g. Alopecia UK, Age Concern, Changing Faces • Patient leaflet, posters, FAQ’s and ‘Plain English’ documents per policy. • Social media – Twitter and Facebook. • Press releases – proactive PR; launch, mid and summary • Dedicated email and phone contact point • Easy read documents for leaflet and FAQs • Information available in other languages and formats upon request • Reactive media statements signed off prior to engagement 12
Thank you Any questions
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