Introduction to clinical commissioning and prioritisation

Question 1

What is commissioning?

Answer 1

• Continual process of planning, agreeing and monitoring services
• Includes health-needs assessment for a population

Question 2

Who can commission services?

Answer 2

• Local authorities
• Integrated commissioning board locally
• NHS England on local, regional and national bases

Question 3

Groups involved in commissioning

Answer 3

• Health Equity committee - do we have correct services? distribute according to need
• Quality and Safety committee - evidence based criteria
• Clinical executive group - GPs, Public Health assessing what policies need refreshing/prioritising
• Collaboratives - local authority + hospitals + community working together

Question 4

How are resources allocated in NHS?

Answer 4

• ICBs (commissioners) receive funding directly from NHS England
• They then plan and buy services from organisations which provide patient care including GP practices, hospitals, mental health and community trusts
• Funding is tried to be shared fairly and appropriately considering competing demands on NHS budget

Question 5

Commissioning cycle described

Answer 5

1. Assess needs
2. Review current services
3. Decide priorities
4. Design service
5. Shape structure of supply
6. Manage demand - ensure appropriate access
7. Clinical decision making
8. Manage performance

Question 6

How can services be organised to try and reduce costs and manage diseases?

Answer 6

Tiering system
* Tier 1 - universal services (eg reinforcement of healthy eating and activity messages)
* Tier 2 - lifestyle interventions (eh weight management services like slimming world)
* Tier 3 - specialist services (multidisciplinary team, specialist assessment)
* Tier 4 - surgery (eg bariatric surgery)

Question 7

Why is health economics important?

Answer 7

• Helps make some of the underlying values that help us allocate resources explicit
• Relies on and contributes to evidence used by clinicians to treat

Question 8

What do we use to determine health economics?

Answer 8

QALY

If you don’t know how to calculate cost per QALY - check the lecture

Question 9

How is cost per QALY gained used for decision making?

Answer 9

• If below £20K - NICE normally approves
• If between £20-30K - NICE takes into account distinctive benefits not captured in QALY
• Above £30K needs stronger case

Question 10

What is the function for clinical prioritisation?

Answer 10

• Produce guidlines that help commissioners choose allocation of resources to benefit most
• Advise commissioners on interventions that should be high and low priority
• Develop eithical framework to make fair and consistent decisions to treat patients equally
• Assess patients health needs according to their ability to benefit from healthcare

Question 11

What are individual funding requests?

Answer 11

• There is a commissioning policy for every treatment - in principle
• BUT it is impossible to predict every new condition and treatment there is a process to decide whether to fund individual requests

Question 12

Who are individual funding requests for?

Answer 12

• Patients who fall outside of what is currently commissioned and have genuinely exceptional circumstances

Question 13

When can someone apply for individual funding requests?

Answer 13

• If clinician believes their patients clinical situation is different to other patients with same condition

Question 14

What is the individual funding request panel?

Answer 14

They consider requests for treatments that are not routinely available based on patients clinical circumstances

Question 15

Who is usually on an individual funding request panel?

Answer 15

• Commissioners
• Secondary care clinicians
• GPs
• Public health consultants
• Lay representaitives
• Pharmacists

Question 16

Checklist for Panel when assessing individual funding requests

Answer 16

• Anticipated clinical benefits over other options available
• Why can they not have standard treatment
• Impact of not funding, other treatmetns available?
• Would it set precedent for other requests - would other people want the same?
• Is this patient exceptional?

Question 17

When is a patient classed as exceptional?

Answer 17

• Patient is in different clinical condition when compared with typical patient population with same condition
• And because of that difference the patient is likely to receive additional clinical benefit from this treatment

Question 18

Recommendations found from focus groups assessing public health interventions

Answer 18

1. Build trust and rapport
2. Improve access to healthcare
3. Improve knowledge and awareness

Question 19

How do we build trust and rapport (reccomendation 1)?

Answer 19

• Working alonside community to develop health events and info
• Patient participation groups need to be representative
• Upskill healthcare workers on cultural sensitivity and local language needs

Question 20

How do we improve access to healthcare (recommendation 2)?

Answer 20

• Explore alternative times for appointments eg weekends/evenings
• Re-evaluate community provisions eg mobile clinics if accessible and suitably located

Question 21

How do we improve knowledge and awareness? (recommendation 3)

Answer 21

• Make every contact count - in general and when engaging with community champions to target certain groups
• Engage homeless population to educate on cancer symptoms, screening and being transparent on procedures
• Use trusted sources to share info within community. Eg GPs and local health champions are most trusted sources