Review of the Cheshire and Merseyside Commissioning Policy 2014/15 - - PowerPoint PPT Presentation

Review of the Cheshire and Merseyside Commissioning Policy 2014/15 St Helens Council Overview and Scrutiny Committee December 3rd 2018 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 covers Examples of procedures in the policy diabetes Continuous glucose monitoring Orthopaedics Secondary Care Administered Steroid Peripheral Joint Injections Urology Policy for Prostatism/Lower Urinary Symptoms in Men Ophthalmology Cataract * 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

Commissioning policy review – why now?

Current policy

• 3 year policy needs updating
• Is the policy all up to date
• Confusing and hard to follow
• Updated guidance on procedures eg

from NICE

• Lacks clarity
• Contradictory

Method – a 6 phase review

• CCG signed up for first 3 phases
• Phase 1 and 2 completed
• Phase 3 underway

Terminology

• The policy sets out criteria that must be met for the patient to have

the procedure

• CBCTs can be carried out if a patient meets a set of criteria
• Or they can be carried out if funding is agreed via an individual

funding request But some of the procedures in the policy are

• Restricted - not routinely commissioned procedures (NRCs) – there is
• nly one route to use for an NRC and this is an application to the IFR

panel

Cost of PLCPs and NRCs 17/18

PLCP NRC Number in 17/18 Cost in 17/18 4562 7,994,329 1144 1,589,418

Example

What if the criteria are not met for a CBCT or the procedure is for an NRC?

• 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

The engagement process The engagement process The engagement process The engagement process

• Initial plan – pre-consultation engagement for 8 policies and the assisted conception policy
• Will begin December to mid January 2019
• Consider feedback and then update the equality impact and risk report:
• formal consultation may follow avoiding purdah
• See below how levels of engagement are defined.

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Engagement Level Description 1 Survey posted online and offline with no target 2 Survey posted online and offline, targeted at specific cohorts

• f people through social media and support groups/charities

3 Survey posted online and offline, targeted at specific cohorts

• f people through social media and support groups/charities

with additional face to face targeted engagement

The word engagement is used to cover any engagement of consultation activities for clarity The word engagement is used to cover any engagement of consultation activities for clarity The word engagement is used to cover any engagement of consultation activities for clarity The word engagement is used to cover any engagement of consultation activities for clarity

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 any engagement periods.

• 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

• utlining engagement.

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Engagement materials and channels – as appropriate

• Survey – Online, Hard copy available at on request from some GP practice, over the phone (0121 612 3806)
• r 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 where needed
• Patient leaflet, posters, (for consultation only) 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
• Information available in other languages and formats upon request
• Reactive media statements signed off prior to engagement

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Which policies are we engaging about?

• Treatments for Dupuytrens Disease
• Botulinum Toxin A & B
• Policy for Prostatism/Lower Urinary Symptoms in Men
• Secondary Care Administered Steroid Peripheral Joint Injections
• Cough Assist Devices
• Continuous Glucose Monitoring
• Insulin pumps
• Transanal irrigation
• Assisted conception policy

Thank you

Any questions