The Cheshire and Merseyside Commissioning Policy 2014/15 St Helens - - PowerPoint PPT Presentation

The Cheshire and Merseyside Commissioning Policy 2014/15 St Helens Council Overview and Scrutiny Committee September 11th 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 covers Examples of procedures in the policy 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 Cost in 16/17 4,824 9,221,578 1,288 1,818,094

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 5 phase review

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

The The eng engagement pr process

• cess
• 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.

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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

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

• utlining engagement.

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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

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Thank you

Any questions