Primary care treatment funding decisions:
developing a resource to share the evidence
Linda Ward
Clinical Review & Effectiveness Specialist , EMSCG
Linda.ward@emscg.nhs.uk
Overview
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Commissioning NHS services
Local decision making - ethical framework
Individual Funding Requests (IFR) - a regional policy
IFR database for audit and monitoring
Project risks and concerns
Benefits
Future developments
Commissioning NHS services
East Midlands
Nine PCTs
Clinical networks
Public Health
Cancer
Renal
Burns
Neonatal
Specialised Services
National Definition Set
Local decision making
Ethical framework
• Equity
• Evidence of clinical and cost effectiveness
• Cost of treatment
– Affordability
– Rarity
– Opportunity costs
• Needs of the community
• National standards / NICE
• Individual patients
Individual Funding Requests (IFRs)
• Richards Report* 2008
“unexplained variations in access to treatment”
• Regional Individual Funding Request (IFR) Policy 2009
“promotes rational, consistent and transparent decision
making based on a single decision making framework
e.g. definitions of exceptionality / rarity
• Audit and quality assurance of policy implementation
to identify and overcome unexplained variation in local
decision making and promote equity in decision-making
*Improving access to medicines for NHS patients: a report for the Secretary of State for Health by Professor Mike Richards. 2008
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_089927
IFR database
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Secure, web-based database for real-time data entry
• Single data entry point with data collection consistent
across the region
• Searchable
• Reports for PCTs and EMSCG
• Meets requirement for a regional monitoring and audit
process
• Shared development and maintenance costs
Search and report functions
Individualised log-in. Amendments auditable
Contact details for all
funding request teams
Search by any of the fields shown
Search by PCT or search ‘all’ to find similar requests
Patient Identifiers and ‘view’ function only visible for own organisation
Start a
new record
Search, generate a report on the search results
or extract all data to excel for audit
Unique
identifier
A sample record
Dynamic record of
related activity or
documents added
Edit sections of
record via tabs
New options
visible
as request
passes
through the IFR
process
Tracking status timeline (against 40 day
policy standard for decision) starts when
funding request form uploaded
All decision points include a free text field for entering information supporting and making transparent the reasons.
The complete record can be printed at any point for review at panel.
The completed decision framework document will be included and will be signed off by the chair of the IFR panel.
Project risks and concerns
Technical
• Escalation of costs and delays in development due to
unrecognised technical requirements
• Technical barriers to daily use of a web-based product e.g.
limited local bandwidth and slow Internet connection
Resolved
Users
• Transition between old and new data collection systems
Resolved ??
Tight project management and engagement with all
stakeholders via project board e.g. to clarify processes and
identify acceptance criteria and quality expectations
Hosted on NHS.net and supported by local Health
Informatics Service
Benefits
• Improved communication and mutual support for IFR teams
• Collective learning and knowledge sharing (e.g. evidence
searches) reduces duplication and can make funding
decisions speedier
• Promotes equity with consistent funding decisions
• Outliers, especially where there is a regional policy, can be
identified and justified
• Identifies interventions (e.g. new specialised service
devices) where a regional perspective is needed
• Highlights discrepancies in who is responsible for dealing
with requests - specialised and non-specialised can be
better identified and directed to the appropriate team
…in summary
Benefits to patients from the database and audit are:
• The promotion of transparent and equitable local
decision making based on shared decision frameworks
and evidence reviews
• Timely access to information to support decision making
results in speedier processes and access to treatments.
Benefits to the NHS
• Provides value for money
• Maximises capacity
• Time and resource saving
• Minimises PCT exposure to corporate and clinical risks
e.g. costs (cash and public relations) of judicial Review
Future developments
• NHS changes & uncertainty about how IFRs to be managed
• Consolidate the database and make adjustments to it's
functionality e.g.
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Monitoring and follow-up of successful funding requests
Evidence summary documents to be uploaded and stored
alongside the requests
• The database is a fully functional, robust audit and reporting
framework that will meet the needs of future decision
makers, local and national.