Post on 24-Dec-2015
transcript
Specialised Commissioning
• Where does it fit into NHS England?– Alongside commissioning of primary care,
offender healthcare and aspects of armed forces healthcare
• What is included?– Prescribed services meeting defined criteria
• Budget of £13.8 billion pa (14% NHS budget)• Six national Programmes of Care
Operating model for specialist commissioning
• Single ‘do once’ function at national level
• Strategic interpretation at a regional level
• Provider/commissioning interface at Area Team level
Roles of CRG
• Specialised advice and guidance• Developing national service level strategy• Developing and providing assurance of
commissioning products• Evolving performance management role
Specialised Commissioning Taskforce
• Established April 2014• Improve how NHSE commissions specialised
services and to put commissioning arrangements on a stronger long term footing
• Seven work streams• Priorities– Deliver balanced financial plan– Reducing unwarranted variation & improving
quality– Strengthening commissioning infrastructure
What has been done?
• Service specification• Commissioning policies• CQUIN• Quality measures and dashboard• 5 year strategy• Collaborative working• Business as usual
Service Specifications
• Clear description of what a service is and the acceptable standards that need to be in place for delivery
• Benefits of country wide single service specification
• Recognise different ways of service delivery and interface with RDI CRG
• Concentrate on the ‘what’ not the ‘how’
Commissioning Policies
Current• Reimbursement of
expenses for living kidney donors
Consulting• Eculizumab for the
treatment of refractory antibody mediated rejection post kidney transplant
• Bortezomib for the treatment of refractory antibody mediated rejection post kidney transplant
CQUINs 2013/14
• Cold ischaemia time–DCD <12 hours–DBD <18 hours
• Increase use of Renal Patient View
Quality Measures
• NHS England/NHSBT agreement• Kidney Centre Specific reports– Robust data– Validated by centres– Available to units, commissioners, patients
• Purpose to reduce unwarranted variation and improve quality
RTR Dashboard
• Access to renal transplant– Median waiting time– DBD Organ Decline rates – standard & extended– % of living donor transplants that are pre-emptive
• Transplant outcomes– 1 & 5 year graft and patient survival rates for
deceased and living donor transplantation
Five Year Strategy
• Improving the deceased donor transplant patient pathway - from assessment to transplantation
• Living Donor Kidney Transplantation• Improving the deceased donor transplant
patient pathway - from assessment to transplantation
• Improving the effectiveness of kidney transplant follow-up
Business as Usual
• Advice and Guidance – Local Area Teams– Clinicians– Patient Groups– IFRs– Drug issues
• NICE stakeholder• Performance management
What is coming?
• National Tariff• QIPP• Future commissioning models• Peer Review• Managing capacity
Different ways of working
• Work-up – what, who, where?• Maintenance on list – what, who, where?• Transplant procedure• Follow-up – what, who, where?• Repatriation – who, when, where?
Need a single model of currency and costing that will capture different ways of working
Currency development
• Workshop January 2013• Mandated currency from April 2013• Four pilot networks – Effectiveness of recording currencies– Case mix audit undertaken – variation in investigations and
frequency • Workshop October 2013– Currencies best recorded through adapted clinic outcome
form – Broad agreement reached on pathway in terms of currency
and tariffs to be utilised
Next Steps
• Initial finance workshop June 2014
• Costings being modelled to currencies
• Shadow tariff 2015/16• National tariff 2016/17
QIPP 2013/14
• Immunosuppression prescribing– Secondary care prescribing & Homecare delivery– National Procurement– Push towards increased used of generic brands
• Pre-emptive living donor transplantation– Linked to NHSBT LDKT strategy
QIPP 2015/16
• Clinically led QIPP programme to produce 3% savings - £420 million
• CRGs working with area teams• Dilemma for transplantation – increased
activity vs savings– Increasing transplantation– Reducing unwarranted variation
Future Commissioning Models
• National specialised commissioning• Co-commissioning with CCGs• Commissioning by CCGs
Why consider peer review?
Benefits• Recognise and share
good practice• Identify and act on
reasons for non-standard variation
• Increase public and commissioner confidence
Disbenefits• Increased regulatory
burden• Negative perception• Time and resource
required