Linda Ward Clinical Review & Effectiveness Specialist, EMSCG Primary care treatment funding decisions: developing a resource to share the evidence

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 Overview

East Midlands Nine PCTs Clinical networks  Public Health  Cancer  Renal  Burns  Neonatal Specialised Services National Definition Set Commissioning NHS services

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 Local decision making

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 Individual Funding Requests (IFRs)

IFR database. 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 Search by any of the fields shown Search, generate a report on the search results or extract all data to excel for audit Search by PCT or search ‘all’ to find similar requests Patient Identifiers and ‘view’ function only visible for own organisation Individualised log-in. Amendments auditable Contact details for all funding request teams Unique identifier Start a new record

Edit sections of record via tabs New options visible as request passes through the IFR process Dynamic record of related activity or documents added 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. A sample record

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 Users Transition between old and new data collection systems 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 Resolved Resolved ??

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 Benefits

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 …in summary

NHS changes & uncertainty about how IFRs to be managed Consolidate the database and make adjustments to it's functionality e.g. 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. Future developments