EVIDENCE BASED COMMISSIONING NHS KIRKLEES BOARD- 27 OCTOBER 2010
Background Evidence-based commissioning aims to support collaborative development by PCTs, using the SCG mechanisms. In conjunction with providers and clinical networks, the EBC uses a single regional process to deliver consistent written statements and policies for non-specialised drugs and interventions for publication by PCTs. The EBC programme is led by Ailsa Claire and supported by a project team, which includes the following: • Professor Chris Welsh, YHSHA • Professor Paul Johnstone, YHSHA • Jayne Brown, CE NHS North Yorkshire and York • Dr Peter Reading, Doncaster and Bassetlaw Hospitals FT • Paul McManus, YHSCG • Kate Whitfield, SHA The EBC programme has been divided in to a number of waves of policy development by PCTs, from wave one (sharing of existing policies) to wave three (identification and prospective development of new topics based on PCT priorities). Wave one started with a stock-take of all PCT commissioning policies in the region. The author PCT was invited to review their policy, to ensure that it was still relevant, accurate, and reflected current evidence, and convert it into the regional policy template. These standardised policies were then submitted to the project team for review and the policies were scrutinised at a meeting of two sub-groups of the Regional Policy Sub Group, comprising: • • • •
Dr Matt Walsh, NHS Calderdale and Chair of RPSG Annabel Johnson, NHS North Yorkshire and York Neill McDonald, NHS Kirklees Paul McManus, YHSCG
• Dr Kevin Smith, YHSCG • Greg Fell, NHS Bradford & Airedale • Paul McManus, YHSCG As part of this scrutiny, assurance was sought that there had been clinical input to the development of the policies, and that they had been equality impact assessed.
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Policies approved by the PCTs via the Specialised Commissioning Group Wave 1 policies were presented to the Specialised Commissioning Group at their meeting on 24th September and 19 policies were adopted as regional commissioning policies. These polices are: • • • • • • • • • • • • • • •
Armour Thyroid (thyroid tablets USP, Forrest Pharmaceuticals) and other non – UK licensed products (Hypothyroidism) Bevacizumab (Avastin, Roche) – (Metastatic Colorectal Cancer) Botulinum toxin type A (botox, Allergan; and all other brands) – (Hyperhidrosis) Botulinum toxin A (Available as Botox (allergen), Vistabel (Allergen), Dysport (Ipsen), Xeomin (Merz pharma), Azzalure (Galderma) – (Overactive Bladder) Botulinum toxin type A (Available as Botox (Allergen), Vistabel (Allergen), Dysport (Ipsen), Xeomin (Merz pharma), Azzalure (Galderma) – (Prophylaxis of Migraine) Botulinum toxin A (Available as Botox (Allergen), Vistabel (Allergen), Dysport (Ipsen), Xeomin (Merz pharma), Azzalure (Galderma Ltd) – (Anal Tissues) Cetuximab (Erbitux, Merck) – (Metastatic Colorectal Cancer) Co-careldopa 2000mg/500mg intestinal gel for administration via PEG tube – (Parkinson’s Disease) Penile Prostheses – (Erectile Dysfunction) Gemcitabine IV infusion (Gemzar, Eli Lilly) Capecitabine 150mg or 500mg tablets (Xeloda, Roche) – (Pancreatic Cancer) Infliximab – (Hidradenitis Supportiva) Mecasermin (Increlex, Ipsen) – (Growth Failure) Rituximab – (SLE) Sacral Nerve Stimulation [SNS] (Sacral Nerve Neuromodulation) – (Urinary retention/urinary urge incontinence/faecal incontinence/chronic constipation) Spinal Cord Stimulation (neuromodulation) – (Intractable Chronic Pain)
These policies now need to be implemented via each PCT in Yorkshire and the Humber. A further 16 policies were endorsed by the Specialised Commissioning Group but not formally adopted as regional policy. It was agreed that PCTs should adopt these unless there were specific local reasons not to. PCTs would feed back to SCG if they were not planning to adopt any of these policies. In NHS Kirklees, the Clinical Effectiveness Group will take responsibility for assessing if we wish to adopt these polices and these will be submitted to the Board for approval at a later date. Implementation of EBC policies – SCG Role Whilst the policies developed through Evidence Based Commissioning are primarily for non-specialised services, the Specialised Commissioning Team will seek to support PCTs in the implementation of these policies, through:• • • •
Circulating copies of the policies once they have been approved Identifying common audit criteria for those policies deemed a priority for ongoing audit and monitoring Providing advice and support to PCTs in implementing the policies Providing training for Individual Funding Request panel members and managers
Implementation of EBC policies – PCT Role PCTs will need to lead the implementation of all EBC policies that relate to the contracts they hold with secondary care. (i.e. not covered by SCG contracts). PCTs should follow Z:\Corporate Services\Meetings\Board\2010\Oct 10\PDF 2\KPCT-10-184 2 Briefing Note for Commissioners Oct Board.docx Policies Filename and Path: Z:\Corporate Services\Meetings\Board\2010\Oct 10\PDF 2\KPCT-10-184 2 Briefing Note for Commissioners Oct Board.docx -2-
any existing mechanisms and processes for implementing policy, but we would recommend the following actions as a minimum, to ensure that these policies are properly implemented and the associated financial benefits realised:• • •
• • •
Local assessment of the impact on activity and finance, if deemed necessary To carry out any additional local patient and public engagement, if deemed necessary Communication and engagement with primary and secondary care, to:o Minimise inappropriate referrals o Ensure inappropriate referrals are returned from secondary care o Advise primary and secondary care about the various work on policies underway regionally, to identify stakeholders and gain clinical engagement early on in these processes Publication of the policies (for example on the PCT website), in accordance with directions from the Secretary of State (April 2009). Incorporation of policies (and audit criteria once available) into contracts, with appropriate incentives/penalties Audit and monitoring of compliance against the policy.
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