AGENDA ITEM 7
HEALTH AND SOCIAL CARE OVERVIEW AND SCRUTINY COMMITTEE
1 JULY 2010
PRIOR APPROVAL/LOW PRIORITY PROCESS: NHS BOURNEMOUTH AND POOLE
- INTRODUCTION
1.1.The purpose of this paper is to explain the prior approval/low priority process for patients in Bournemouth and Poole.
1.2.NHS Bournemouth and Poole and NHS Dorset commissioners have worked collaboratively with clinicians across primary and secondary care to develop a joint approach to provide clarity on procedures for procedures which require prior approval or which are low priority
1.3.A booklet has been produced to clarify for clinicians and the public those clinical procedures which will only be commissioned following prior approval by the commissioners and those low priority clinical procedures which will no longer be commissioned.
1.4.This paper is being presented to the Health Overview and Scrutiny Committee for consideration as it presents a change in approach to the activity which is commissioned for the local population.
- BACKGROUND
2.1.The NHS is at the forefront of medical technological developments some of which are of benefit to a very small number of patients at a very high cost per treatment. The National Institute for Health and Clinical Excellence (NICE) provides guidance on those procedures within this category which are cost effective and should be commissioned.
2.2.The NHS Contract with acute hospitals allows for the introduction of a prior approval process by the commissioners for these high cost/ low volume procedures which are NICE approved.
2.3.In addition there are a number of nationally recognised low priority procedures which on evidence of clinical effectiveness and cost efficiency should not be routinely commissioned.
2.4.It is however recognised that there may be individual patients with exceptional circumstances for whom a low priority procedure may be appropriate and there is a clear process to allow this to happen.
2.5.The NHS Bournemouth and Poole and NHS Dorset commissioners have developed this approach in line with national guidance from the Public Health Commissioning Network–“QIPP programme/Right Care/Value Improvement: Identifying Procedures of Low Value” February 2010.
2.6.This approach is also based on the Pan Dorset Individual Treatment policy and supports the work of the Pan Dorset Technologies Forum.
- CURRENT POSITION
3.1.An managed approach to prior approval and low priority procedures was introduced in October 2009. Feedback on the practicalities of the process and on the contents of the initial procedure guidance from both primary and secondary care colleagues has been considered and is reflected in an updated policy.
3.2.This revised prior approval/ low priority procedure policy was completed in June 2010 has now been developed and is currently out to consultation with clinicians.
3.3.This revised policy will form part of our specification for commissioned services with our acute hospitals. It will also be available on the PCT website and on the GP website.
3.4.The commissioners intend to use this policy as part of the programme of productivity improvements required to ensure best use of NHS resources within the current financial climate.
- RECOMMENDATIONS
4.1.We are asking the Health Overview and Scrutiny Committee to note the policy, the procedures outlined as requiring priory approval, or as low priority and the process for appeal, and provide views on the PCT approach.
- CONCLUSION
5.1.The introduction of a managed process for prior approval and low priority procedures is necessary to ensure the best use of NHS resources for the best outcomes for local patients.
5.2.This policy will effect the range of commissioned activity and ensure that there is an agreement and understanding amongst GPs and consultants about which procedures are standard and which require additional referral.
5.3.Individual patients with exceptional circumstances will be considered for treatment via an individual patient funding request process, and GPs or consultants can refer cases to an independent panel for further consideration.
APPENDICES
Attached is a copy of the draft Prior Approval/Low Priority Procedure Policy dated June 2010.
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