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STAKEHOLDER MEETING WITH ALL SERVICEPROVIDERS AND PWID

FOCUS GROUP DISCUSSION S WITH PWID1 MILLION Contract for HCV treatment (70 patients) per

financial yearHowever only 30 patients treated (of which 5 PWID)High DNA rates of Ist and 2nd appointments (appt) amongPWIDIst appt: 1562nd appt :76GAPS IDENTIFIED:

NO PROVISIONS FOR HCV TESTING AT DRUG SERVICEDISTANCE TO TESTING SERVICE IS FAR

LACK OF AWARENESS AND KNOWLEDGE OF HCV ANDTREATMENT (PWID AND KEYWORKERS)

UNDERUTILIZATION OF CURRENT TREATMENT SERVICE

Bedfordshire Joint ClinicalCommissioning Group (BJCCG)-

Practice memberPractice lead

Commissioning directorsCommissioning lead

Commissioning teamPatients and community members

World Class Commissioning (WCC)WCC Framework (DH: 2007)-

1. Planning2. Procuring3. Monitoring & Evaluating

11 COMPETENCIES- WHAT BEST PRACTICE IN COMMISSIONING SHOULD

BE.

RationaleLead clinician identified

1 MILLION Contract for HCV treatment (70patients) per financial year

However only 30 patients treated High DNA rates of Ist and 2nd appointments

(appt) Ist appt: 156 2nd appt :76

-Therefore underutilization of current serviceleading to inefficient service

Wasted resources

AssessingHealth Needs

Reviewing

CurrentProvision

CapacityPlanning

Identifying

and Priorities

PLANNING PHASE

Feedback

User and LocalAuthority

views , choice

Monitoring activity& quality

Invoicing datavalidation and

payment

PROCURMENT PHASE

DemandManagement

ServiceDesign/Redesign

Defining Contracts

ProcuringAppropriate

Services

MONITORING PHASE

Health Equity Audit- Identified- Distance tohospital, Time of appointments , lack of stafftraining, Lack of HCV knowledge and awarenessof HCV , Disjointed Service, under usedPrioritiesHCV educationHCV testing and treatment within drugservicesONE STOP SHOPConflict occurs: resolved using the LEAPS

The ten principles for cooperation and

competition (DH:2010)Transparent and non discriminatory

New service designedAdvertise in NHS Supply 2Health-Any Willing Provider3 Providers selected- Duringthe interview stage One of

the competitor was thebrother in law of acommittee member Kickbacks (removed frombidding)

BJCCG, LOCAL AUTHORITY,NHS, DRUG SERVICEPROVIDERS, PUBLIC HEALTH, PATIENTS , VOLUNTARY

THE HEALTH NEEDS ASSESMENTReview LiteratureHPA (2009) -majority of people are infected withhepatitisC virus(HCV) are people who inject drugs (PWID).Simvanathan (2011)- PWID -4087 with 794 HCVAPPHG (2010)- HCV curable and preventable;HPA (2011) to cost to NHS- 8 billion in 25 yrs

To treat individuals is between 4000-16000Cost for transplant if patient remain undiagnosedand untreated- 88-89,000 per patient per yearHepatitis C Strategy (2002)Hepatitis C Action Plan (2004) guidelines onprevention, diagnosis and treatment

Quality , Performance &ProductivityIndicatorCaseload activityScreening activity

Screening outcome

Hepatology Service to report QuartelyHowever the information can be calledupon anytime-cavetService to carry out Patient Survey collect patient experiences andFeedback about service

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Meeting 1.(M1)

Focus Group-WITH PWID

Meeting 2 (M2)

Hepatologist and HCV specialist nurse

Stakeholder Meeting

Commissioning lead and team, serviceproviders and PWID

WORKED TOGETHER TO DESIGN NEW

SERVICE

RESULTS

HCV testing & treatment to be included in

drug service-ONE STOP SHOP

BJCCG, LOCAL AUTHORITY,NHS, DRUG SERVICE PROVIDERS, PUBLICHEALTH, PATIENTS , VOLUNTARY

THE HEALTH NEEDS ASSESMENTReview LiteratureHPA (2009) -majority of people are infected with hepatitisC virus(HCV) are people who inject drugs (PWID).Simvanathan (2011)- PWID -4087 with 794 HCV

APPHG (2010)- HCV curable and preventable;HPA (2011) to cost to NHS- 8 billion in 25 yrsTo treat individuals is between 4000-16000Cost for transplant if patient remain undiagnosed and untreated- 88-89,000 per patient per yearHepatitis C Strategy (2002)Hepatitis C Action Plan (2004) guidelines on prevention, diagnosis andtreatmentASSESS SERVICESPATIENT ADVICE LASION SERVICE (PALS) 1 MILLION Contract for HCV treatment (70 patients) per financial yearHowever only 30 patients treated (of which 5 PWID)High DNA rates of Ist and 2nd appointments (appt) among PWIDIst appt: 1562nd appt :76

GAPS IDENTIFIED:NO PROVISIONS FOR HCV TESTING AT DRUG SERVICE

DISTANCE TO TESTING SERVICE IS FARLACK OF AWARENESS AND KNOWLEDGE OF HCV AND TREATMENT

(PWID AND KEYWORKERS)UNDERUTILIZATION OF CURRENT TREATMENT SERVICE

Resulted to Health Equity Audit (HEA)

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Bedfordshire Joint ClinicalCommissioning Group (BJCCG)

Practice members, practiceleader, community members,commissioning directors, lead

and teams

e oya o ege o eneraPractitioners (RCGP)

Commissioning Competency Framework(2010) Improving Outcomes

Patient EmpowermentEvidence Based practiceCommunity Mobilisation

Sustainability

2010

5 Domains and 24 Competences

1. Leading People2. Leading a Consortium

3. Serving a Local community4. Leading Commissioning

5. Leading Improvement &Innovation

Analyse and Plan

Analyse Population Needs

Assess Services and Gaps

Agree Outcomes

Design Pathways

Build Partnerships

Appraise Evidence

Design Service

Test and Refine

Specify &Procure

Specify Provision

Determine Intervention

Manage Contracts

Deliver & Improve

Manage Demands

Measure Performance

Continually Improve

Serve a total population420,000

BJCCG, LOCAL AUTHORITY,NHS, DRUG SERVICE PROVIDERS,PUBLIC HEALTH, PATIENTS , VOLUNTARY

THE HEALTH NEEDS ASSESMENTReview LiteratureHPA (2009) -majority of people are infected with hepatitisC virus(HCV) are people who inject drugs (PWID).Simvanathan (2011)- PWID -4087 with 794 HCVAPPHG (2010)- HCV curable and preventable;HPA (2011) to cost to NHS- 8 billion in 25 yrsTo treat individuals is between 4000-16000Cost for transplant if patient remain undiagnosed and untreated- 88-89,000 per patient per yearHepatitis C Strategy (2002)Hepatitis C Action Plan (2004) guidelines on prevention, diagnosis andtreatment

ASSESS SERVICESPATIENT ADVICE LASION SERVICE (PALS) 1 MILLION Contract for HCV treatment (70 patients) per financialyearHowever only 30 patients treated (of which 5 PWID)High DNA rates of Ist and 2nd appointments (appt) among PWIDIst appt: 1562nd appt :76

GAPS IDENTIFIED:NO PROVISIONS FOR HCV TESTING AT DRUG SERVICE

DISTANCE TO TESTING SERVICE IS FARLACK OF AWARENESS AND KNOWLEDGE OF HCV AND TREATMENT

(PWID AND KEYWORKERS)UNDERUTILIZATION OF CURRENT TREATMENT SERVICE

Resulted to Health Equity Audit (HEA)

Meeting 1. (M1)Focus Group-WITH PWID

Meeting 2 (M2)Hepatologist and HCV specialist nurse

Stakeholder MeetingCommissioning lead and team, service providers and

PWIDWORKED TOGETHER TO DESIGN NEW SERVICE

RESULTSHCV testing & treatment to be included in drug service-

ONE STOP SHOP

New Service Advertise in NHS Supply 2 Health

Local Hospital- Disclose their interest and affiliation withthe JCCG in helping design serviceMarginal analysis considered

Quality , Performance & ProductivityIndicatorCaseload activityScreening activityScreening outcomeTreatment

Patient ExperiencesFeedback about service

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Bedfordshire Joint ClinicalCommissioning Group (BJCCG)

Practice members, practiceleader, community members,commissioning directors, lead

and teams

World Class Commissioning (DH: 2007)-

CYCYICAL PROCESS1. Planning

2. Procuring3. Monitoring & Evaluating

DH (2007)11 COMPETENCIES- BEST PRACTICE

RationaleLead clinician identified

1 MILLION Contract for HCV treatment (70patients) per financial year

However only 30 patients treated High DNA rates of Ist and 2nd appointments

(appt) from People who Inject drugs (PWID) Ist appt: 156 2nd appt :76

-Therefore underutilization of current serviceleading to inefficient service

PLANNING PHASE

BJCCG, LOCAL AUTHORITY,NHS, DRUG SERVICE PROVIDERS, PUBLIC HEALTH, PATIENTS ,VOLUNTARYTHE HEALTH NEEDS ASSESMENTReview LiteratureHPA (2009) -majority of people are infected with hepatitisC virus(HCV) are people who inject drugs (PWID).Simvanathan (2011)- PWID -4087 with 794 HCVAPPHG (2010)- HCV curable and preventable;HPA (2011) to cost to NHS- 8 billion in 25 yrs

To treat individuals is between 4000-16000Cost for transplant if patient remain undiagnosedand untreated- 88-89,000 per patient per yearHepatitis C Strategy (2002)Hepatitis C Action Plan (2004) guidelines on prevention,diagnosis and treatmentASSESS SERVICESPATIENT ADVICE LASION SERVICE (PALS) 1 MILLION Contract for HCV treatment (70 patients) per financial yearHowever only 30 patients treated (of which 5 PWID)High DNA rates of Ist and 2nd appointments (appt) among PWIDIst appt: 1562nd appt :76

GAPS IDENTIFIED:NO PROVISIONS FOR HCV TESTING AT DRUG SERVICEDISTANCE TO TESTING SERVICE IS FARLACK OF AWARENESS AND KNOWLEDGE OF HCV AND TREATMENT (PWID AND KEYWORKERS)

UNDERUTILIZATION OF CURRENT TREATMENT SERVICEResultedtoHealthE uit Audit HEA

Assessing HealthNeeds

Reviewing Current

ProvisionCapacity Planning

Identifying andPriorities

Service Design/Redesign

Defining Contracts

Procuring Appropriate Services

Demand Management

Monitoring activity

and qualityInvoicing datavalidation and

paymentUser and Local

authority views,choice

Feedback

PROCURMENT PHASEMONITORING PHASE

Hepatology Service to report Quartely

However the information can be calledupon anytime-cavetService to carry out Patient Survey collect patient experiences andFeedback about service

New Service Advertise in NHS Supply 2 HealthQuality , Performance & ProductivityIndicator

Caseload activityScreening activityScreening outcome

Local Hospital- Disclose their interest and affiliationwith the JCCG in helping design serviceService Awarded Hepatology service at BedfordHospital to deliver outreachMarginal analysis considered -COST EFFECTIVEIncentive Included in contract if 100% HCV test are

performed