WestawayGillis Innovators in Healthcare Solutions
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Transcript of WestawayGillis Innovators in Healthcare Solutions
WestawayGillisInnovators in Healthcare Solutions
Development of a Business case in the NHS
Mr Kim Sergeant
Managing Director
WestawayGillis: Innovators in Healthcare Solutions
Agenda
Context – the NHS today– Focus on PCTs
Business cases– Information needs– Good business cases– Common mistakes
WestawayGillis: Innovators in Healthcare Solutions
Although NHS Trusts remain the main providers of secondary care…they now get their money from PCTs!
Department of Health
28 SHAs
308 PCTs & CTs
LocalAuthorities
AccountabilityContractsBudgets
AcuteTrusts &
Foundation Trusts
Own org money only
‘Special payments’
PCTs hold 75% of the NHS budget!
WestawayGillis: Innovators in Healthcare Solutions
PCTs are responsible for commissioning the majority of care…
PCT•Board sets overall strategy•Executive (PEC) develops policy
GMS GPs PMS GPs & PMS Plus
“Provider services”
employed by PCT
e.g. District Nurses, Health Visitors
Mental Health Trusts
NHS Trusts Private Sector
Tertiary & specialist centres
PCT Consortia at different levels
PrimaryMental health
Secondary
Specialised
Central commissionin
g
WestawayGillis: Innovators in Healthcare Solutions
From a Trust perspective things are changing too…
Historically
Trusts hold contracts with multiple commissioners
Commissioning arrangements are often based on historical precedent and do not change frequently
Some localities have block contracts, others have case-by-case arrangements
Contracts may or may not include cost of drugs
WestawayGillis: Innovators in Healthcare Solutions
Introduction of Payment by Results– HRGs & the National Tariff
The new system of payment will be introduced gradually over five years
HRGs and a national tariff will be put in place to enable volume-casemix commissioning
This will be developed to capture as much NHS activity as possible, so radically changing PCT commissioning methods
Foundation Trusts will use the National Tariff for all procedures from April 2004
WestawayGillis: Innovators in Healthcare Solutions
Across the NHS there is an increasing need to justify new or increased investment in services or products
Key questions to address include:– What is the product / service
• New drug / indication / technique– The problem / situation this is addressing– The benefits– Where will it be prescribed / utilised– Who will it be prescribed to / used for (specific
groups of patients / entry and exit criteria)– Performance in relation to alternative therapies /
techniques• Efficacy• Safety
– Where does it fit with national / local priorities
WestawayGillis: Innovators in Healthcare Solutions
Even if D&T Committee approval is given funding still needs to be found
Funding can be found by– Using within current budget
• replacement / cheaper products• stopping doing something else
– Approach the Trust for funding – Approach PCT for in-year funding– Approach PCT for future funding
WestawayGillis: Innovators in Healthcare Solutions
Timing is important for success:
the funding process starts in September
2º care directorates look at previous spend– Budgeted figure– Outturn
Within directorates each department will review – future requirements– Cost pressures– Review inflationary uplift and any savings
that may be needed
WestawayGillis: Innovators in Healthcare Solutions
There are key stakeholders involved in the process
2º Care Business / directorate manager Management accountant Chief pharmacist / directorate senior pharmacist Clinician Contract manager dealing with commissioners Director of operations
1º Care / PCT Director of Commissioning / Lead commissioner Chief pharmacist Chair of Rx committee Finance Director
WestawayGillis: Innovators in Healthcare Solutions
Within the trust – priorities have to be established
Each directorate
flags up budget needs
Trust management
team
Prioritisation process
startsTrust meet with PCTs
Agreement reached in
funding - LDP
WestawayGillis: Innovators in Healthcare Solutions
Money will generally follow priority areas
Anything that can demonstrate a positive impact on – waiting lists – waiting times
Star ratings Anything that fits in with the PCT priorities
WestawayGillis: Innovators in Healthcare Solutions
When presenting a ‘business case’ PCTs have specific information needs
Impact on other parts of the system– Primary/secondary care interface– Walk in centres– PGDs (Patient Group Directives)– Nurse/pharmacist prescribing– training
Policy/target hooks/performance management– Any impact on NICE/NSFs– “This is the bit that the industry are pretty good at”
Costs – in a form that matches up with requirements and reflects NHS budgeting & planning frameworks – Immediate costs– Longer term costs
WestawayGillis: Innovators in Healthcare Solutions
If the case isn’t clear cut additional information may be requested
Effect on referrals – “Likely to become more critical under new
contract as GPs already feel over-burdened” Risks and assumptions in realising financial
benefits– Are there external factors that might
jeopardise benefit realisation Closer look at outcome data
– Qalys/NNTs
WestawayGillis: Innovators in Healthcare Solutions
There are some common mistakes that need to be avoided when making a business case
Timing is everything– “If you get something at the wrong time you generally
put it in the bin” Budgets and services are parochial
– Be careful when trying to sell on a cost saving realised by another department / trust / budget
– “Moving funding around is getting better but it is time and energy consuming”
– “Projects often founder because there are dependencies or benefits elsewhere in the system”
Using language that is too ‘clinical’– Information needs to be in a format that more
‘generalist’ purchasers can understand
WestawayGillis: Innovators in Healthcare Solutions
Good business cases are setting the standard
Business cases need to be comprehensive Business cases need to be realistic Anything that enables localities to
personalise information is key– “draft protocols that can be amended for
local use saves us heaps of time” Independent review of evidence is
persuasive