Individual Funding Requests Group Work MMS Year 4 Public Health Workshop in O&G

NHS England Aim: to improve health outcomes and deliver high-quality care for people in England by: Providing national leadership for improving outcomes and driving up the quality of care; Overseeing the operation of clinical commissioning groups (CCGs); Allocating resources to clinical commissioning groups; Commissioning primary care and directly commissioned services Direct commissioning Primary care Specialised healthcare services (~10% of NHS budget) Health services for serving personnel and families in the armed forces Health services for people who are in prison or other secure accommodation, and for victims of sexual assault (adults and children) Public Health, Year 4 MMS, O&G2

Clinical Commissioning Groups (CCGs) 211 CCGs Serve a population 61, ,000 Clinically led, local membership bodies made up of GP practices in their area Commission: – –Urgent and emergency care – –Elective hospital care – –Community health services – –Maternity and newborn – –Mental health and learning disabilities. commission from a range of providers, inc voluntary and private sectors Public Health, Year 4 MMS, O&G3

How is money paid to service providers? 'block contracts‘ – –annual lump sum to provide a service locally. not linked to the number of patients seen, the work actually carried out, or the quality of care provided. 'Payment by Results' (PbR), – – an activity based system that reimburses providers for the work that they carry out, at an agreed national price. Public Health, Year 4 MMS, O&G4

Outside standard contracts individual funding requests Public Health, Year 4 MMS, O&G5

CCG Clinicians are entitled to make a request (an "individual funding request") to the IFR Panel for treatment to be funded by the CCG outside of its established policies on one of two grounds, namely: The patient is suffering from a presenting medical condition for which the CCG has no policy ("an individual request"), or The patient is suffering from a presenting medical condition for which the CCG has a policy but where the patient's particular clinical circumstances are perceived by the referring clinician to fall outside that policy ("an exceptionality request"). Where an experimental or unproven treatment is sought, this will be regarded as "an individual request". Public Health, Year 4 MMS, O&G 6

NHS England Clinicians, on behalf of their patients, are entitled to make a request (an “individual funding request”) to the NHS CB for treatment that is not normally commissioned by the NHS CB under defined conditions: The request does not constitute a request for a service development; AND The patient is suffering from a medical condition for which the NHS CB has commissioning responsibility and a commissioning position and the patient’s particular clinical circumstances falls outside the criteria set out in an existing commissioning policy for funding the requested treatment OR The patient is suitable to enter a clinical trial which requires individual explicit funding by the NHS CB as opposed to being part of a group of such trial patients OR The patient has a rare clinical circumstance, thus rendering it impossible to carry out clinical trials, and for whom the clinician wishes to use an existing treatment on an experimental basis. Public Health, Year 4 MMS, O&G 7

Groups Assessors (up to 6 groups) – –Each group is given IFR. Assess and determine whether they recommend that this is funded – –Prepare to present this to the panel Panel – –Decide criteria – –Hear presentations – –Decide and justify Public Health, Year 4 MMS, O&G8

Outline TaskTimeDetails Initial Brief10 minutes Preparation time30 minutesAssessor groups- IFRs Panel- criteria and process Assessors present to panel 60 minutes5 minute presentation for each IFR including recommendation 5 minute for questions/discussion and decision whether to fund Panel present their decisions and the criteria/ process 10 minutes Sum up10 minutes Public Health, Year 4 MMS, O&G9