Transcript Exceptional Case Review (ECR) Panel

Individual Funding Requests (IFR)
&
Joint Strategic Needs Assessments (JSNA)
Richard Crookes
Resource Centre Manager
NHS Nottingham City
IFH Study Day, York Hospital
4th February 2010
Objectives
Individual Funding Requests
• Background to IFRs
• The IFR panel
• The role of the librarian
Joint Strategic Needs Assessment
• What is the JSNA?
• National & local picture
• The role of the librarian
DH Expectations of the PCTs
• The NHS allocates finite resources on the basis of
clinical need
• No duty of care owed by PCTs to patients
– Increase the healthy lifespan of your client
population
– Reduce inequality in healthy lifespan of your client
population
– Break even!
• A fixed budget to fund comprehensive health care
• A statutory duty not to exceed budget
• Cannot afford every healthcare intervention
Why Have IFR Panels?
• PCTs need to make decisions in relation to
treatment requests not currently commissioned by
the PCT
• IFRs –
– Interventions for which there is no specific
commissioning policy
– Interventions for which a specific policy ‘not to
routinely fund’ is in place
– Where the patient doesn’t fulfill the criteria
Exceptionality
• A rare or unusual event
• Far beyond what is usual in magnitude or
degree
• Exceptional likelihood of benefit
• Most cases that come before Panel are not in
any way, shape or form exceptional
NHS E Midlands IFR Policy
• Background
– Richard’s Report identified ‘unexplained variations’
in individual funding decisions between PCTs
– EMSCG developed regional IFR policy (2009)
• Purpose
– To reduce potential ‘postcode funding’
– Develop clarity around the ethical principles
underpinning IFR decisions
– To support greater consistency in the process and
decision-making between PCTs in E Midlands
– Quality assurance of the process across the 9 PCTs
The IFR Panel
• Pre-screening
• Multidisciplinary panel: chair, medical director,
consultants, commissioning manager, senior
pharmacist & librarian
• Voting members
• Monthly meetings
• Main responsibility answering complex (clinical)
enquiries
• Decisions
Evidence Gathering
• Searcher must have full case documentation
(PICO)
• Evidence sources:
–
–
–
–
NICE, SMC, HTAs, CE, CKS
TRIP, Cochrane, MEDLINE, EMBASE
Google Scholar
NeLM, DTB, MeReC, conferences
• Levels of evidence: 1 & 2
• Presentation of results
Examples of Requests
• MRgFUS for uterine
fibroids (pedunculated)
• Ganciclovir Implants for
cytomegalovirus (CMV)
retinitis
• ACI & Meniscal graft
• IVF low weight (mother)
• Irinotecan for Ewing’s
Sarcoma
• Sorafenib for Advanced
Hepatocellular Carcinoma
• Umbilical Blood Cord
Transplantation (UBCT)
for severe Aplastic
Anaemia in adults
• Magnetic Navigation
System Cardiac Ablation
for Ventricular
Tachycardia (VT)
• Imatinib (Glivec™) for
Gastrointestinal Stromal
Tumour (GIST) - exon 11
mutation
Issues & Challenges
•
•
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•
•
Short notice
Timescales
Search requests
Quality of evidence
Appraisals (what to
exclude)
• Writing summaries
• Staff cover for panels
Coming to a PCT near you!
• Regional collaboration
–
–
–
–
IFR librarians
Standardisation of IFR search results
GRADE methodology
EMSCG repository of searches
• MK
• NHS Nottingham City
Joint Strategic Needs
Assessment
(JSNA)
Richard Crookes
Resource Centre Manager
What is a JSNA?
• A “means by which PCTs and Local Authorities will
describe the future of health and well-being needs of
local populations and the strategic direction of service
delivery to meet these needs” – Department of Health
(2007) Commissioning for Health and Wellbeing
• Requirement for PCTs and local authorities to produce
a Joint Strategic Needs Assessment of the health and
wellbeing of their local community (The Local
Government and Public Involvement in Health Act
2007)
• Identifies the current and future health and wellbeing
needs of a population
Joint Strategic Needs Assessment (JSNA) I
• Undertaken by Directors of Public Health, Adult
Social Services and Children's Services working in
collaboration with Directors of Commissioning
• Provides analysis of data to show the health and
wellbeing status of local communities, defining
where inequalities exist and using local knowledge
alongside evidence of effectiveness of
interventions
Joint Strategic Needs Assessment (JSNA) II
The JSNA process should:
• Lead to agreed commissioning priorities that will improve
health and wellbeing outcomes and reduce health
inequalities.
• Reflect the competencies of a World Class Commissioner,
being underpinned by:
• partnership working; community engagement;
• evidence of effectiveness: identifying relevant best
practice, innovation and research to inform how needs
will best be met.
• Be continuous
• What we PCTs should be doing based on the evidence
JSNA in Nottingham I
• Driven by a steering group with representatives from
NHS Nottingham City, Children’s Services and Adult
Support and Health and facilitated by jointly-funded
project manager
• Designed to be used by Nottingham’s health and social
care commissioners to ensure plans and available
resources meet Nottingham’s health and wellbeing
needs
• The JSNA is updated regularly
– 1st round 2008
– JSNA development workshop in October 2009
– The 3rd round of JSNA will be published in April 2010.
JSNA in Nottingham II
• Standard Template
• Consists of 42 chapters e.g. Alcohol, End of Life,
Mental Health, Asylum Seekers, refreshed annually
• Wide authorship
• Wide readership
• Approaching its 3rd round
• Available on the Nottingham Insight website (Feb
2010)
• Knowledge Resources support re advising on
consistent referencing e.g. Harvard style
JSNA on Nottingham Insight
JSNA Chapters’ Template
Librarian Involvement
• Identifying high-quality evidence
• Updating referenced materials
• Using non-medical resources e.g. SCIE, Campbell
Collaboration
• Organising website content
• Referencing of cited documents
• Storage of key documents, works cited
Thank You!
Richard Crookes
Resource Centre Manager
Knowledge Resources
Tel 0115-883 4213
email: [email protected]