Transcript No Slide Title

WestawayGillis
Innovators in Healthcare Solutions
Development of a Business
case in the NHS
Mr Kim Sergeant
Managing Director
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
Accountability
Contracts
Budgets
Own org money
only
PCTs hold 75% of the
NHS budget!
28 SHAs
‘Special
payments’
Acute
Trusts &
Foundation
Trusts
WestawayGillis: Innovators in Healthcare Solutions
308 PCTs &
CTs
Local
Authorities
PCTs are responsible for commissioning
the majority of care…
Central
commissioning
PCT
• Board sets overall strategy
• Executive (PEC) develops policy
Primary
GMS GPs
PMS GPs &
PMS Plus
Mental health
“Provider
services”
employed by
PCT
e.g. District
Nurses,
Health Visitors
WestawayGillis: Innovators in Healthcare Solutions
Mental Health
Trusts
PCT
Consortia
at different levels
Secondary
NHS Trusts
Specialised
Private Sector
Tertiary &
specialist
centres
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
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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
1º Care / PCT
Business / directorate
manager
 Management accountant
 Chief pharmacist /
directorate senior
pharmacist
 Clinician
 Contract manager dealing
with commissioners
 Director of operations


WestawayGillis: Innovators in Healthcare Solutions
Director of Commissioning /
Lead commissioner
 Chief pharmacist
 Chair of Rx committee
 Finance Director
Within the trust – priorities have to be
established
Each
directorate
flags up budget
needs
Agreement
reached in
funding - LDP
WestawayGillis: Innovators in Healthcare Solutions
Trust
management
team
Trust
meet with
PCTs
Prioritisation
process
starts
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
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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”
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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”
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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”
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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


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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
WestawayGillis: Innovators in Healthcare Solutions