Commissioning of Metabolic Services in England and the Role of the Metabolic Clinical - PowerPoint Presentation

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Commissioning of Metabolic Services in England and the Role of the Metabolic Clinical Reference GroupJoan Ward, Commissioning Manager, NHS England

12

th

October 2019

Background to the commissioning of metabolic services in EnglandRole of the Clinical Reference group CRG work programme

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From 1991 Commissioner/ provider relationship came into being Commissioning is the continual process of planning, agreeing and monitoring services. Commissioning is not one action but many, ranging from the health-needs assessment for a population, through the clinically based design of patient pathways, to service specification and contract negotiation or procurement, with continuous quality assessment.

There is no single geography across which all services should be commissioned: some local services can be designed and secured for a population of a few thousand, while for rare disorders, services need to be considered and secured nationally

Background to the commissioning of metabolic services in England

Primary Care Trusts were the main commissioning organisations. Some services were commissioned nationally, including some metabolic services for people with lysosomal storage disordersPCTs commissioned for geographical areas and for some less common and rare disease they combined commissioning leading to the development of

Specialised Commissioning groups

.

What they commissioned varied across the country, some SCGs commissioned metabolic services, mainly for children.

All the funding was the responsibility of PCTs

Previous organisational structure

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New arrangementsClinical Commissioning Groups, commission 80% of NHS budget NHS England, commissioning lead for England for all services, took on the responsibility of direct commissioning of specialised services.Based on four principles

The number of individuals who require the provision of the service or facility;

The cost of providing the service or facility;

The number of persons able to provide the service or facility; and

The financial implications for Clinical Commissioning Groups (CCGs) if they were required to arrange for the provision of the service or facility

In practical terms, what was commissioned by Specialised Commissioning Groups transferred to NHS England

NHS England commissions about 150 services

2013

,

last set of major NHS reforms in England

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Separate directorate in NHS England, sits within the commercial team. Organised into seven regions and a national team Current structuresSpecialised Commissioning and Health & Justice Strategy Group and Specialised Commissioning and Health & Justice Delivery Group (these groups have just been established following a reorganisation)

Clinical Priorities Advisory Group

Six National Programme of Care Boards

Each has an NPoC Board which coordinates and prioritises work across the services in that programme of care.

The six NPoCs are:

Internal medicine – digestion, renal, hepatobiliary and circulatory system

Cancer

Mental health

Trauma – traumatic injury, orthopaedics, head and neck and rehabilitationWomen and children – women and children, congenital and inherited diseases

Blood and infection

– infection, immunity and haematology

NHS England Specialised Commissioning

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The role of the NPoC is to provide leadership and oversight of the development and delivery of a comprehensive work programme that achieves demonstrable improvements in the quality, equity, value and outcomes of commissioned specialised services.The Women and Children NPoC covers services in women and children, congenital and inherited diseases. It consists of an NPoC Board , (currently under review) and Clinical Reference Groups (CRGs) as follows:

Specialised Surgery in Children (E02)

Paediatric Medicine (E03)

Paediatric Neurosciences (E04)

Congenital Heart Services (E05)

Metabolic Disorders (E06)Paediatric Intensive Care (E07)Neonatal Critical Care (E08)

Specialised Women’s Services (E09)

Women and Children Programme of Care

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CRGs provide clinical advice and leadership on the specialised services in the Women and Children’s NPoC. These groups of clinicians, commissioners, public health experts, patients and carers use their specific knowledge and expertise to advise NHS England on the best ways that specialised services should be provided.CRGs lead on the development of clinical commissioning policies, service specifications and quality standards. They also provide advice on innovation, horizon scanning, service reviews and guide work to reduce variation and deliver increased value. CRGs, through their Patient and Public Voice (PPV) members, also help ensure that any changes to the commissioning of specialised services involve patients and the public.

Role of Clinical Reference Groups

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Membership refreshed this year, Work programmeMetabolic services in England Examination of IssuesMetabolic services drug formularyPeer review Highly Specialised Services

Metabolic Clinical Reference Group

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Different commissioning arrangements for metabolic services across EnglandSome areas have more limited provision, Particular challenges in relation to adult servicesTransition is difficultOngoing problems with prescribing

Not all patients are seen in specialist centres

NHS England is looking into these issues, to try and decide the best way of addressing them

Metabolic Services Examination of Issues

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Major problem for a lot of peopleHistorically hospitals have started patients on treatment and GP’s have taken on the prescribing responsibility with advice from the specialist centresThese arrangements are under pressureReluctance of GP’s to prescribe for conditions they don’t fully understand

(Responsibility for prescribing between Primary & Secondary/Tertiary Care)

Hospitals are often far away making accessing prescription difficult

Hospitals aren’t funded to provide the medication long term

The CRG, with the British Inherited Disease Group (BIMDG) are developing a formulary which will set out the prescribing responsibilities of hospitals and GPs

NHS England will be asked to support this

CCGs will be asked to adopt this

National Drug Formulary for Inherited Metabolic Diseases (IMDs)

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Any Questions

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