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


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!


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


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


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


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


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


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


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


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


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


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


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


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


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

westawaygillis innovators in healthcare solutions

Documents