WestawayGillis Innovators in Healthcare Solutions

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WestawayGillisInnovators in Healthcare Solutions
Development of a Business case in the NHS Mr Kim
Sergeant Managing Director
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Agenda

• Context the NHS today
• Focus on PCTs
• Business cases
• Information needs
• Good business cases
• Common mistakes

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Although NHS Trusts remain the main providers of
secondary carethey 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
308 PCTs CTs
Local Authorities
Acute Trusts Foundation Trusts
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PCTs are responsible for commissioning the
majority of care
Central commissioning
PCT
PCT Consortia at different levels

• Board sets overall strategy
• Executive (PEC) develops policy

Primary
Mental health
Secondary
Specialised
GMS GPs
PMS GPs PMS Plus
Provider services employed by PCTe.g. District
Nurses, Health Visitors
Mental Health Trusts
NHS Trusts
Private Sector
Tertiary specialist centres
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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

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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

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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

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Even if DT 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

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Timing is important for successthe 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

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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

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Within the trust priorities have to be
established
Each directorate flags up budget needs
Trust management team
Prioritisation process starts
Trust meet with PCTs
Agreement reached in funding - LDP
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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

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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

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If the case isnt 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

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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

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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