Why commission and develop Home Oxygen Clinical Assessment and Follow Up Services CAFS

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Why commission and develop Home Oxygen Clinical
Assessment and Follow Up Services (CAFS)?

• Helen Ellis,
• Primary Care Contracting

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Introduction

• The journey so far where we have been
• Where we need to be
• Benefits
• Why do it?
• Common concerns and obstacles
• Solutions

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The journey so far

• Previous system recognised by all parties to be
  less patient-friendly and flexible than it could
  be
• Patients wanted a modern service with modern
  equipment options and lobbied accordingly.
• The principle being a desire for an integrated
  service with modern equipment and the flexibility
  to suit each patients needs.

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• Originally CAFs part of the service spec
  Unfortunately this did not happen in most areas.
• The NHS and the DH needed to establish how many
  people were on oxygen therapy on formal
  assessment or other data at that point.
• Fully transitioned last October and all good!

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Where are we going?

• The vision (according to the network)
• . the development and improvement of Home
  Oxygen Clinical Assessment and Follow Up services
  within the NHS improves patient health and
  wellbeing by providing a cost and clinically
  effective service for those requiring home oxygen
  therapy.

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Where we got to

• Huge and valuable support from pharmacists
  through the transition period and the
  aforementioned problems.
• Sorted the South West out with its particular
  problems and its subsequent later, additional
  transition.
• Supplier companies buy outs (and ins)
• A steady state - an improved service for
  patients.
• Policy transition previously governed by the
  Pharmacy team, now by the COPD NSF team and
  Commissioning Department.
• Commercial Dept keep the contract management role
  and the NHS manages the day to day running of the
  contract locally.

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Benefits of Commissioning CAFS

• By commissioning clinical assessment and follow
  up services, the PCT
• can
• influence a reduction in
• inappropriate prescribing or over-prescribing
  of oxygen therapy
• inappropriate hospital admissions (including
  emergency admissions)
• bed days
• ambulance call-outs
• readmission rates
• GP visits
• clinical risk
• service related costs.

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Benefits of Commissioning CAFS ii

• the opportunity of meeting AE 4-hour wait
  targets
• enable appropriate early discharge
• effective utilisation of available specialist
  expertise
• appropriate use of resources (right
  patient/place/prescription)
• choice and flexibility for patients
• delivery of key Public Service Agreement targets
• the opportunity to advise and inform patients
  about treatment, thus
• encouraging and achieving compliance
• patient satisfaction
• related service cost savings.

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Why do it?

• Better patient care
• Potential and quickly realised cost benefits
• Real savings (e.g 50k in the first quarter
  across SLA 2 PCTs)
• Considered good practice
• DH guidance recommends
• Everyone else is!

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Obstacles and Concerns

• Lack, or perceived lack, of specialist staff and
  resources
• Lack of awareness of the range of different
  service
• models that might be used or adapted locally
  (including
• some low-cost or even cost neutral services)
• Lack of access to information and/or varying
  awareness
• of the clinical assessment and review services
  currently
• provided in different parts of the country

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Solutions

• Learn from others
• Share concerns
• Talk to finance department
• Build relationships (across secondary and
  primary, with GPs, and with other teams and
  initiatives, COPD, Breatheasy etc).
• Look at what resources available and what is
  already happening in the patch

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Questions to be considered to ensure that key
features are included

• What is required to provide an assessment
  service?
• How can this be provided?
• How much will it cost?
• Will the service be following clinical guidelines
  and best practice?
• Will the service be following standard operating
  procedures?

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key features..

• Will the equipment used and procedures followed
  (blood gas testing, spirometry etc) be according
  to national standards and protocols?
• Will those operating the service be competent and
  trained to do so?
• How will the service, its staff and equipment be
  audited?

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.key features

• Assessment service should include screening to
  identify patients with an O2 saturation of less
  than 92.
• Patients with an O2 saturation of less than 92
  to be referred to a formal assessment service for
  Long Term Oxygen Therapy (LTOT).
• Formal patient assessment should be undertaken in
  accordance with the British Thoracic Society
  (BTS) and NICE guidelines.

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key features..

• Competencies for spirometry as defined by
  Association of Respiratory Technicians
  Physiologists (ARTP) and BTS and Education for
  Health, Warwick who provide training. National
  standards to be found for spirometry
  http//fp.artpweb2.f9.co.uk/
• Assessments and follow-ups can take place in a
  variety of places including secondary and primary
  care settings, the home.

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Next steps for PCTs

• Undertake Local Needs Assessment
• Look at what Home Oxygen patients currently
  receiving, why and how
• (Assess the range of home oxygen services being
  ordered by health professionals and the extent to
  which this is influenced by any level of clinical
  patient assessment before these services are
  ordered.)
• Consult with patient groups
• Develop a forum/network linking in with other
  related Health Professionals, particularly across
  secondary and primary services and look at ways
  to join up services

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Next steps 2

• Secure support from other areas, for instance
  Service Improvement and Medicine Management Teams
  and including COPD colleagues
• Learn from other (newly developed) services
• Produce a business case ( those who are
  developing service)
• Commissioners consider standard service
  specification(s) with local requirements
• Develop performance management tools and ensure
  training and education needs met

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Next steps 3

• Look at educational support to GPs and other
  clinicians in making the best use of the Home
  Oxygen Service
• Identify local champions (BTS new oxygen
  champions in all hospitals)
• Use the Commissioning Framework, and the new
  forthcoming DH Guidance document (and the tools
  and guidance within).
• Utilise the available network of experts who have
  set up services

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What is the network?

• An opportunity to share knowledge and experience
• A group of champions, experts made up of
  clinicians, commissioners, and managers involved
  in developing and running CAFs

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The network aims to

• To support the development of CAFs
• To encourage quality of care for Home Oxygen
  patients
• To act as a reference group to all NHS
  organisations requiring support with the
  development and improvement of CAFs

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What can the network offer?

• Implementation support
• Sharing of key papers (protocols, job
  descriptions, service specs etc)
• Mentoring
• Presentations at regional events
• To act as a reference group
• Encourage and exert influence on PCTs

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The guidance

• What is it?
• A new DH booklet which builds on the
  Commissioning Framework acting as a toolkit for
  those developing CAFs
• To include key features of a service, models,
  examples, how to

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The guidance

• What can it offer?
• A toolkit for commissioners
• Real examples in all sorts of different areas and
  models
• A suite of resources - demonstrable cost savings,
  
• Provide leverage

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Contact Details

• Helen Ellis
• helen.ellis_at_pcc.nhs.uk
• 07500 126 618