The NHS constitution

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The NHS constitution

• Alison Tennant
• Specialist in Pharmaceutical Public Health
• Dudley PCT

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• 6. The NHS is committed to providing the best
  value for taxpayers money and the most effective,
  fair and sustainable use of finite resources.

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• 7. .The system of responsibility and
  accountability for taking decisions in the NHS
  should be transparent and clear to the public,
  patients and staff.

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You have the right to expect local decisions on
funding of other drugs and treatments to be made
rationally following a proper consideration
of the evidence. If the local NHS decides not to
fund a drug or treatment you and your doctor feel
would be right for you, they will explain
that decision to you.
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• DIRECTIONS
• NATIONAL HEALTH SERVICE, ENGLAND
• Directions to Primary Care Trusts and NHS trusts
  concerning decisions about drugs and other
  treatments 2009

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Primary Care Trust responsibilities on funding
and commissioning medicines and treatments
2.(1) In exercising the functions of the
Secretary of State under section 2(1)(a) (general
power to provide services) and section 3(1) (duty
as to provision of certain services) of the Act,
each Primary Care Trust must have in place
arrangements for making decisions and adopting
policies on whether particular health care
interventions are to be made available for
patients for which the Primary Care Trust is
responsible.
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• (3) Those arrangements must
• (a) ensure that the Primary Care Trust complies
  with any directions given by the Secretary of
  State as to the application of sums paid to the
  Primary Care Trust under section 228(1)(b) of the
  Act (public funding of Primary Care Trusts) in
  relation to health care interventions recommended
  by NICE

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• (b) include arrangements for the determination of
  requests for the funding of a health care
  intervention for an individual, where the Primary
  Care Trusts general policy is not to fund that
  intervention

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Get your processes right

• Documentation
• Criteria
• Decision making groups (APC,PEC)
• Engagement public, patients and clinicians
• Implementation
• IFRs
• Communications

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NICE

• Health Economy NICE Implementation Committee
  (HENIG)
• Minutes of meetings, audits, contact with
  clinicians provide evidence of how NICE TAs are
  implemented.
• Clinical Governance Department operating
  monitoring system to ensure all other guidance
  used in commissioning services

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Exceptional Treatment Requests

• ETAP Exceptional Treatment Applications Panel
• Policies
• In year pressures
• Engage acute trusts if possible!

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particular health care interventions

• Why isnt the PCT doing treatment x?
• Annual operating plan decided using
  prioritisation framework
• Area Prescribing Committee
• Horizon scanning
• In year developments interim commissioning
  policy

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common, rational framework

• Are all of these processes using the same values
  and assessments?
• To what extent does patient/clinician pressure
  affect your PCT?
• What are neighbouring PCTs doing?

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Funding of New Drugs In Dudley PCT there are a
number of ways that decisions on funding new
drugs are made Annual Operating Plan This is
the annual review of what services the PCT needs
to provide for the population of Dudley. The PCT
considers new developments and existing services
and makes a decision using a prioritisation
framework as to what interventions will benefit
the population most and give the best value for
money.  Health Economy Nice Implementation
Group (HENIG) This committee reviews the NICE
technology appraisal and interventional procedure
programme and ensures that local services are
commissioned so that patients have access to all
NICE approved drugs and interventions. Area
Medicines Management Committee This committee
oversees the standards around medicines and the
Dudley Drug Formulary which is shared with Dudley
Group of Hospitals Foundation Trust. The
committee reviews new drugs which are not covered
by NICE and considers them for prescribing by
hospital consultants only, named specialists only
or by all prescribers. Exceptional Treatment
Request Panel This panel reviews cases where the
intervention or treatment is not covered by other
contracting arrangements.
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Summary

• Opportunity to engage other people such as
  directors, PEC, PBC, acute trusts
• Review the big picture on decision-making around
  drugs
• Is collaboration possible?
• This isnt just the Medicines Management team
  responsibility!