Bedfordshire Joint Clinical Commissioning Group (BJCCG)Practice member Practice lead Commissioning directors Commissioning lead Commissioning team

Patients and community members

World Class Commissioning (WCC) WCC Framework (DH: 2007)1. Planning 2. Procuring 3. Monitoring & Evaluating 11 COMPETENCIES - WHAT BEST PRACTICE IN COMMISSIONING SHOULD BE.

Rationale
Lead clinician identified
1 MILLION Contract for HCV treatment (70 patients) per financial year However only 30 patients treated High DNA rates of Ist and 2nd appointments (appt) Ist appt: 156 2nd appt :76 -Therefore underutilization of current service leading to inefficient service Wasted resources

Feedback

Invoicing data validation and payment

User and Local Authority views , choice

Hepatology Service to report Quartely However the information can be called upon anytime-cavet Service to carry out Patient Survey collect patient experiences and Feedback about service

BJCCG, LOCAL AUTHORITY,NHS, DRUG SERVICE

PROVIDERS, PUBLIC HEALTH, PATIENTS , VOLUNTARY THE HEALTH NEEDS ASSESMENT Review Literature HPA (2009) -majority of people are infected with hepatitis C virus(HCV) are people who inject drugs (PWID). Simvanathan (2011)- PWID -4087 with 794 HCV APPHG (2010)- HCV curable and preventable; HPA (2011) to cost to NHS- 8 billion in 25 yrs To treat individuals is between 4000-16000 Cost for transplant if patient remain undiagnosed and untreated- 88-89,000 per patient per year Hepatitis C Strategy (2002) Hepatitis C Action Plan (2004) guidelines on prevention, diagnosis and treatment

Monitoring activity & quality

MONITORING PHASE
New service designed Advertise in NHS Supply 2 Health-Any Willing Provider 3 Providers selected- During the interview stage One of the competitor was the brother in law of a committee member Kickbacks (removed from bidding)

The ten principles for cooperation and competition (DH:2010) Transparent and non discriminatory

PLANNING PHASE
Assessing Health Needs

PROCURMENT PHASE
Demand Management

Identifying and Priorities

Procuring Appropriate Services Service Design/Redesign

Reviewing Current Provision

STAKEHOLDER MEETING WITH ALL SERVICE

Quality , Performance & Productivity Indicator Caseload activity Screening activity Screening outcome

Defining Contracts

Health Equity Audit- Identified- Distance to hospital, Time of appointments , lack of staff training, Lack of HCV knowledge and awareness of HCV , Disjointed Service, under used Priorities HCV education HCV testing and treatment within drug servicesONE STOP SHOP Conflict occurs: resolved using the LEAPS

Capacity Planning

PROVIDERS AND PWID FOCUS GROUP DISCUSSION S WITH PWID 1 MILLION Contract for HCV treatment (70 patients) per financial year However only 30 patients treated (of which 5 PWID) High DNA rates of Ist and 2nd appointments (appt) among PWID Ist appt: 156 2nd appt :76 GAPS IDENTIFIED: NO PROVISIONS FOR HCV TESTING AT DRUG SERVICE DISTANCE TO TESTING SERVICE IS FAR LACK OF AWARENESS AND KNOWLEDGE OF HCV AND TREATMENT (PWID AND KEYWORKERS) UNDERUTILIZATION OF CURRENT TREATMENT SERVICE

BJCCG, LOCAL AUTHORITY,NHS, DRUG SERVICE PROVIDERS, PUBLIC HEALTH, PATIENTS , VOLUNTARY

THE HEALTH NEEDS ASSESMENT Review Literature HPA (2009) -majority of people are infected with hepatitis C virus(HCV) are people who inject drugs (PWID). Simvanathan (2011)- PWID -4087 with 794 HCV APPHG (2010)- HCV curable and preventable; HPA (2011) to cost to NHS- 8 billion in 25 yrs To treat individuals is between 4000-16000 Cost for transplant if patient remain undiagnosed and untreated- 8889,000 per patient per year Hepatitis C Strategy (2002) Hepatitis C Action Plan (2004) guidelines on prevention, diagnosis and treatment ASSESS SERVICES PATIENT ADVICE LASION SERVICE (PALS) 1 MILLION Contract for HCV treatment (70 patients) per financial year However only 30 patients treated (of which 5 PWID) High DNA rates of Ist and 2nd appointments (appt) among PWID Ist appt: 156 2nd appt :76
GAPS IDENTIFIED: NO PROVISIONS FOR HCV TESTING AT DRUG SERVICE DISTANCE TO TESTING SERVICE IS FAR LACK OF AWARENESS AND KNOWLEDGE OF HCV AND TREATMENT (PWID AND KEYWORKERS) UNDERUTILIZATION OF CURRENT TREATMENT SERVICE Resulted to Health Equity Audit (HEA)

Meeting 1.(M1) Focus Group-WITH PWID Meeting 2 (M2) Hepatologist and HCV specialist nurse Stakeholder Meeting Commissioning lead and team, service providers and PWID WORKED TOGETHER TO DESIGN NEW SERVICE RESULTS HCV testing & treatment to be included in drug service-ONE STOP SHOP

The Royal College of General Practitioners (RCGP) Commissioning Competency Framework (2010) Improving Outcomes Patient Empowerment Evidence Based practice Community Mobilisation Sustainability

Bedfordshire Joint Clinical Commissioning Group (BJCCG) Practice members, practice leader, community members, commissioning directors, lead and teams

RCGP (2010)
5 Domains and 24 Competences 1. Leading People 2. Leading a Consortium 3. Serving a Local community 4. Leading Commissioning 5. Leading Improvement &Innovation
BJCCG, LOCAL AUTHORITY,NHS, DRUG SERVICE PROVIDERS,
PUBLIC HEALTH, PATIENTS , VOLUNTARY THE HEALTH NEEDS ASSESMENT Review Literature HPA (2009) -majority of people are infected with hepatitis C virus(HCV) are people who inject drugs (PWID). Simvanathan (2011)- PWID -4087 with 794 HCV APPHG (2010)- HCV curable and preventable; HPA (2011) to cost to NHS- 8 billion in 25 yrs To treat individuals is between 4000-16000 Cost for transplant if patient remain undiagnosed and untreated- 8889,000 per patient per year Hepatitis C Strategy (2002) Hepatitis C Action Plan (2004) guidelines on prevention, diagnosis and treatment ASSESS SERVICES PATIENT ADVICE LASION SERVICE (PALS) 1 MILLION Contract for HCV treatment (70 patients) per financial year However only 30 patients treated (of which 5 PWID) High DNA rates of Ist and 2nd appointments (appt) among PWID Ist appt: 156 2nd appt :76 GAPS IDENTIFIED: NO PROVISIONS FOR HCV TESTING AT DRUG SERVICE DISTANCE TO TESTING SERVICE IS FAR LACK OF AWARENESS AND KNOWLEDGE OF HCV AND TREATMENT (PWID AND KEYWORKERS) UNDERUTILIZATION OF CURRENT TREATMENT SERVICE

Serve a total population 420,000

Analyse and Plan
Analyse Population Needs Assess Services and Gaps Agree Outcomes

Quality , Performance & Productivity Indicator Caseload activity Screening activity Screening outcome Treatment Patient Experiences Feedback about service

Deliver & Improve

Manage Demands Measure Performance Continually Improve

Design Pathways
Build Partnerships Appraise Evidence Design Service Test and Refine

Resulted to Health Equity Audit (HEA)

Specify &Procure
New Service Advertise in NHS Supply 2 Health Local Hospital- Disclose their interest and affiliation with the JCCG in helping design service Marginal analysis considered

Specify Provision Determine Intervention Manage Contracts

Meeting 1. (M1) Focus Group-WITH PWID Meeting 2 (M2) Hepatologist and HCV specialist nurse Stakeholder Meeting Commissioning lead and team, service providers and PWID WORKED TOGETHER TO DESIGN NEW SERVICE RESULTS HCV testing & treatment to be included in drug serviceONE STOP SHOP

Bedfordshire Joint Clinical Commissioning Group (BJCCG) Practice members, practice leader, community members, commissioning directors, lead and teams

World Class Commissioning (DH: 2007)Rationale

CYCYICAL PROCESS 1. Planning 2. Procuring 3. Monitoring & Evaluating DH (2007) 11 COMPETENCIES- BEST PRACTICE

Lead clinician identified

1 MILLION Contract for HCV treatment (70 patients) per financial year However only 30 patients treated High DNA rates of Ist and 2nd appointments (appt) from People who Inject drugs (PWID) Ist appt: 156 2nd appt :76 -Therefore underutilization of current service leading to inefficient service

MONITORING PHASE
Monitoring activity and quality Invoicing data validation and payment User and Local authority views, choice Feedback Hepatology Service to report Quartely However the information can be called upon anytime-cavet Service to carry out Patient Survey collect patient experiences and Feedback about service

PROCURMENT PHASE
Service Design/Redesign Defining Contracts Procuring Appropriate Services Demand Management

PLANNING PHASE
Assessing Health Needs Reviewing Current Provision Capacity Planning Identifying and Priorities
BJCCG, LOCAL AUTHORITY,NHS, DRUG SERVICE PROVIDERS, PUBLIC HEALTH, PATIENTS , VOLUNTARY THE HEALTH NEEDS ASSESMENT Review Literature HPA (2009) -majority of people are infected with hepatitis C virus(HCV) are people who inject drugs (PWID). Simvanathan (2011)- PWID -4087 with 794 HCV APPHG (2010)- HCV curable and preventable; HPA (2011) to cost to NHS- 8 billion in 25 yrs To treat individuals is between 4000-16000 Cost for transplant if patient remain undiagnosed and untreated- 88-89,000 per patient per year Hepatitis C Strategy (2002) Hepatitis C Action Plan (2004) guidelines on prevention, diagnosis and treatment ASSESS SERVICES PATIENT ADVICE LASION SERVICE (PALS) 1 MILLION Contract for HCV treatment (70 patients) per financial year However only 30 patients treated (of which 5 PWID) High DNA rates of Ist and 2nd appointments (appt) among PWID Ist appt: 156 2nd appt :76 GAPS IDENTIFIED: NO PROVISIONS FOR HCV TESTING AT DRUG SERVICE DISTANCE TO TESTING SERVICE IS FAR LACK OF AWARENESS AND KNOWLEDGE OF HCV AND TREATMENT (PWID AND KEYWORKERS) UNDERUTILIZATION OF CURRENT TREATMENT SERVICE

New Service Advertise in NHS Supply 2 Health Quality , Performance & Productivity Indicator Caseload activity Screening activity Screening outcome
Local Hospital- Disclose their interest and affiliation with the JCCG in helping design service Service Awarded Hepatology service at Bedford Hospital to deliver outreach Marginal analysis considered -COST EFFECTIVE Incentive Included in contract if 100% HCV test are performed