poster schedule Thursday 30th

Session 3.4 – Prioritizing within the NHS

Thursday October 30th 8:30am - 10:00am

Evaluation of Westminster Primary Care Trust’s Decision Support Service to Improve Priority Setting

(Abstract 0053)

Rosalind Blackwood, Adrian Brown
Westminster Primary Care Trust, United Kingdom

Background: Commissioning decisions must be based on sound knowledge and evidence (DH 2007). Research (King's Fund) concluded that it is impractical to set priorities on evidence of cost effectiveness alone. Locally, the PCT’s ability to priority set effectively was hampered through lack of systematic, robust information regarding service developments. In response, a decision support service (DSS) was implemented on 01/04/2008 to provide consistent, uniform public health support to commissioning and transparent priority setting. The DSS uses a framework to consider service developments in terms of:

Objective: The DSS aims to:

1. facilitate commissioners’ decision making 2. improve the quality of priority setting at the PCT

Methods: A formative evaluation running concurrently to the DSS assesses whether the service is meeting its objectives, by comparing:

1. qualitative stakeholder views on public health commissioning support before and with the DSS, using questionnaires completed by commissioners when requesting support and on receiving support, assessing whether their expectations were met and whether the DSS has improved the quality of their decision making.

2. quantitative data on whether commissioning decisions made between 01/04/07 – 01/09/07 (before DSS) compared to 01/04/08 – 01/09/08 (with DSS) show evidence of consideration of all aspects of the DSS framework.

Results: Evaluation results will be available early-September 2008 though early feedback on the DSS has been positive.

Needs-based prescribing budgets - juggling patient need and practice stability

(Abstract 0142)

Don Sinclair, Sangeeta Saran, Eleanor Mitchell
Berkshire East Primary Care Trust, United Kingdom

Background: At the start of 2007/08, Berkshire East PCT was facing a projected primary care prescribing overspend of £3 million, and was not achieving the national markers of prescribing efficiency. With practices grouped into five localities, with very different historical prescribing behaviours, a common plan looked difficult to achieve.

Objectives: 1. To improve the efficiency of primary care prescribing in all five localities, without compromising patient care.
2. To move resources towards populations with greater need.
3. To promote locality responsibility for prescribing spend and encourage helpful peer pressure.

Methods: The Director of Public Health worked with PCT lead pharmacists and locality lead GPs to develop a budget-setting methodology based on practice shares of:
1. Patients registered with long term conditions,
2. Age, Sex, Temporary Resident Originated Prescribing Units (ASTRO-PU)
3. Markers of efficiency for drugs contributing the highest proportions of overall spend
4. Historic spending patterns (aiming to remove this over time)

Results: The needs-based forumla was accepted by practices. Localities took responsibility for prescribing spend, managed locality risk, and showed improvement in prescribing efficiency - although not all to the same extent. Two localities achieved freed-up resources under PBC rules. There are requests to apply the same methodology to commissioning budgets

Policy Implications: It is possible to engage groups of practices to manage their resources and financial risk collectively, provided that the underlying formula for sharing resources is accepted, and considerable effort put into engaging locality partners.

PPI & Prioritisation in World Class Commissioning: How to Achieve This in 3 Easy Steps.

(Abstract 0133)

Khesh Sidhu, James Green, Jon Dicken, Richard Young
Sandwell PCT, United Kingdom

This paper describes the experience in Sandwell PCT and it's iterative approach to ensuring PPI involvement in it's LDP process. It explains how Sandwell PCT prioritisation approach enables the PCT to commission with confidence, ensure the Board is WCC compliant, and enable the people of Sandwell to influence the LDP process. The paper will describe the process as a three stepped approach. Each broken down into simple stages. The first stage is a wide consultation process which is accessible to a diverse population, simple and informative. The second stage is a measured balanced means of ensuring that each LDP submission has been quality assured. The last process relates to how the LDP submissions are prioritised using the findings of the consultation process applied against each submission.

Strengths and weaknesses are discussed and described. It time permits a simple example of how the approach is used in real life could be undertaken but this requires time and resources to do this.

Prioritising Opportunities: Finding and Prioritising the Right Opportunities for the Strategic Delivery of System Wide Improvements in Health Care

(Abstract 0037)

Richard Jenkins, John Burton
NHS Institute for Innovation and Improvement, United Kingdom

In the current health care situation there is a need to make a significant reorientation in the way care is delivered. From our field work with seven health communities, we developed a complete process for agreeing priority areas and delivering system-wide programs of change. Our learning from these sites demonstrated that identifying the right opportunities to pursue was a critical step in delivering improvement and deciding priorities is a key element in an organizations strategic planning.

As a result we have designed a 4 stage system to allow organizations to prioritise opportunities. The process enhances and aligns different perspectives into focused coordinated action.
The first two stages help decide which projects should be developed and taken forward using a robust and reliable process. A key component of this process is to develop a “long list” of projects by agreeing priority areas, scoping the evidence, brainstorming with local knowledge and expertise, formulating potential solutions and then compiling a complete initiative long list.

With finite resources, the long list needs to be reduced to a manageable level by means of a robust and reliable prioritising process. Using co-production with the field sites we developed a web based prioritisation system. All the initiatives are scored for “importance” including patient, clinical and financial benefit, fit with local and national priority and then also scored against “do-ability” including stakeholders, buildings, workforce, service delivery and investment. The tool plots the scores on a chart, supporting the decision on which initiatives to take forward.