13.12.16
Improving quality, safety and efficiency in IBD care
Source: NHE Nov/Dec 16
The national inflammatory bowel disease (IBD) audit is changing, and the IBD Registry is now the vehicle for the biologics audit and quality improvement programme. Dr Fraser Cummings, clinical lead, and Stuart Bloom, chair of the organisation, explain what this means.
In his report on efficiency and productivity in the NHS, Lord Carter highlighted the potential for savings of up to £60m a year through the use of biosimilars. NHS England has included biosimilars usage in the medicines optimisation dashboard, and initiatives such as Future Focused Finance and the Right Care programme are looking at how the NHS can be supported to take value-based decisions, but clinicians and commissioners need to balance efficiency with optimal patient care.
Effective local and national data collection is key to achieving this balance, and the IBD audit has been the cornerstone of quality improvement (QI) in NHS IBD services for 10 years, driving significant improvements in patient care and outcomes. Its final report, published in September, focused on the use of biological therapies to treat IBD. It suggests that new biosimilar medicines, which work in the same way as more expensive originator treatments, are safe and effective and can reduce the cost of treatment by half.
The loss of central funding for the national IBD audit and QI programme poses a risk to the NHS in terms of its ability to monitor the appropriate and safe use of biological therapies for IBD, and to check for quality and variation in the provision of IBD care across the UK.
However, the IBD Registry presents a solution. Continuing the audit’s focus on biological therapies, the Registry will initially report on six key performance indicators (KPIs) for biologics and biosimilars. Nationally, this will provide a mechanism to monitor safety, value and the appropriate use of biological therapies in line with NICE guidance and is also aligned with NHS cost-efficiency aims, especially in the context of IBD teams implementing switch programmes to support patients moving from biologics to biosimilars. Collecting national data allows for benchmarking, and Registry data can be combined with hospital episode statistics (HES) data to demonstrate IBD patients’ utilisation of healthcare resources and give long-term outcomes and health economic data.
The IBD Registry has been developed in line with NHS information governance and IT standards, so that all hospitals can participate in the collection of routine clinical data at the point of care. Teams can participate using a choice of data entry systems including existing local systems where these are capturing the relevant clinical information. The Registry now presents an opportunity for continuing data collection across the whole of the UK for audit and QI, as well as research and – importantly – local management reporting for trusts and commissioners.
Southampton gain-share agreement
Locally, participating in the Registry will give teams better data at the point of care to manage their biologics patients and their IBD service more effectively and efficiently. A successful partnership between IBD Registry’s clinical lead, Dr Fraser Cummings, and local commissioners has demonstrated the role of data for service development at Southampton University Hospital, where a biosimilars gain-share agreement (a collaborative arrangement between commissioners and providers in working together to create incentives that achieve better outcomes for patients and more efficient use of medicines which are not reimbursed via the National Tariff) is providing both value to the CCG and resource for the IBD service.
Between 2011 and 2014, biologic use in Southampton expanded rapidly by 68% from 196 to 330 patients. To cope with the increased demands of this complex patient group, they implemented an electronic biologics management system as part of an update of the pre-existing EMIS gastroenterology database to facilitate point of care data capture to improve monitoring and feed data into the national IBD Registry.
A business case was developed to establish the role of a biologics clinical nurse specialist (CNS) to ensure safe, cost-effective use of these high-cost drugs. The trust invested approximately £60,000 to deliver the improvements to the service and a scheme was agreed with local commissioners as a gain share of savings.
NHS England recommends a number of key principles to facilitate service improvements using gain share, which include the prescription of more cost-effective alternatives, moving to more effective operating strategies and reducing wastage, all of which may be addressed by the implementation of a biologics nurse specialist. NHS England has also commented that “making the most of biosimilars in our healthcare systems requires investment in transparent and clear decision-making frameworks”.
The IBD Registry provides such a framework, and with the end of central NHS funding for the IBD audit, the ongoing collection of this important data will need to be funded by hospital trusts and CCGs. The cost is likely to be up to £3,000 per annum. However, with the average cost per patient year of biological drug use at £11,000, there is an obvious benefit in having a robust mechanism to ensure that biological therapies are being used in line with NICE guidance, while fulfilling NHS medicines optimisation goals and feeding data to the IBD Registry.
The savings generated by being able to identify just one patient on inappropriate biological therapy would fund being part of the programme for more than two years.
For more information
W: www.ibdregistry.org.uk
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