04.07.18
‘Exemplar sites’ to help phase out 17 ineffective NHS interventions in major savings bid
A small number of ‘exemplar geographies’ will be handpicked by NHS England in the next few weeks to test a new approach to more effective practice by helping phase out 17 interventions where there is clinical consensus and evidence that they should not be routinely commissioned.
In board papers for its meeting today, NHS England revealed that if it does not take action now to reduce the amount of unnecessary interventions currently performed across the health service, it will take up to 25 years to “reduce activity to the level we propose to aim for.”
To fix this, a new programme will be launched with a tight focus on 17 specific interventions that will test out the new proposals as part of an initial phase, setting the stage for a much wider, ongoing scheme later on.
The 17 options were compiled from a long list of interventions with “no or limited clinical effectiveness,” which were then prioritised and refined into a smaller list of changes that could be implemented relatively quickly and on a large scale.
If sufficient progress is made in the first phase, NHS England will consult on further interventions for phase 2, to be launched early next year. This phase will also include specialised services commissioned by the national body.
The 17 interventions being targeted include four that should no longer be routinely commissioned unless a successful individual funding request is made, either because “they are ineffective or have been superseded by a safer alternative.” The other 13 are interventions that should only be commissioned by CCGs or performed when specific clinical criteria are met, because they are only effective in certain circumstances.
“The main reason for introducing this programme is to prevent avoidable harm to patients and free up clinical time and capacity,” the board papers explained, adding that last year, the 17 interventions were performed over 348,000 times to a projected cost of almost £440m. The national organisation’s ‘moderate estimate’ is a reduction of just over 168,000 procedures in 2019-20, which should save more than £200m.
While it acknowledged that there have been “numerous prior initiatives” also aimed at eliminating ineffective practice with partial or limited success, NHS England promised that this programme will be different because it is taking 12 specific actions to ensure change is delivered.
These include forming a new collaboration nationally with NHS Clinical Commissioners, NHS Improvement, NICE, the Academy of Medical Royal Colleges and other relevant royal colleges to steer the scheme, as well as an ambition to work alongside exemplar geographies which are “furthest advanced” in implementing the clinical recommendations for the chosen 17 interventions. These areas will form a reference group to further test the proposals and share learning.
It is also proposing to better align incentives to the available evidence by asking providers to seek clinical approval to perform the interventions only when they can demonstrate exceptionality. And from April 2019, it will amend the terms of the national NHS standard contract to require both CCGs and providers to comply with the policy.
In terms of assessment, NHS England will set activity-based targets for 2019-20 and produce an integrated monthly dashboard to monitor how the programme is being implemented across the country. Local systems will be expected to perform an annual audit to ensure they aren’t paying for interventions that shouldn’t be routinely commissioned.
Pending board approval, the consultation for phase 1 will run from 4 July to 28 September this year.
This week’s news follows on from last year’s programme focused on phasing out items that shouldn’t be routinely prescribed in primary care, after which the NHS England board recommended a similar approach be adopted across clinical interventions.