It is essential that all NHS funding decisions are made in a robust, open and transparent way that ensures fair access to clinical treatments or interventions. This can be particularly challenging for treatments or interventions not routinely commissioned by the NHS, either locally by the Integrated Care Board or nationally by NHS England.
Developing and harmonising clinical policies, and incorporating rigorous processes, ensures consistent eligibility and treatment options across a local health and care system. This helps to address health inequalities, tackle the most urgent clinical priorities, and support delivery of the Triple Aim duty of better health for everyone, better care for all patients and sustainable NHS services.
We provide clinically evidence-based solutions that support population-based commissioning through our unrivalled expertise in individual funding requests, policy harmonisation, health economic modelling, clinical and cost-effective reviews, ethical decision making and corporate governance.
We identify system resource challenges which limit the introduction of new treatments and interventions for patients; agree common decision criteria to support the whole system to prioritise funding and make fair and equitable funding decisions between different clinical treatments and/ or interventions. We also ensure clinical policies are supported and implemented by all ICS stakeholder organisations.
Our support includes:
IFR and prior approval management
- Fully managed IFR services, from receipt to decision and notification, as well as case reviews
- Co-ordinating and facilitating IFR panels
- Monitoring to ensure policies and procedures are followed, reducing workload and risk
- Comprehensive reporting information
- Management and administration of the Prior Approval Process in line with policy criteria
- Clinical triage of prior approval cases and IFR applications
- Support with co-ordinating Clinical Commissioning Policy development and the review process
- Access to Blueteq® software, this remotely accessible, secure technology provides a holistic approach to case management, supporting data collection and presentation, audit trails, decision monitoring, reporting and communication with stakeholders throughout.
Policy development process and governance review
- Review of existing policy development processes and governance arrangements, providing recommendations to ensure future policy approaches reflect system-wide decision criteria and priorities
- System-wide organisational development that enhances executive understanding of the need for good governance to support the creation of healthcare policy
- Identification and support for the management of risks inherent in the governance review process.
Ethical framework review and development
- Development of ethical frameworks utilising evidence of clinical and social effectiveness, evidence of cost effectiveness and trade-offs between equity and efficiency
- Identification of where applying an ethical framework can provide legitimate, publicly acceptable decisions as well as demonstrating which frameworks offer genuine value for systems and their population.
Policy mapping review
- A unique, forensic approach to identifying weaknesses, strengths and potential loopholes within commissioning and strategic policies
- Matching policies to circumstances, both clinically and strategically, identifying and consulting key stakeholders to minimise risk
- Developing consensus models to harmonise and integrate recommendations from multiple policies to minimise risk and enhance understanding of targets and national requirements.
New Clinical policy development
- Expertise in drafting clinical policy which utilises patient selection criteria to ensure transparency and objectivity, as well as reflecting the decision criteria adopted by each healthcare system
- Ensuring equity of access to the individual care intervention for all patients based on clinical need, regardless of the provider or their personal characteristics
- Delivering consistent policies across systems that reduce unwarranted variation and place the focus on evidence-based patient care.
Rapid evidence reviews
- Collaborative research scope development, tailored to meet individual challenges
- Selection of the best quality evidence using an established standardised process to identify, appraise and apply the evidence
- Draughting recommended commissioning options utilising a structured and rigorous search which provides unique, robust and defensible methodologies.
Financial impact modelling
- Synthesising and comparing the costs and benefits of healthcare services or treatments to make decisions about which interventions could provide the best patient and commissioning outcomes
- Financial expertise that enables systems to make better informed clinical policy decisions which, in addition to clinical and cost effectiveness, also reflect those outcomes and realistic financial implications.
Clinical and stakeholder engagement
- Tailored engagement approaches that identify and manage relationships with all stakeholders that hold an interest in a programme and have responsibility for leading, directing, influencing and motivating others towards the desired outcome
- Allowing valuable clinical and patient insights and context to be considered by policy makers
- Providing the capacity and expertise required to seek the views of patients and their families directly using public consultation, survey, interview or focus group approaches.
Equality impact assessment
- Equality impact assessments that meet your legal requirements by providing a systematic and evidence-based tool which delivers understanding and consideration of the likely impact policy changes could have on different groups of people
- Equality focus reviews of all policies giving due regard to the principles of the public sector equality duty. This highlights the potential risks around each policy or change and provides recommendations for mitigations or further work for improvements.
Prioritisation and refinement
- Prioritisation and refinement adaptations to support the process of delivering a solid evidence base for policy, considering local needs and challenges.
- Supporting the identification of patients who might be considered to have the greatest need, or the greatest capacity to benefit from a particular treatment or intervention.
- Enabling prioritisation where treatments cannot be made available to all patients due to resource constraints including limited supply from manufacturers, the cost of treatment or limited supply of staff or hospital admission slots.
Supporting change in clinical practice
- Providing the structure and expertise required to embed change within clinical practice by successfully managing all organisations and stakeholders towards a single vision for improving patient care.
- Developing and implementing appropriate information and education packages that prepare all stakeholders for change, whilst ensuring the process is rooted in the principles of stewardship and delivery of the triple aim duty.
Clinical audit and quality assessment
- Providing assurance to organisations that healthcare interventions are being delivered in line with the expected systems processes and standards, whilst improving patient care and outcomes by identifying any potential improvements and minimising potential risks
- Extensive experience in conducting, monitoring and evaluating clinical audits and providing a thorough quality assurance programme. Our approach includes novel methodology and detailed reporting that provides feedback and recommendations to ensure pathways of care are robust and best placed for successful delivery.
Our key strengths and expertise:
- Our experienced team of clinical services experts have delivered Individual Funding Request (IFR) and Prior Approval services since 2016 and currently support health systems across Birmingham and Solihull, Northamptonshire, Lincolnshire and NHS England Armed Forces healthcare commissioning
- We offer end-to-end and modular services specifically designed to support our clients exact requirements. Our IFR team operates from three regional hubs that are co-located within customer areas. This offers an ideal combination of consistency, while allowing sufficient local flexibility to meet individual customer requirements
- All our services are clinically led and underpinned by the latest technology, our IFR service supports transparent and robust decision-making, designed to ensure that decisions are evidence based, equitable, timely and compliant with policy.
RELEVANT READING
Find out more about our individual funding request service by accessing the resources below.
Facilitating a smooth transition to a more efficient IT system for Armed Forces prior approvals
NHS Arden & GEM’s Clinical Support service identified and facilitated the transition to a more efficient and reliable IT solution to support NHS England Armed Forces Health in processing an increasing number of referrals to their prior approvals service.
Mapping training and career pathways for pharmacy professionals in the Midlands and East of England
In response to a perceived lack of clarity about training and education needs for pharmacists and pharmacy technicians, Health Education England commissioned Arden & GEM to conduct a pilot study to explore current post-registration education and training pathways.
CONTACT US
If you’d like to find out more about individual funding requests, prior approval and policy development please contact us here: