Sussex NHS Commissioners have been working together to review and standardise non-emergency treatments and procedures available to patients across the area.
The Clinically Effective Commissioning (CEC) Programme, led by local GPs, hospital doctors and other specialists, will:
- ensure that services offered to patients are shaped using the latest evidence and guidelines from national experts
- deliver value for money for the NHS budget
- give the best results for individual patients and the public
At present, there can be differences in the criteria (clinical policies) used by local specialists to determine when patients should be referred for tests and treatment. This issue, often referred to as a “postcode lottery”, means that some patients are not receiving treatment when they should, purely because of where they live, while others receive NHS-funded procedures that offer little or no clinical benefit. These may include alternative therapies such as aromatherapy, herbal remedies, reflexology and homeopathy. Some procedures, for example, tonsil removal, are four times more likely to be carried out in some parts of Sussex than others.
It is critically important that we make sure NHS funding is spent on care that we know is clinically effective and will bring benefit to our patients.
Through the CEC programme, a list of treatments and procedures has been divided into three groups. So far, the seven CCGs across Sussex have adopted a number of updated shared clinical polices in groups 0-2, covering a range including tonsillectomies, gallstones and trigger finger. You can see the full list by downloading the Clinically Effective Commissioning Policy. The procedures in this list are not new – most already had guidelines. Our work has been about reviewing those that have limited or no clinical benefit, or those that demonstrate benefit within certain criteria.
Updates also focus on supporting joint conversations between clinicians and patients, and them making shared decisions about treatment options, thinking about the best end result for the individual patient.
If you have any questions about your own treatment or a referral, please speak to your GP in the first instance.
Involving patients in these changes
Our Clinical Commissioning Groups’ (CCGs’) formal duty to involve and consult the public is a fundamental part of developing and improving health and care for local people in our communities. We want to be as open and honest as possible with our public about any decisions we have to make.
All updates to the clinical policies are evidence based and built on NICE (National Institute for Health and Care Excellence) guidance and best practice. Thorough engagement with patient groups has already been completed for procedures at a national level by NICE and it is this guidance that we have built our work on, completed by clinical evidence and local clinical input.
Importantly, we have also listened to the experiences and views of local patients and carer representatives about the best possible way to implement the changes.
At a workshop in December 2017, patient representatives from across the Sussex Health and Care Partnership discussed the best approach to communicate changes with patients, before a further two workshops on 21 February 2018 and 7 September 2018 discussed implementation of the changes; specifically thinking about shared decision making between patients and their clinicians, as well as how to use local patient participation groups (PPGs) to help people find the right information and support them to make decisions about their own health and care and what treatment is right for them individually. It was agreed that any support tools or information given to patients should recognise the differences across our communities in terms of social, economic or cultural factors.
Equality for our populations
Before we implement any changes to services, the CCGs complete a thorough assessment to help us to understand how our decisions may affect people. The Equalities and Health Inequalities Impact Assessment (EHIA) process helps us to identify what we need to do to better meet people’s needs and to think clearly about how what we do may impact on all communities or groups.
It involves anticipating what the consequences of our actions may be and considering what we need to do to make sure that any negative consequences are removed or at least minimised. It also provides us with an opportunity to consider how we can further promote equality, diversity, inclusion and human rights in everything that we do.
As we implement the new clinical policies for groups 0-2 (from 13 September 2018), we have already started thinking about how we talk to local people about the procedures in group three. We are working in partnership with Healthwatch, the voluntary and community sector, and patient representatives and leaders. This will make sure that we hear from people who will be, or are likely to be, affected by any further changes. Group three is likely to see more significant differences between existing policies or the need for new policies, and so involving patients and local people is critical.
CCGs have a formal duty to involve and consult local people over any proposals that would involve significant changes to services they provide.
The CCGs in Sussex are working together, and with other NHS organisations and local councils, through the Sussex Health and Care Partnership to improve people’s health and improve local health and care services within the resources available. The review forms part of this work.