Determining local service levels

Benchmarks for a standard population

Available data suggest that the standard benchmark rate for new referrals to a service for the accurate diagnosis of the epilepsies in adults is 0.03%, or 30 per 100,000 population, aged 15 years and older per year. Approximately 80% of the population in England is aged 15 years and older.

The NICE clinical guideline CG20 on the epilepsies defines adults as individuals aged 18 years and older and young people as those aged 12-17 years. The guideline also states that there is a variable age range (15-19 years) at which care is transferred between child and adult health services by local healthcare trusts and primary care organisations. For the purpose of this commissioning guide the adult population has been defined as people aged 15 years and older. This definition is also used in the commissioning and benchamrking tool and has been chosen because of the availability of population data at general practice level within certain age bands.

For an average primary care trust population of 300,000 (with 240,000 people aged 15 years and older) the average number of people requiring a new referral to a service for the accurate diagnosis of the epilepsies would be around 70 per year (0.03% of the population aged 15 years and older).

For an average general practice list size of 10,000 (with around 8000 people aged 15 years and older), the average number of people requiring a new referral to a service for the accurate diagnosis of the epilepsies would be 2 per year (0.03% of the population aged 15 years and older).

Of these newly referred individuals, approximately 70% may be expected to have the diagnosis of epilepsy confirmed and hence will require ongoing support and regular structured review.

Examine the assumptions used in estimating these figures.

Epilepsy is likely to fall under the programme budgeting category 207X (neurological).

Use the service for the accurate diagnosis of the epilepsies commissioning and benchmarking tool to determine the level of service that might be needed locally and to calculate the cost of commissioning the service using the indicative benchmark and/or your own local data.

Further information

Sources of further information to help you in assessing local health needs and reducing health inequalities include:

• Annex A of the Commissioning framework for health and well-being outlines the process and data needed to undertake a joint strategic needs assessment.
• Department of Health Delivering quality and value - focus on benchmarking.
• NICE Health equity audit - learning from practice briefing.
• Delivering the 18 week patient pathway: 18 week commissioning pathways.
• The No delays achiever provides access to service improvement tools aimed at reducing time between referral and treatment.
• The Practice-based commissioning comparators reporting service provides access to a range of indicators and activity data at practice level, enabling a better understanding of local commissioning activity, referral patterns and outcomes.
• The Disease management information toolkit (DMIT) is a good-practice tool for decision-makers, commissioners and deliverers of care for people with long-term conditions, which presents data on conditions that contribute to high numbers of emergency bed days. It models the effects of possible interventions that may be commissioned at a local level and helps users to consider the likely impact of commissioning options.
• PARR (Patients at risk of re-hospitalisation) is a risk prediction system for use by primary care trusts to identify patients at high risk of hospital re-admission.
• PRIMIS+ provides support to general practices on information management, recording for, and analysis of, data quality, plus a comparative analysis service focused on key clinical topics.