This project demonstrates the effective implementation of NICE Technology Appraisals for Payment by results (Pbr) excluded drugs via a technology platform called Blueteq. The project aimed to engage clinicians to improve compliance with NICE Technology Appraisals. To achieve this, a High Cost Drugs Strategic Oversight Group was established to position the NICE Technology appraisals into pathways for patients across the Staffordshire Health Economy. The Project included importing historic patient data onto the Blueteq platform, collaboration on governance for Blueteq forms and designing local commissioning pathways.
Aims and objectives
- Ensuring compliance with commissioned NICE Technology Appraisals.
- To streamline the implementation of NICE Technology Appraisals.
- Communicating NICE Technology Appraisal guidance using the Blueteq platform forms.
- Ensure medicines are available in a timely manner as per NICE Technology Appraisals guidance.
- Improve knowledge and expertise of the NICE Technology Appraisals across the health economy.
- Improving processes and governance by utilising the Blueteq technology more effectively.
- To introduce an increasingly effective & efficient process for Individual funding requests using the Blueteq platform.
- To improve working relationships with the commissioners and to enhance collaborative working.
- To work in collaboration across the Staffordshire STP (sustainability and transformation partnership) footprint for a uniformed approach.
- Improve the patient experience.
- To take a strategic view and create pathways for specialities.
- To drive the change to biosimilar options.
Reasons for implementing your project
Burton Hospitals NHS Foundation Trust (BHFT) introduced the use of the Blueteq platform as part of a CQUINN (commissioning for quality and innovation - the CQINN system was introduced in 2009 to make a proportion of healthcare providers' income conditional on demonstrating improvements in quality and innovation in specified areas of patient care.)
- A lack of progress identified absence of expertise and resources at both BHFT and the commissioner organisations, which was resulting in key milestones not being achieved.
- Improvements from the BHFT and commissioner were needed at pace. The commissioner was failing to consistently provide accurate Blueteq forms as per the NICE Technology Appraisals in a timely manner and in some cases this resulted in forms not being available to the provider trust within 90 days of NICE approval, causing conflict between the provider trust and the commissioner.
- There was no governance in place for the generation of Blueteq forms which led to inaccuracies and acted as a further barrier to implementation.
- Clinicians were used to initiating treatments without a form, which resulted in some patients starting on treatments for non-NICE approved indications, again leading to conflict. Clinical teams at BHFT required significant support to help change deeply embedded practice.
- The project needed to be delivered within strict timeframes in order for BHFT to meet CQUINN targets.
How did you implement the project
The Pharmacy team leading the project at BHFT were clear about problems with the project at an early stage and communicated the barriers to East Staffordshire CCG. A face to face meeting was arranged to discuss the problems with proposed solutions being adopted immediately. The initial meetings were difficult and tense as both stakeholders had conflicting objectives. These conflicts were resolved overtime until a unilateral working group was established with representation from the commissioners and the Trust Pharmacy team. This learning and listening exercise began to bear fruit with rapid progress in governance arrangements for the project.
BHFT Pharmacy team offered:
- Dedicated pharmacist resource to address backlog of historic patients dating back to 2003 before the inception of Blueteq.
- Attendance at the monthly meetings.
- Positive, collaborative attitude.
- To respond to the Medicine Optimisation Team (MOT)’s queries and challenges with regard to invoice and treatment challenges in a timely manner.
- To provide invoice data in a form compatible with Blueteq
- To invite consultants to the monthly meeting to discuss treatment pathways.
- To challenge clinical decisions on behalf of the CCG if outside the scope of the NICE Technology Appraisals.
- To provide expert input into the Blueteq forms on publication of NICE technology pathways
- Aid the CCG with non-NICE compliant historic patients
The CCG MOT were able to offer practical solutions:
- To provide dedicated resource and expertise by establishing a High Cost Drugs lead post in the MOT.
- Ensuring Blueteq forms were accurate as per recommendation from the NICE Technology Appraisals and practical. Previous forms had sometimes requested fields that the provider trust couldn’t supply. This was due to lack of expertise by the author and lack of consultation with the provider trust.
- Provider trust pharmacists and clinicians were given the chance to consult on the forms.
- A system was established to review historic patients that had been initiated on treatment outside of NICE criteria.
- On-going face-to-face monthly meetings and support.
- The CCG funded 0.5WTE Band 7 Pharmacist for this project
The provider trust pharmacy team offered:
- Dedicated pharmacist resource to address backlog of historic patients not entered on Blueteq and ensure NICE compliance.
- Attendance at the monthly meetings.
- Positive, collaborative attitude.
- To respond to the Medicine Optimisation Team's queries and challenges with regard to invoice and treatment challenges
The initial aims and objectives were limited but as a result of collaborative working, both the commissioners identified further objectives around the project.
The trust was able to account for all historic treatments and process the backlog of approx. 1600 patients.
Commissioners and trust pharmacy team were able to develop a collaborative governance framework for the Blueteq form approval.
The trust and commissioners now have a highly efficient method to communicate IFR requests using Blueteq improving the speed at which patients can access treatment.
The trust pharmacy team successfully changed culture at the trust and introduced new working practice.
There is now greater knowledge and expertise of the NICE Technology Appraisals across the East Staffordshire health economy.
The rust pharmacy department met its aims for the CQUINN
Key learning points
- Prior to this project Blueteq technology had been purchased and levers for change e.g. CQUINNs were in place, but the technology was not being properly implemented and the systems were failing.
- This project demonstrates that technology and following processes will only succeed with dedicated human resources, training, mutual respect and collaboration and shared goals.
- The implementation of Blueteq increased administrative burden on clinical and pharmacy teams during a period where services are already stretched. Only with commissioner funding for dedicated staff did the project progress to completion
- Efficiency and financial savings realised by commissioners could form a platform for ongoing support for provider Trusts to ease the additional burden and improve compliance with use of Blueteq.
- Anonymised patient identifiers do not synergise with invoicing processes which forms further barriers to full utilisation of such technology platforms
- Developers such as Blueteq should engage with both commissioners and provider trusts to develop systems with all stakeholders in mind.
- Developers should engage with NHS Digital to investigate potential interface with current ePMA (End-to End E-prescribing and Medicines Administration)
systems being utilised within provider Trusts