Commissioning Policy
Background
South Staffordshire Primary Care Trust (PCT) is responsible for commissioning healthcare services for its resident population. These services include hospital care, mental health services, prison health services, general practitioners (GPs), screening programmes, dentists, pharmacies and opticians.
In any health care system there are limits set on what is available and on what people can expect. Primary Care Trusts (PCTs) are required to achieve financial balance; they have a complex task in balancing this with individuals’ rights to health care. As a consequence treatments, services and medicines are prioritised against the competing needs of the population and priority is given to those which provide the greatest health gain to patients (clinical effectiveness), those which represent good value for money (cost effectiveness) and where the PCT has the resources available to invest in said services or treatments (affordability).
Through what is called a Local Delivery Planning process, the PCT reviews all the services it commissions on an annual basis.
The Local Delivery Planning process involves prioritising investment in interventions that deliver PCT objectives in the most cost-effective manner and which benefit the wider population of the PCT. Those interventions that are low priority or not clinically or cost effective are, therefore, not commissioned. Commissioning policy decisions and local delivery planning priorities are made based on the PCT ethical framework and the PCT commissioning framework which can be found here commissioning Policies.
Commissioning Advisory Group
The PCT Commissioning Advisory Group assists the PCT in reviewing new treatments and medicines. The group considers the clinical and cost effectiveness, prevalence in the population, patient safety, affordability and health gain in determining the priority status of that treatment for routine commissioning.
The group award a high priority status to those treatments which are significantly clinically and cost effective and where the PCT has the resources available to invest in them in year. The group also ensures where it has regarded the treatment as a medium priority these are considered through the PCT Local Delivery Plan round for annual prioritisation against other calls for NHS funding.
Click here for Terms of Reference of the Commissioning Advisory Group
Following the priority decision, the Commissioning Advisory Group develops commissioning policies which describe the outcome of their considerations and the priority status given to the said treatment.
The PCT has a number of commissioning policies that restrict access to services or interventions; these are considered to be a low priority for routine NHS funding. These policies are available on this website; please click here for a list of South Staffordshire PCTs Commissioning Policies.
Many new policies have been added and old policies updated or republished. Some policies, however, are still being considered, this is an ongoing process and policies are reviewed in light of any new significant clinical evidence.
Individual Funding Policy
There are instances where a request for funding is made for services not routinely commissioned or covered under existing contracts, such as healthcare interventions and high cost drugs. The PCT considers these requests through an Individual Funding Policy.
The Individual Funding Policy for South Staffordshire PCT relates to referrals under the following circumstances:
a) Where a treatment is specifically restricted under the PCT’s commissioning Policy, but where there may be exceptional circumstances that could justify relaxation of the policy for that individual. (Click here for commissioning policies).
OR
b) Where specific approval is needed for a treatment to take place. This may be because the treatment is new or costly and a hospital trust needs to gain specific authorisation or because the request is for treatment in the private sector or with an organisation that South Staffordshire PCT does not have commissioning arrangements.
For cases to be considered by the panel, Clinicians must be able to demonstrate that their patient has exceptional circumstances as defined in
our Individual Funding Policy.
Requests for funding are only accepted only from Consultants, Principals in General Practice, General Dental Practitioners; they are not accepted directly from patients.
Each request should be accompanied by a completed Individual Funding Request Application form, which your clinician will have access to.
Please note, our Individual Funding Policy and process only covers patients registered with a South Staffordshire PCT GP.
Requests for consideration should be sent to the
Exceptional Treatment Panel
South Staffordshire Primary Care Trust
Angelesy House
Towers Business Park
Wheelhouse Rd
Rugeley
WS15 1UL
Requests will be acknowledged and this acknowledgement will include the date of the panel meeting, which meet on a monthly basis.
The outcome of the panel’s decisions will be sent out in the week following the meeting. Where the application form specifies that the patient has consented to us contacting them direct, the patient will be copied into Exceptional Treatment Panel letters.
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