1. Market Access in the NHS
The Challenges and Opportunities
Richmond House London

3. 4 Key Areas
 NHS Structures and Decision Processes
 Appraisal – The role of NICE
 The Health and Social Care Bill
 NHS Innovation Review

4. The NHS Structure
A Different Perception

5. A Complex Structure
• Currently
 8230 General Practice Surgeries in England manned
by 34,101 GPs supported by practice nurses and other
professionals
 164 Hospital Trusts
 Operating 350+ Hospitals
 152 Local Commissioning Bodies holding the budgets
Plus Opticians‘, Dentists and Pharmacies delivering
commissioned services on behalf of the NHS

6. Decision Processes in NHS
 The interdependencies within the Healthcare Economy
Providers are In
Commissioning general hospitals
Bodies Hold Budget. They and other Suppliers of
They Commission clinical Organisations equipment,
services on behalf of Contract to deliver a
their Local ICT services
range of services in
Healthcare economy primary, secondary Support services
and tertiary care for
Care

7. Systems Impact
 It is critical that Companies understand the impact
of their device on the system as well as on the
patient.
 Who benefits v Who pays?
 Impact on tariff?
 Pathways v Episodes of Care?
 Quality Standards?
 Impact of QIPP Programme?
 What is the role of procurement?

8. Multiple Decision makers ....
. Require Different evidence and information
 Clinicians
- Clinical Efficacy
- Safety
- Skills requirements
- Who else is using the device
 Hospital Management
- Tariff Impact
- Implementation time
- Resource Changes
- Realising the benefits

9. ........And
 Commissioners
- Head room in current tariff
- Creation of a local tariff/ innovation
payment
- Impact on overall cost of managing
patient

10. ... And Finally
 Procurement Organisations
National
- NHS Supply Chain
- Buying Solutions
- Drug Tariff
Regional
- Shared Business Services
- Procurement Hubs
Local
Individual Hospitals
- Likely demand
DAILY READING – OJEU TENDERS
Specification and PRICING STRUCTURES

11. Technology Appraisal - The Role of NICE
 The National Institute for Health and Clinical
Excellence (NICE) is the independent organisation
responsible for providing national guidance on the
promotion of good health and the prevention and
treatment of ill health.
 NICE reviews
- Pharmaceuticals
- Interventional Procedures
- Devices and Diagnostics
- Cost Effectiveness , Efficacy and Safety

12. NICE programmes for Medtech
Medical Technologies Evaluation Programme
(MTEP) and Diagnostic Assessment Programme
(DAP)
 There was limited capacity for medical
technologies in existing programmes
 Not designed to assess early in life cycle
 Particular challenges for diagnostic technologies
 Intense interest in technology/innovation and
UK as ‘slow adopter’.....

13. MTEP overview
www.nice.org.uk

14. Key Issues
 MTEP understands and adjusts for:
- medtech industry has limited experience of
health technology assessment
- medical technologies often have a sparse
evidence base
- there are significant differences between
devices, in-vitro diagnostics and imaging
- technical considerations (safety,
compatibility, procurement, maintenance,
calibration, training, upgrades) need careful
consideration
- the need for flexibility for different value
propositions

15. Patient/system benefits of published guidance
Topic Patient System Cost saving
benefits benefits (per patient*)
MTG 1 Sequent Lower rate of restenosis and Fewer repeat 450
Please balloon reduced need for re-treatment procedures
catheter for and major cardiac adverse events
restenosis
MTG 2 Better treatment planning (and Fewer skin grafts 1248
moorLDI imager for less prodding !)
medium-severe Avoidance of unnecessary surgery
burns
MTG 3 Fewer post-op complications Reduced length 1100
Cardio Q ODM for Earlier mobilisation of stay
intraoperative fluid (No increase in repeat surgery or
management re-admission)

16. Cost Consequences
 Not always looking for cost savings.
 Improved patient outcomes at a higher may
also gain positive approval
 Also considering cost consequences across
the pathway and acknowledging there will be
winners and losers in the funding stream

17. QIPP
 Quality Innovation Productivity and Prevention
 Aim is to create $30Bn of savings in 4 years
by ‘doing things differently’
 Multiple Work Streams
 Main ‘game in town’ . Now talk about products being
Quippable
www.dh.gov.uk/en/Healthcare/Qualityandproductivity/QIPP/

18. QIPP Work Streams
Commissioning Provider System Enablers
pathways efficiency
• Primary Care
•Safe Care Back Office Commissioning
Efficiency and
•Right Care management • Clinical
Commissioning
•Long Term Procurement Groups
Conditions
Clinical Support
•Urgent and
Emergency
Productive care
•End of Life care Medicine Use and
procurement

19. Health and Social care Bill
 Establishes an independent NHS Board to allocate resources
and provide commissioning guidance
 Increases GPs’ powers to commission services on behalf of
their patients
 Strengthens the role of the Care Quality Commission
 Develops Monitor, the body that currently regulates NHS
foundation trusts, into an economic regulator to oversee
aspects of access and competition in the NHS
 Cuts the number of health bodies to help meet the
Government's commitment to cut NHS administration costs
by a third, including abolishing Primary Care Trusts and
Strategic Health Authorities.

20. Changing Incentives within the System
 Previous targets set around activity
 Success measured against number of patients
treated, waiting times and cost
 Budget holders commissioned for quantity and Cost
not improved outcomes
 Quality of patient outcome and quality of patient
experience become the main measures of success.

21. Private Healthcare Provision and the NHS
 Budget holders can commission
services from any qualified provider
 Private patient cap removed from
NHS Trusts

22. Innovation: Health and Wealth
 Commissioned by Sir David Nicholson CEO of
NHS
 Delivered by a team led by Sir Ian Carruthers
CEO of SW SHA and Chair of the NHS Innovation
Delivery Board
 Substantial consultation with industry, clinical
groups, commissioners and researchers
 27 Key Recommendations
 15 Task and Finish Groups now working on these

23. Key Role for NICE
 We will introduce a NICE Compliance Regime to reduce variation and drive up
compliance with NICE Technology Appraisals
 We will require that all NICE Technology Appraisal recommendations are incorporated
automatically into relevant local NHS formularies in a planned way that supports safe
and clinically appropriate practice
 We will establish a NICE Implementation Collaborative to support prompt
implementation of NICE guidance
 We will develop and publish an innovation scorecard to track compliance with NICE
Technology Appraisals
From April 2013, compliance with the high impact innovations will become a pre-
qualification requirement for CQIN Payments
i
(CQIN = Commissioning for Quality and Innovation)

24. Setting the Incentives
 We will align financial, operational and performance incentives to support
the adoption and diffusion of innovation
 We will increase the profile of, and maintain investment in, the NHS
Innovation Challenge Prizes
 The NHS operating framework asks the NHS to prioritise the adoption and
spread of effective innovation and good practice
 Clinical Commissioning Groups will be under a duty to seek out and adopt
best practice, and promote innovation
 We will strengthen leadership and accountability for innovation at Board
level throughout the NHS

25. Any Questions?
steven@odelletechnology.com