Transcript Individual Patient Commissioning Committee (IPCC)

Individual Patient
Commissioning
Committee (IPCC)
Shelly Keane
F2 in Public Health
Halton and St Helens PCT
Background
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Primary care trusts have legal responsibility for NHS
healthcare budgets

Their primary duty is to provide for the healthcare needs
of the whole population as well as individuals and to
live within the budget allocated to them
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The NHS should only invest in treatments which are of
proven effectiveness (except in high quality clinical trials)
Acknowledgement: East Midlands Specialised Commissioning Group. (EMSCGN003V1): Key Principles for the development of commissioning policies by the PCT.
http://www.emscg.nhs.uk/Library/EMSCGN003V1EMSCGKeyPrinciples.pdf
The need for an Individual Patient
Commissioning Committee (IPCC)
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Individual patients sometimes have exceptional needs
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These not covered by routine NHS contracts and funding decisions
locally are the responsibility of the IPCC
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Halton and St Helens IPCC makes decisions whether to fund
treatment in these special cases. Decisions should be:
 Evidence-based and rational
 Fair
 Accountable
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Detailed application to IPCC is submitted by requesting clinician
Halton and St Helens Individual patient commissioning committee (IPCC). Annual Review 2009/2010
Making the decision:
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Three main questions for reviewing team to consider:
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Has patient demonstrated exceptional clinical circumstances in
comparison to cohort of other similar patients?
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Is it likely that the requested treatment will be clinically effective?
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Is it likely that the requested treatment will be a cost effective use
of NHS resources?
Decisions are explained to requesting clinician and patient
and appeals process is available
David Lock, Barrister and Head of Public Law at No5 Chambers: April 2011: What does the duty on PCTs to give reasons for an individual treatment decision mean in practice?
Types of request:
There is either NICE guidance
or a local PCT policy which
does not recommend funding
for the requested indication
There is no NICE or local PCT policy in place that specifically covers the request for this patient.
Type 1
Exceptional Case Request
Type 2
Individual Funding Request
Rare/Unique Clinical Scenario
Type 3
Individual Funding Request
Service Development
Type 4
Individual Funding Request
Experimental/Unproven
Treatment
The request is for funding of a
treatment that is not routinely
offered to other patients with
the same condition and at a
similar stage by the PCT. This
includes requests for funding
during or following a clinical
trial.
The request is a treatment for a
very rare condition or almost
unique clinical scenario for which
the PCT has not previously
needed to make provisionon.
The request is for a new or
established treatment that has
not been considered by the
PCT before because it is a
new or different way of treating
a definable group of patients
(however small).
The request is for a treatment
that is experimental, novel,
developing or unproven, and is
not currently funded by the PCT
for this indication.
The PCT will only fund a case
when it can be demonstrated
that it is fair and equitable to
offer the treatment to this one
patient, when others from the
same patient group at the
same stage of the disease are
not being funded or offered the
treatment at the same stage of
the NHS pathway.
In these situations, in addition to
questions about priority and
value for money/opportunity
costs, the following questions
will be asked:
What is the nature of the
condition? What is the nature of
the intervention?
What is the evidence that this
treatment might work in this
situation?
Is there biological plausibility that
this treatment might work?
This will not be funded through
the individual funding request
panel.
Treatments which are judged
experimental or unproven are
not routinely funded. Funding
for individual patients or groups
of patients within trials or
unstructured ‘evaluation’ of new
treatments will not be supported.
PCTs may make an exception
for rare conditions/scenarios
where it is considered
impossible to carry out
appropriate trials – see Type 2.
Requests should be made to
the PCT for all relevant
patients (now and in the future)
to be considered through the
PCT commissioning process
for medicines & treatments.
NW Medicines and Treatments Group May 2010
Appendix Two
Dummy Application Guidance for Clinicians Submitting Individual Funding Requests (IFRs) & Exceptional Cases
Case scenario 1:
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Mr X has a very rare type of muscle tumour
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Two chemotherapy drugs have been tried but were unsuccessful
He has started trial of new drug ‘Amazat’, which has been funded
as a ‘top up’ (patient- funded)
Amazat is unlicensed for this tumour type
He has responded well to Amazat; tumour has shrunk
significantly and patient and his Doctor want to continue tx
Mr X and his clinician now request NHS funding to continue
treatment with Amazat
Case scenario 2:
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Prof Y has chronic severe migraine
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She has been trying various medications without success
A new drug ‘head-o-heal’ is marketed for this condition but NICE
have recently recommended that it should not be used routinely
due concerns regarding cost-benefit. It has shown to be effective.
Prof Y has clinical depression which has increased in severity
with her migraines being a major source of concern
Prof Y and her clinician request that the drug be funded in this
instance as the condition is causing her to become depressed
and she has made several attempts to end her life
HSTH IPCC Annual review 09-10
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IPCC considered a total of 69 cases (2009-2010)
Funding approved: Over £300,000 for 43 patients
£140,000 ineffective expenditure avoided
Next steps
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Introduce systemised search strategy
Develop collaboration with Mid-Mersey Medicines
management group
Halton and St Helens Individual patient commissioning committee (IPCC). Annual Review 2009/2010