Upload
morgan-stafford
View
217
Download
0
Tags:
Embed Size (px)
Citation preview
Contracting for supply of Enteral Feeds
What is it?
Enteral feeding is used where someone has a functioning GI tract, but has a swallowing or eating disorder which makes it impossible to meet nutritional requirements orally e.g. MND, MS, post CVA.
Most are fed through a PEG tube (percutaneous endoscopic gastrostomy), though some are via a nasal tube.
Can of worms
• Feeds are usually given through a pump (supplied free by Provider – training needed)
• Common problems: buried bumper, blocked tubes, overgranulation of stoma site, medicines administered through the tube (specials!), infection,
• Increase in hospital admissions if no access to timely expert advice
• Change in carer (in care home)
Why QIPP?
• Check your enteral feed primary care prescribing costs – each monthly script costs on average £150 to £250
• Also check what’s being paid for ‘ancillaries’ – supplies delivered direct to the patient or carer by the contractor
• Then check primary care sip feed costs
Why QIPP?
• For Norfolk this was c. £ 4 million per year for sips & enterals in primary care, and c. £300k per year for ancillaries
• Value for money?
• Feeds VAT free as FP10, ancillaries usually VAT free (but only if claimed for)
Contracts
• Specialised contracts like these are usually managed by the Trusts – so the incentive to save costs in primary care is not often considered
• Contract monitoring is often also managed by the Trusts (lots of primary care NHS re-organisations over the years!)
Contracts
• Fear of possible change of status quo from patients, clinicians and commissioner
• Up to date specification was needed e.g. improved clinical support in community, electronic patient data & invoices.
Contracts
• NHS has specialist enteral feeding group which provides advice to Commissioners
• Advised to re-tender as the same Provider had held the contract for many years
• Process started after talking to Trusts and engaging help of procurement hub
• First had to establish database of patients & feeds & equipment used – took about two months
Writing the Specification
• Aim to meet future needs as far as possible e.g. increase in patient numbers, care in community, needs of different patient groups (paed/adult) etc.
• Explore the options: flat pricing, off FP10, rebates, split paeds/adult
• Don’t re-invent the wheel – find out what others have done – what worked/what didn’t
• Get it agreed with the clinicians & patients
• Get the weightings right to meet the need
Form a Committee!!!• Nutrition Committee established to evaluate
offers, select supplier & manage future contract monitoring
• Members drawn from patients, Primary & Secondary care
• Made an advisory sub-committee of Area Prescribing Group
Keep calm
• It’s hard work
• Potential change in supplier for the needs of such a specialised patient group isn’t easy
• It may cost more initially (e.g. time)
• Not everyone will agree about ‘savings’
What happened?
• Significant reduction in primary care costs
• Maintained lower costs to Trusts
• Option for further savings in primary care
• Most importantly – increased clinical provision in the community – 4WTE nurses from 1.8 WTE (cost met by Provider)
• Shifted balance of contract management from Trust only to Trust & Primary Care – shared responsibility