Written evidence from the Evidence Adoption
Centre (CFI 02)
The Evidence Adoption Centre (EAC) is the East of
England's coordinating centre for the Adoption of Evidence-Based
Practice and Innovation.
EXAMPLE OF
BEST PRACTICE
FROM THE
EAST OF
ENGLAND AND
DEVELOPMENTS TO
SUPPORT GP CONSORTIA
COMMISSIONING
1. Introduction
The Evidence Adoption Centre provides a rapid on
demand reviewing and evidence analyses service for commissioners
of health care. We help them to make informed commissioning decisions
by providing evidence based answers to focused questions. We aim
to complete the reviews within a short space of time, usually
8-10 weeks.
2. What is the process?
We provide a short, realistic analyses of the most
up to date and relevant literature available in response to a
specific and focused commissioning question. Together with the
submitter of the question we focus the question to ensure that
the answers will prove of real value to support commissioning
decisions. The critical analyses of the evidence is conducted
by our research officers, health economists and a network of high
caliber critical appraisers based across the East of England.
This provides a pool of expert senior health care
professionals conducting evidence appraisal reviews and peer reviewing
their colleagues work. We are currently working with NICE to ensure
that our methodology and processes are robust and vigorous. We
aim to have NICE accreditation in place so that we can give all
our reviews a kite mark to help commissioners be confident in
the decisions that they make.
3. The Critical Appraiser Network (CAN)
The Critical Appraiser Network is made up of high
caliber critical appraisers form across the East of England working
in health care. We currently have academics from the University
of East Anglia, input from the Eastern Region Public Health Observatory
(ERPHO), appraisers from the Institute of Public Health, Research
Officers and Public Health Consultants. The CAN members are often
the policy makers in their own organisations. As part of the EACCAN
the members review the work plan, and share the work around reviews
and peer reviews requested. The can ensures that the best expertise
across the East of England is pooled and available for difficult
commissioning questions.
4. The Priorities Advisory Committee
The EAC hosts the East of England Priorities Advisory
Committee (PAC). The PAC addresses the need for medicines and
technologies where NICE guidance does not exist, needs updating
with current evidence, or needs local interpretation. The objective
of the PAC is to achieve prioritisation and make recommendations
across the East of England which are high quality, consistent,
efficient, transparent and evidence based. The PAC has resulted
in a significant reductions in variations and duplications across
the East of England and makes efficient use of resources and expertise.
RESPONSE TO
THE SELECT
COMMITTEE (SELECTED
POINTS ONLY)
4.1 We intend to examine further the assurance
regime which it is proposed to establish around commissioning
consortia in order to satisfy itself that the NHS Commissioning
Board has sufficient authority to deliver its objectives defined
in its Commissioning Outcomes Framework. (Paragraph 89)
5.1 The EAC welcomes the Committee's view that
a robust assurance regime is required. Commissioning consortia
should be encouraged to seek expert local input into all commissioning
decisions. The EAC can help achieve this. Use of the EAC services
will help commissioning consortia make intelligent commissioning
decisions. No service redesign should be instigated without an
expert review of the evidence for it, neither should any adoption
of technology take place without supporting evidence. The EAC
supports commissioners in this function.
6. The Committee believes it is essential
for clinical engagement in commissioning to draw from as wide
a pool of practitioners as is possible in order to ensure that
it delivers maximum benefits to patients. GPs have an essential
role to play as the catalyst of this process, and under the terms
of the Government's changes they, through the commissioning consortia,
will have the statutory responsibility for commissioning. They
should, however, be seen as generalists who draw on specialist
knowledge when required, not as the ultimate arbiters of all commissioning
decisions. The Committee therefore intends to review the arrangements
proposed for integrating the full range of clinical expertise
into the commissioning process. (Paragraph 96)
6.1 The Reviews and Peer Reviews of the EAC are
made via the Critical Appraisal Network, described in point 3
above. The CAN is made up of Public Health Consultants, Commissioners,
Health Economists and Academics etc, across the East of England
who have an interest in Health Care Commissioning and are experts
in their field. The EAC has a high personal specification for
CAN members. The EAC welcomes the Committee's view that high calibre
expertise from a wide pool of practitioners should be available
to Commissioning Consortia and that these views should be sought
for commissioning decisions.
7. Although the Committee understands the
value of the separation of the commissioner and provider functions
it believes it is important that this function separation is not
allowed to obstruct the development of high quality and cost effective
service solutions. We therefore intend to review the arrangements
proposed in the Bill for reconciling these conflicts. (Paragraph
102)
7.1 The EAC welcomes this approach. Advice, recommendations
and opinions in response to commissioning questions are independently
made by the EAC and PAC and will follow robust, NICE accredited
processes.
8. The Committee agrees that local engagement
with the commissioning of primary care services is important and
therefore welcomes this development. The potential conflict of
interest between consortia and local primary care providers does
however remain. We therefore intend to review the arrangements
proposed in the Bill for the commissioning of primary care services.
(Paragraph 104)
8.1 As per 7.1 above.
9. The commissioning of services that either
work across [health and social care] boundaries, or are intimately
linked is therefore an issue to which the Committee attaches great
importance, and we intend to review the effectiveness of the structures
proposed in the Bill which are designed to safeguard co-operative
arrangements which already exist and promote the development of
new ones. (Paragraph 107)
9.1 The EAC regards the use of evidence when
commissioning across boundaries services as essential. The EAC
is actively seeking across professional boundaries input to the
CAN. This will encourage cross sectional input in commissioning
decisions. The EAC is a model that could be adopted nationally
to support cross boundary commissioning decisions.
10. We intend to review the arrangements proposed
in the Bill to enable commissioning consortia to address these
issues [cross-area collaboration by consortia in reconfiguring
services] effectively; this will include a review of the ability
of the new system to encourage commissioning consortia to cooperate
in achieving the benefits to patients which may be available from
major service reconfiguration. (Paragraph 110)
10.1 As 9.1 above.
11. The Committee intends to review the arrangements
proposed in the Bill for enabling consortia to reconcile this
potential conflict [between patient choice and commissioning]
by enhancing patient choice at the same time as delivering the
consortium's clinical and financial priorities. (Paragraph 115)
11.1 The EAC welcomes this stance. Patient choice
and input into commissioning is a difficult task. Traditional
assessments based on effectiveness and cost effectiveness need
to assess individual value as well. The EAC and PAC have incorporated
PPI into the development and discharge of its processes. PPI is
encouraged via workshops, presentations, web forums and feedback.
The evidence reviewed is assessed for patient participation and
input. Emphasis is laid on showing how evidence has been used
to inform commissioning decisions.
12. The Committee does not find the current stance
on patient and public engagement in commissioning persuasive.
The National Health Service uses taxpayers' resources to deliver
a service in which a high proportion of citizens take a close
interest both as taxpayers and actual or potential patients. While
the Department may be right to point out that there is no special
virtue in uniformity of structure, the Committee regards the principle
that there should be greater accountability by commissioners for
their commissioning decisions as important. We therefore intend
to review the arrangements for local accountability proposed in
the Bill. (Paragraph 118)
12.1 As above in 11.1.
13. The Government must support consortia and
existing commissioning organisations to form clear and credible
plans for debt eradication and for tackling structural deficits
within their local health economy. The Committee intends to further
review this issue in its further work. (Paragraph 123)
13.1 The EAC welcomes the proposal that the government
insists on credible deficit plans. The EAC in the East of England
has been specifically designed to support the current SHAs QIPP
plans which are designed to address the need for efficiency savings
and innovation. This model is appropriate for adoption nationally.
14. Further information about the EAC can be
obtained from www.eac.cpft.nhs.uk
January 2011
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