We vastly improved our funding application process by creating a comprehensive Individual Prior Approval Scheme, resulting in efficiency savings, improved patient flow with a faster turnaround of applications and outcomes.

Background

Clinical commissioning groups (CCGs) need to ensure that funds are spent on treatments and procedures bringing the greatest value and benefits to patients in a way which is affordable and equitable. Chorley & South Ribble CCG and Greater Preston CCG wanted to improve their funding application process. The challenge was to change behaviour, educate clinicians, improve the patient journey, reduce inappropriate referrals and ensure consistent outcomes.​

Action

We trained clinicians and created a bespoke, streamlined system for submitting funding applications. Our comprehensive Individual Prior Approval Scheme involves the provider of treatment seeking funding approval from the commissioner prior to treatment. CCGs can challenge providers for activity that does not have the relevant authorisation codes generated by the scheme, ensuring only appropriate treatments are delivered.​

With Chorley & South Ribble CCG and Greater Preston CCG, we developed and implemented a robust manual Individual Prior Approval Scheme for seven policies over an initial six-month period. Following a successful outcome, this was extended for a further two years to cover 15 procedures of limited clinical value and nine cosmetic procedures.​

In addition to the monitoring and validation of activity data, we captured qualitative data in relation to themes and trends affecting potential future commissioning intentions. We ensured commissioners and referring clinicians understood the requirements of the scheme. Reporting mechanisms were developed and continually reviewed in line with CCG requirements. ​

Our ‘wrap-around’ service included finance and contracting expertise to support reconciliation process at intervention level and clinical policy development support to ensure effective application of policy criteria.​

Impact

Inappropriate referrals at Chorley & South Ribble CCG and Greater Preston CCG have fallen, resulting in efficiency savings and improved patient flow, with applications receiving a decision within five working days. Health outcomes have improved by ensuring the right treatment for patients at the right time, only undergoing elective treatments and interventions where benefit outweighs the clinical risk. ​

More than 9,000 applications went through the process over the first two years of implementation and 13 per cent were declined.​

With increased knowledge of clinical policy criteria at secondary and primary care level, clinicians are managing patient expectations more appropriately, improving patient experience and reducing misunderstandings and complaints. Working relationships are enhanced between stakeholders, with a culture of continuous improvement. ​Hospital providers involved have praised the Prior Approval system, saying they would like all CCGs to commission this process so there would be a single, robust and efficient system, making processing applications simple and easy for clinicians. ​

The scheme has contributed to quality and improvement programmes through the reduction of activity. It has also supported other commissioning demand management schemes to support CCGs to realise further activity and cost savings.​

Feedback

“I’ve always found the IFR Team to be very approachable and highly professional. They are consistent and efficient in the administration of the IFR process, appear very knowledgeable and are always willing to provide advice and assistance regardless of the nature of the enquiry. The team clearly recognise the importance of listening to patients and clinicians. They are patient focussed and always endeavour to deliver a responsible, flexible, empathic and patient-led service.”

Dr Matthew Orr, GP Director and IFR Panel Member, Chorley and South Ribble CCG

Further information

If you would like more information about our services, you can contact us on our help and contact page.