Commissioning Policy (WM12) Patients Changing Responsible Commissioner Version 2 February 2012 Version: 2.0 Ratified by (name of West Mercia Cluster Board and Worcestershire Clinical Committee): Senate Date ratified: September 2012 Date issued: February 2012 Expiry date: (Document is not valid after March Any revisions to the policy will be based on local and this date) national evidence of effectiveness and cost effectiveness together with recommendations and guidelines from local, national and international clinical professional bodies Review date: January Lead Executive/Director: Name of originator/author: Target audience: Distribution: Simon Hairsnape Dr Daphne Austin Consultant in Public Health West Midlands Commissioning Support Unit on Behalf of West Midlands Specialised Commissioning Group NHS Trusts, Independent Providers, GP s, patients NHS Trusts, Independent Providers, GP s, patients, Worcestershire MP s, Public & Patient Involvement Forum CONTRIBUTION LIST Key individuals involved in developing the document Name Jonathan Howell David Lock Designation Consultant in Public Health, West Midlands Specialised Commissioning Group (original author) Legal Adviser Page 1 of 7 WM12 - Patients Changing Responsible Commissioner - Version 2 - Feb 2012 Expires March
1. The policy 1.1 This policy applies to any patient who is in circumstances where the Primary Care Trust is the responsible commissioner for NHS care for that person or needs medical treatment where the Secretary of State has prescribed that the Primary Care Trust is the responsible commissioner for the provision of that medical treatment as part of NHS care to that person. 1.2 Where responsibility for providing NHS services to the patient has been transferred to the NHS Commissioning Primary Care Trust, the Primary Care Trust will, subject to the terms of this policy, honour existing funding commitments made by the patient s previous commissioner. 1.3 Patients who become the responsibility of the Primary Care Trust, having formerly been provided with healthcare under NHS in Wales, Scotland or rthern Ireland, shall also enjoy the rights provided under paragraph 1.2 above. 1.4 Patients who become the responsibility of the Primary Care Trust, having been formerly provided with healthcare under private healthcare arrangements or pursuant to a state healthcare system anywhere else in the EU or in a non-eu country, shall not be entitled to take advantage of the rights under paragraph 1.2 above. 1.5 Where paragraph 1.2 applies, the Primary Care Trust reserves the right to seek a formal clinical review of the patient s future healthcare needs and to consider whether the decision to provide the patient with any further courses of treatment of the type previously provided, and of any other nature, is equitable and appropriate. The Primary Care Trust shall have regard to its other commissioning policies and it s ethical framework for priority setting and resource allocation when conducting any such review. 1.6 The rights under paragraph 1.2 above shall not apply if the patient would not, for any reason, have continued to have had the treatment in question commissioned for the patient by the patient s previous responsible commissioning organisation. 1.7 This policy should be read in conjunction with the Department of Health s responsible commissioner guidance, currently: Who Pays? Establishing the Responsible Commissioner. Page 2 of 7 WM12 - Patients Changing Responsible Commissioner - Version 2 - Feb 2012 Expires March
2. Documents which have informed this policy The Primary Care Trust s Commissioning Policy: Ethical Framework to underpin priority setting and resource allocation Department of Health, The National Health Service Act 2006, The National Health Service (Wales) Act 2006 and The National Health Service (Consequential Provisions) Act 2006. http://www.dh.gov.uk/en/publicationsandstatistics/legislation/actsandbills/dh_064103 Department of Health, The NHS Constitution for England, July 2009, http://www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandgui dance/dh_093419 The National Prescribing Centre, Supporting rational local decision-making about medicines (and treatments), February 2009, http://www.npc.co.uk/policy/resources/handbook_complete.pdf NHS Confederation Priority Setting Series, 2008, http://www.nhsconfed.org/publications/prioritysetting/pages/prioritysetting.aspx Guidance for PCTs on establishing the Responsible Commissioner is available on the Department of Health website at http://www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandgu idance/dh_4069634 Page 3 of 7 WM12 - Patients Changing Responsible Commissioner - Version 2 - Feb 2012 Expires March
Glossary TERM Healthcare intervention NHS commissioned care Priority setting Prioritisation Treatment DEFINITION A healthcare intervention means any form of healthcare treatment which is applied to meet a healthcare need. NHS commissioned care is healthcare which is routinely funded by the patient s responsible commissioner. The Primary Care Trust has policies which define the elements of healthcare it is and is not prepared to commission for defined groups of patients. Priority setting is the task of determining the priority to be assigned to a service, a service development, a policy variation or an individual patient at a given point in time. Prioritisation is needed because the need and demands for healthcare are greater than the resources available. Prioritisation is decision making which requires the decision maker to choose between competing options. Treatment means any form of healthcare intervention which has been proposed by a clinician and is proposed to be administered as part of NHS commissioned and funded healthcare. Page 4 of 7 WM12 - Patients Changing Responsible Commissioner - Version 2 - Feb 2012 Expires March
Guidance note The range of services commissioned by the Primary Care Trust are defined in legislation and by Directions made by the Secretary of State. It follows that they may change over time. As a result there maybe occasions when the responsible commissioner of a patient is transferred from the NHS Commissioning Board to the Primary Care Trust. Under these circumstances the Primary Care Trust is entitled to review commissioning decisions relating to a patient. Following such a review, the commissioning decisions of the Primary Care Trust may not be in line with the package of care or the treatment options that were approved by the original organisation responsible for commissioning care for the patient. The Primary Care Trust will normally, at least initially and subject to resource constraints, agree to continue to fund the treatment/care pathway the patient has been receiving. However commissioning decisions for patients for whom commissioning responsibility transfers to the Primary Care Trust will be reviewed as the Primary Care Trust considers appropriate. Page 5 of 7 WM12 - Patients Changing Responsible Commissioner - Version 2 - Feb 2012 Expires March
Equality Impact Assessment Tool To be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval. Commissioning Patients changing responsible commissioner Policy This policy document addresses the issues when ongoing treatment when a patient becomes the responsibility of the PCT, having moved into the area and changed their general practitioner. Yes/ Comments 1 Does the policy/guidance affect one group less or more favourably than another on the basis of: Race Ethnic origins (including gypsies and travellers) Nationality Gender Culture Religion or belief Sexual orientation including lesbian, gay and bisexual people Age Disability - learning disabilities, physical disability, sensory impairment and mental health problems 2 Is there any evidence that some groups are affected differently? 3 If you have identified potential Page 6 of 7 WM12 - Patients Changing Responsible Commissioner - Version 2 - Feb 2012 Expires March
Yes/ Comments discrimination, are any exceptions valid, legal and/or justifiable? 4 Is the impact of the policy/guidance likely to be negative? (If no, please go to question 5.) If so can the impact be avoided? What alternatives are there to achieving the policy/guidance without the impact? Can we reduce the impact by taking different action? 5 Health inequalities Human Rights Assessment Tool The Human Rights Act, which came into force in October 2000, incorporates into domestic law the European Convention on Human Rights to which the UK has been committed since 1951. Section 6 of the Human Rights Act makes it unlawful for a public authority to act in a way, which is incompatible with a Convention right. The underlying intention of the Act is to create a Human Rights culture in public services. We do not consider that infringes a person s human rights, however if it is considered that this policy does infringe on a person s human rights legal advice will be sought before proceeding. Details (names and roles) of staff involved in this impact assessment Name Role Date completed Outcome Daphne Austin Consultant in Public Health, West Midlands Specialised Commissioning Group January 2010 Circulated to PCTs in support of draft policy. Policy was ratified by WMSCG and West Midlands PCTs. Page 7 of 7 WM12 - Patients Changing Responsible Commissioner - Version 2 - Feb 2012 Expires March