Commissioning products:
What are they?
How do they deliver better services
for patients?
Frances Flinter
Chair, Medical Genetics CRG
UKGTN Conference
22 November 2012
Service Specification
• Medical Genetics can be divided into to two main service areas both
covering children and adults: Clinical Genetics and Laboratory Genetics
(consisting of molecular and cytogenetic tests and, in some specified centres,
specialised biochemistry tests or other specialist tests).
• In summary, in Clinical Genetics Departments, clinical staff will see patients
affected by or at risk of a genetic condition and will provide diagnostic and
genetic counselling services. The Laboratory Genetics services will provide
either or both molecular and cytogenetic testing, together with advice and
support to referrers and interpretation of results.
• SCOPE: Under this service specification, the laboratory services will only
provide the Genetic tests for patients referred by the Clinical Genetics
service. (They will have other contractual arrangements for other referrals
which they receive).
Dashboard
Dashboard requirements
12 – 15 indicators covering the following
areas:
• Clinical outcomes
• Clinical effectiveness
• Patient experience
Gen 01: Proportion of tests that return a positive result
for affected patients who have the test to determine a
diagnosis and are seen in clinical genetics
Numerator:
Number of tests that return a positive result ordered for symptomatic
patients who have the test to determine a diagnosis and are seen in
clinical genetics (exclude Fragile X)
Denominator:
Number of tests ordered for symptomatic patients who have the test to
determine a diagnosis for patients seen in clinical genetics (exclude
Fragile X)
NB excludes cascade testing, carrier testing, pre-symptomatic testing
GEN 02: Proportion of clinical genetic clinics that are
part of a MDC / MDT
Numerator:
Number of clinical genetic clinics that are part of a MDC / MDT
Denominator:
Total number of Genetics clinics
NB Clinic is half day/4 hours
GEN 03: Proportion of clinical audits completed and
action plans put in place
Numerator:
Number of clinical audits completed and action plans put in place (from the
agreed list of audits)
Denominator:
Number of clinical audits that the clinical genetics department was expected
to participate in
NB CGS/lead clinicians to choose audits
GEN 04a: Proportion of Cytogenetics reports meeting
turn round times as agreed by the professional
organisations (CMGS/ACC)
Numerator:
Number of cytogenetics reports meeting turn round time
Denominator:
Number of cytogenetics reports issued by the laboratory
GEN 4b: Proportion of Molecular reports meeting turn
round times as agreed by the professional
organisations (CMGS/ACC)
Numerator:
Number of molecular reports meeting turn round time
Denominator:
Number of molecular reports issued by the laboratory
GEN 05: Number of educational sessions provided by
clinical genetics to other specialties
Supports Mainstreaming agenda
One session = 1 hour
GEN 06: Rate of written complaints about the genetics
department
Numerator:
Number of written complaints about the genetics department received
during period
Denominator:
Average (mean) number of patient contacts per month for three months up
to end of period
GEN 07: Rate of letters/emails from patients, carers or
non-genetics consultants registering thanks to the
genetics department
Numerator:
Number of letters/emails from patients, carers or non-genetics clinicians
registering thanks to the genetics department received during period
Denominator:
Average (mean) number of patient contacts per month for three months up to
end of period
GEN 08: Proportion of patients receiving test result
within 5 working days after the clinic receives the
laboratory report for prenatal genetic test results
Numerator:
Of all patients seen in clinical genetics who had prenatal diagnosis during the
period, the number who received their prenatal genetic test result within
5 working days of the clinic receiving the laboratory report.
Denominator:
Number of patients seen in clinical genetics who had prenatal diagnosis
during period
GEN 09: Proportion of appointments that are not
attended
Numerator:
Number of DNAs within period
Denominator:
Total number of appointments booked during period within clinical genetics
GEN 10: Rate of patients consulted without a referral
Numerator:
Number of patients consulted without a referral during period
Denominator:
Total number of patients attending appointments during period
GEN 11a: Rate of patients consulted by a genetic
counsellor during period
Numerator:
Number of patients seen by a genetic counsellor (including telephone
appointments that replace a face to face appointment), at any point during
the period
Denominator:
Total number patients seen (including telephone appointments that replace a
face to face appointment) at any point during the period
GEN 11b: Rate of appointments consulted
independently by a genetic counsellor during period
Numerator:
Total number of clinical genetics independent counsellor appointments
during period
Denominator:
Total number of clinical genetics appointments of all types during period
GEN 12a and 12 b: Serious Untoward Incidents
12a Number of Serious Untoward Incidents involving patient care
12b Rate of Serious Untoward Incidents involving laboratory tests
Numerator:
Number of serious untoward Incidents involving lab tests
Denominator:
Number of lab tests during period
Gen 13: Scores from EQA schemes in which laboratory
participates
Numerator:
Episodes of poor performance notified to the laboratory by UKNEQAS,
EMQN or another EQA service provider
Denominator:
Number of EQA schemes in which labs participate
GEN 14: Proportion of audits participated in by the
genetics laboratory (the number and type of audits to
be agreed by national professional bodies)
Numerator:
Number of audits (from the agreed list of audits) in which genetics
laboratories participate
Denominator:
Number of audits in which the genetics laboratory should be participating
NB CMGS/ACC to determine audits
GEN 15: Proportion of test requests from clinical
genetics that did not comply to UKGTN Testing Criteria
(TC) where TC apply
•
Tests included to be specified annually:
•
2012-13 list is: BWS, MEN2 and Silver Russell
Numerator:
Number of tests requested by clinical genetics from specified list that did not
comply with UKGTN Testing Criteria
Denominator:
Number of tests requested from specified list
Dashboard
https://www.surveymonkey.com/s/clinicalgeneticsdatabook
questionnaire
CQUIN
• Commissioning for Quality and Innovation
• The CQUIN payment framework enables commissioners to reward
excellence, by linking a proportion of English healthcare providers' income
to the achievement of local quality improvement goals.
•
http://www.institute.nhs.uk/world_class_commissioning/pct_portal/cquin.html
Medical Genetics CQUIN
• Goal: To increase the proportion of appointments for patients at high risk
of familial breast cancer (from referral letter) and decrease the number of
genetics appointments for patients with low and medium risk of familial
breast cancer. Risk is defined within the NICE guidelines for Breast Cancer
• Numerator: For each risk level for familial breast cancer (as established
from the referral letter) the number of new patient appointments for
unaffected patients in cancer genetics
• Denominator: For each risk level for familial breast cancer the number of
new unaffected patients referred to cancer genetics
Cancer Genetics CQUIN
• Baseline period: first quarter of 2013/14
• Final indicator value (payment threshold) To be determined once baseline
established and improvement target agreed
• Rules: Quarterly monitoring and payment
• Baseline data must be submitted at end of first quarter for targets to be
set. If this is not completed to time, 25% of CQUIN value will not be paid.
Equally, 25% of the payment will be made for producing the baseline
position. It is suggested that late submission of reports in subsequent
quarter would lead to 10% of quarterly value being lost.
Other CQUINS considered
• Genetic counselling outcome scale: - Audit instead?
• Access to aCGH: - most analyses requested from outside Genetics
• Diagnostic success: - How to verify?
QUIPP
• Quality, Improvement, Productivity and Prevention
• Need to improve productivity and eliminate waste in order to meet tough
savings requirements (£15-20bn by 2013/4)
• eg reduced length of stay, lower readmission rates…………what about
Genetics?
• CQUIN results may help to derive a QUIPP proposal
•
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publications
PolicyAndGuidance/DH_113809
New commissioning policy
Preimplantation Genetic Diagnosis (PGD)
• Not previously commissioned: case-by-case application to PCTs
• CAG approved: awaiting finance and PPE sign off
• Strict referral criteria described to maximise clinical effectiveness of
treatment and achieve equity of access
Thank you for your help
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CRG members
Chairs of other CRGs
Lead clinicians
Commissioning colleagues
Leaders of professional societies