The brief for the webinar was to discuss what the main drivers and challenges are for Diagnostics, what role Diagnostics has in the COVID-19 recovery and backlog and how decision making will work in ICS’s and ICB’s, focusing on where pathology networks fit, who are the customers and where the balance of power is.
We highlighted that Diagnostics was made up of 3 main areas, IVD, Medical Devices and other Health-Tech and the one of the challenges was being “bundled” together without understanding the differing requirements for delivery and models of business faced by each.
BIVDA will be keeping a watching brief on the points below and updating members in more detail through the working parties as the ICS’s mature and develop.
• Currently 7 Regional Teams.
• 42 ICSs.
• Single Operating Model with delivery model being left to each ICS to work out.
• ICSs are seeking more guidance from the centre.
• CCGs no longer exist. Many CCGs still don’t know what their role is in the future.
• Primary Care Networks are exciting, they are motoring on with real investment, often with 24/25 extra clinical posts. IVD opportunities are in the foreground.
• Decision making pathways are still being developed, and IVDs will be important.
• There will be new stakeholders and new opportunities and IVD companies should build new relationships with influential stakeholders, but importantly must maintain and strengthen existing relationships across the pathway as they will also be influential in decisions.
• More emphasis to support education,
• Diagnostics are key to reduce longer waits to improve outcomes.
The ICSs need to address 3 key areas.
2. Prioritising diagnosis and treatment.
3. Transforming pathways.
Members were encouraged to think about their value propositions and how they can leverage into managing population health across the system.
The introduction of a 10 year plan on community assets and less focus on Payment by Results (PBR) which will mean more block contracts with stakeholders and working with commissioners with a much longer term focus. This is a fundamental change from annual planning. A question raised at this point was whether we would start to see finance managed on a long term basis and outside of siloes, budgets and Y1 cash releasing savings and the answer is yes, this is what is expected.
It is accepted that when it comes to PBR, how diagnostics is linked to the overall understanding of pathways is not fully known. This hasn’t changed in the new system, but it has been improved, and it should be up to suppliers to be able to leverage and promote that understanding through stakeholders and pathways. Suppliers should know where the intervention is best placed and have a value proposition to accompany that story. Suppliers need to have confidence to determine how the product/service can make a difference to the most patients. The entire payment structure will change, and the ICSs will be expected to use Value Based Procurement (VBP) methodology.
There is an open door for innovation as the models for VBP are much easier to demonstrate the outcomes (done properly anyway), and there will be a challenge as there is still a risk that procurement teams and commissioners will continue operationally to procure the same way, and do it as it has always been done, this is an area where education and training will be useful for NHS staff.
There are challenges in the systems in the Midlands and the North West, and members should try to understand how each of the systems are embedding, and also understand the status of relationships between provider networks and PCN’s.
Suppliers need to link with PCNs to drive where IVDs can link to primary care, specifically in rapid testing, home testing, patient empowerment and access to quicker diagnostic tests and digital platforms.
This is intended to shift care from clinician led to patients and patients will benefit with the removal of providers competing with each other. There will be a gradual bringing together of services across the system (like hubs), it is a challenge to know how to balance at scale offerings over innovation.
Key organisations within the systems for IVDs are;
• Acute Trusts
• Community Trusts
• Tech companies (network IT companies/ LIMS)
• Social Care settings
Companies were challenged to think creatively.
The interplay between ICSs and Pathology networks is a key issue for BIVDA members. The ICBs hold the budget, but the organisations that are important to IVD suppliers are still statutory organisations (meaning they are in control of their own actions). The pathology networks will be a provider organisation within the ICB’s provider network so will still be a powerful and influential contributor. They will be looked at by the ICB to provide expertise and solutions across the ICB and will leverage that power. This may vary slightly across the ICSs but with strong direction strategically within the Pathology networks’ network, this should not be too different area by area.
The speakers suggested the things for members to do now as follows;
• Members should initially concentrate where pathology networks are aligned with provider networks.
• Point of care testing is a huge focus and ICSs will be seeking to pursue this strategy across the system. This is an opportunity for member companies.
• Members need to understand how their offering improves patient outcomes and delivers an ROI, BIVDA will also be working on training and support for value proposition development.
• Anything that can demonstrate improvement to workforce efficiency will be an effective value proposition as the staff challenges have not been addressed at ICS/ICB or PCN.
• Interoperability across the whole pathway is also extremely important for members to show.
• Access funding is best through the AHSN’s and suppliers should engage with ASHN’s across the regions. BIVDA will be on hand to support members with this moving forward as the systems develop.
• Equity and Sustainability are key deliverables across the ICSs right down to statutory organisation level, and all business cases are expected to include and address these targets, therefore suppliers should show how their offering can improve or help to achieve these targets for the provision at the same time as giving the commissioners confidence in managing testing, results and treatment for patients.
Finally, BIVDA will be keeping members informed on developments with the new procurement regulations expected in 2023 and how the Health and Care Bill interacts with them. It is no longer a requirement in the Health and Care Bill to tender clinical services if an ICS (or provider within) can demonstrate good performance and value for money, this includes where contracts have goods included but the majority is the clinical service itself, there is more clarity and definition required to ensure that the procurements are undertaken lawfully and these discussions are ongoing – more will come on this.
In the new procurement regulations, the light touch regime (which is the current method for procuring clinical services with less burden on providers than the normal Restricted/ Open/ Competitive procedures) remains. BIVDA will be monitoring the scope within each legislative act.