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Point of Care in Community Settings

By July 14, 2023No Comments

With NHS England expanding Virtual Wards, and NICE focusing on Point of Care (POC) solutions, it is clear that POC is rising up the agenda. 

NHS England are keen to promote POC in community settings, as they see it as an enabler to support clinicians in decisions on patient management in the community to effectively triage patients to the most appropriate patient pathways, care and outcomes. 

They see it as supporting the activity on Virtual Wards and recognise the role of POC in frailty and other conditions to provide a safe and useful tool for Clinicians. 

As part of the wider NHS plans, they are looking to reduce the pressure on secondary care in the NHS. 

Their challenge is EVIDENCE. 

The evidence that NHS England need must demonstrate both clinical and cost effectiveness, and it must be clear where in the pathway, a technology provides the best benefit. 

They want to issue guidance from the top down for commissioning and winter pressure management, but they need it in a way that is not technology specific. The test and the instruments must be agnostic, and the evidence needs to show value, savings and improved patient and workforce experience. 

There is an absolute requirement for NHS England to maintain competition within the industry sector, and their guidance cannot favour or promote one company over another, nor would this be something that BIVDA would support and BIVDA is actively enforcing this at every stage of the guidance development to ensure that NHS England are not tempted into national roll out of a technology due to perceived economies of scale and current placements from Pandemic legacy instrumentation. 

Their intention from the centre is to maintain access for all suppliers in this field to have access to commissioning decisions. The work that BIVDA is leading on systemic changes to managed services is related to this pretext. Find out More 

The pilot for ARI hubs was intended to provide this agnostic evidence and was intended to be specific to test Eg. CRP and other inflammatory markers. Unfortunately, the environment they wanted to run the pilots in was pressurised, newly formed and was in need of resource and support other than financial such as systems and data management.  

They want to undertake work or find evidence to understand and build an evidence base to demonstrate that a particular test really delivers benefit to the system and the patient so that NHS England can produce guidance to roll out the principle through the NHS. 

ARI hubs were set up at the peak of the activity in winter 2022 and set up in a crisis state and trying to create additional functionality was a challenge. 

The Urgent and Emergency Recovery plan (UER) mentions that ARI hubs are a way for systems to consider their overall community offering and ICB’s to develop their strategy for delivering care in acute respiratory infections. The regional ICS’s need more time to stand up and deliver services. The central belief is that they have a benefit for patient flow. 

Another aspect to this work is to prove to the existing system, clinicians and support network that POC tests meet their needs and there is not a perceived lower quality in POC than laboratory-based testing. This leads to the requirement of evidence at a class level rather than product level.  

Being summer 2023, winter plans are already underway at ICB level and it is necessary for Industry to understand what is already in place. 

There are a number of recovery plans through systems to primary care access and work underway to understand how systems are considering the burden of care, which includes Virtual Wards and community settings such as Pharmacies. Currently the system requires attendance at an emergency department or primary care setting such as a GP to begin the diagnosis/ treatment pathway. This is identified as an area of significant impact if the changed services can be delivered in the community. There is an impact on the journey and the overall cost. Areas that evidence is required is how to integrate the community and acute offer. 

The evidence that NHS England are looking for will be used to work out how to change pathways and use POC as an intervention for patients and the evidence should show where in the pathway this will happen. 

NHS England has already started work to make sure that POC and community diagnostics in Primary care can receive the governance and support that is needed. Some pathology networks are more advanced than others but there are often no resources to expand into primary or community settings.  

The National Coordination group in NHS England is to ensure that POC is thought about strategically throughout ICB’s and using integrated pathways with the right people around the table to gain a consensus for this route. 

Governance, Quality Assurance, Workforce, and Liability are the main points of resistance in the collective experience of industry and ownership of the services needs to be determined. Infrastructure is key and without this, the value of the POC test diminishes. This includes systems, IT, records and training. 

Industry needs to adapt to provide solutions instead of the traditional features and benefits approach of individual offerings. 

There is resistance, but there is also good practice in the NHS. What would help is a system based and digital solution. How does a solution integrate into current practice? NHS England needs to know if the pathway will be a diagnostic or treatment pathway. 

NHS England need to understand what the need is, where in the pathway the solution benefits, ways in which they should use it and what they want to use. 

They want to use the evidence base to build on and disseminate the new guidance across the whole system with the confidence is the quality and outcomes from using POC technologies. Quality needs to be constant, and variation avoided across the system and this guidance aims to address this. 

The changes whether incremental or disruptive need to be sustainable in terms of delivery and the environment too and the impact on other policy and care issues such as AMR stewardship, antibiotic subscription, net zero and social value considerations. 

The workload and cost are likely to be in primary care but the impact and benefit elsewhere in the system, but consistency is key. 

The situation and winter pressures are serious so incremental improvements, and any reduction in people presenting to secondary care or workforce efficiency will be important with improvements made year on year. 

NHS England are sighted on some pilots from 2022, and others are reporting the findings now, but they are keen to see other work that industry has undertaken and to see whether each study or pilot can be made more general with the evidence requirements made technology agnostic. 

A mapping exercise of evidence is needed to avoid duplication and use resources effectively and any gaps can be addressed. It is thought that a lot of pilots only focus on 1 test and they need to see how others can be integrated. This is critical in determining how clinicians will think. Evidence needs to match how a clinician can diagnose a patient combined with other tests. 

Clinical decision, clinical activity, strategic decisions and specific outcomes for local populations need to be considered in order for NHS England to build a strong case. 

The challenge for NHS England is to build a generic evidence base with industry, and this as a driver for the UK market needs to be given thought. 

The Near Patient Testing Working Party will be producing an industry paper/ policy paper to address this challenge. For more information, please contact Helen – POC paper