Objective To quantify the success of a Pharmacist led paediatric commissioning service in securing individual funding requests (IFR) to Primary Care Trusts (PCTs).
Methods Descriptive, retrospective study over a 4 month period by review of IFR sent to PCTs. The IFRs were completed by the lead clinician with support from the commissioning lead pharmacist. Inclusion criteria included (1) Patient's who's treatment falls outside existing service agreements with clear evidence of clinical effectiveness for the therapy applied for. (2) Where patient was considered exceptional, in that clinical features of the patient made them significantly different to that described within existing commissioning agreements and where the patient would gain an enhanced clinical benefit from the requested intervention, than might normally be expected in the general population. The IFR was sent to relevant patient's PCT. Responses from PCTs were via email and letter and then forwarded to the patient's clinicians. Data was entered into MS Excel 2003 for analysis and included, patient demographics, clinical categories, amount of funding, details of follow-up phone calls to PCTs. Information was sent to the finance department, so treatment costs were reclaimed. If declined, this was logged with reasons so to modify future applications and inform clinical decision making.
Results Responses relating to 15 IFRs, to 10 different PCTs across the country with each PCT receiving 1 or more request (n=1–2). Six specialities, gastroenterology 53.3% (n=8), haematology 13.3% (n=2), respiratory 13.3% (n=2), neurology 6.6% (n=1), rheumatology 6.6% (n=1) and ophthalmology 6.6% (n=1) had made IFR requests during the study period. 73% (n=11) had funding approved, 20% (n= 3) were declined and 7% (n=1) for which a response is still awaited. Of the three declined, there were two cases where the PCT had refused due to the request being retrospective and the other case was determined not to meet criteria as an exceptional case. We received seven responses within 3 weeks, with 53.3% (n=8) of the cases having to be chased on at least one occasion. In monetary terms, a projected benefit of £459k was made as a result of the Pharmacy commissioning service from the 11 approved cases although further work will be required to identify and difference to conventional commissioning arrangements.
Conclusion The pharmacy led paediatric drug commissioning service is highly successful with a 73% success rate and recovering IFR related monies per annum of approximately £459k for the 11 approved cases, with a potential annual value of £1.37M on the basis of the same kind of claims each quarter.
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