Background With the NHS currently facing one of its toughest periods financially, most, if not all, PCTs in England have started to prioritise services and sought to identify those which are either ineffective or of low clinical value for disinvestment. Yet the absence of a nationally accepted list of identified procedures has resulted in PCTs developing their own approaches, with many applying different priority thresholds to different procedures. This has created numerous “black lists” of interventions which will either not be funded or their commissioning severely curtailed. As these decisions are being based on the affordability of procedures rather than clinical efficacy, a post-code lottery in provision has ensued across the UK. Therefore to ensure equitable access to healthcare resources, an evidence based approach towards disinvestment is imperative.
Methods Working in collaboration with NICE R&D, the project used NICE’s ‘do not do’ (DND) database to identify topics based on rigorous evidence for potential disinvestment. DNDs based upon those treatments with evidence suggesting they are ineffective or of low-clinical value were identified from the 850 + DND database. DNDs relating solely to clinical safety were excluded from the study. Procedures were further prioritised by 34 clinical experts in participating ‘pilot’ implementation sites in the SW Peninsula, who were asked to review populated lists of DNDs to ensure: clinical soundness; practicality of implementation; and any DND of potential high impact locally. Using HES data, volumes of DNDs still being performed in the NHS were also collated to give an estimate of overall usage and potential impact. Each DND identified was subjected to a cost analysis to provide an estimate of potential savings at both a local and national level.
Results 209 DND topics developed between 2007 and 2012 were identified for use in the study. Following local clinical prioritisation, cost analysis and exploration of HES data to give an estimate of usage, 30 procedures for a pilot disinvestment programme were identified solely from the NICE DND database.
Conclusion The study successfully developed a single, evidence-based approach towards disinvestment through the identification of ineffective and low clinical value treatments from the NICE DND database. Additional planned research which will implement the ‘pilot’ list across the SW Peninsula, will provide valuable information on the practical implications of disinvestment initiatives and identify any incentives/disincentives for future developments.
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