How NHS changes will affect medtech: Five key questions

Oli Hudson, content director at Wilmington Healthcare, explores some key questions for medtech amid a flurry of changes to NHS organisation and funding coming this year.

1. What does the latest round of NHS reform mean for medtech?

In this column we have recently looked at both imminent changes to NHS structure and organisation, and the new system-based financial model.

Since the publication of the NHS document Integrated care: Next steps to building strong and effective care systems across England, we now know much more about how this will work in practice.

The document underlines the ‘whole-system’ approach, whereby a ‘single pot’ of funding which brings together current CCG commissioning budgets, primary care budgets, the majority of specialised commissioning spend, as well as a system’s share of National Transformation Funding, will fund a contractual network made up of NHS trusts, specialist trusts, primary and community care providers in various integrated groupings.

In secondary care the document calls for the formation of ‘provider collaboratives’ at place level – a similar idea to the ‘integrated care partnership’, who will hold these contracts to serve particular patient groups.

This whole-system approach to payment – founded on a ‘fixed payment’ to cover services rather than an activity based approach that encouraged organisations to compete for commissioning monies – is intended to better reflect care models that use a ‘whole pathway’ outlook covering all sectors of care, and encourage collaboration between them.

Clinicians are also to have an enhanced role in both the establishment of these new, cross-system pathways, and also in their payment decisions.

A good example might be the musculoskeletal pathway developed by Mid-Notts ICP. Here, the surgeons from the main acute trust provide two triage clinics a week in an MSK hub which both helps train community physiotherapists and ensures only patients that require a referral into secondary care are sent through. It’s this kind of model that the new process is designed to encourage.

2. How will GIRFT affect these new pathways?

The Getting It Right First Time initiative – originally established as a means to standardise hospital care processes, techniques, and purchasing to reduce nationwide variation – has been increasingly taking all these system developments into account when issuing guidance – which has a lot of influence in the clinical community about what should be used, on which patients, and in which circumstances.

For instance, the recent report on ophthalmology intended to increase patient throughput of hi-flow services such as cataract surgery, spent a deal of time relating how success was also based on collaboration with primary care, especially through patient stratification and primary care interventions for patients with wet-AMD.

3. Who is responsible for implementing NICE device recommendations now?

NHS organisations must follow recommendations in NICE Technology Appraisals and for some time have had a contractual requirement to take into account other types of NICE guidance, including NICE Medical Technologies Guidance and NICE Diagnostics Guidance.

But with the move to systems and ‘population-based’ healthcare as spelled out in the Integrated care document, these contracts will no longer be held chiefly by individual NHS organisations, but by the so-called ‘provider collaboratives’ acting on behalf of a ‘place’ based population – for which they would then be responsible for running, and funding, the pathway in the contract.

That means that the responsibility for taking into account NICE recommendations passes to these systems as well. 

4. What’s happened to the high-cost devices exclusion list?

Normally for each new tariff, high cost devices steering groups meet to discuss items that could be added or removed from the high-cost, tariff excluded list. There is also a web portal for people to submit nominations for the lists, as well as a horizon scanning exercise to identify new items that might be expected to come onto the list.

However, the steering groups for 2021/22 were not able to meet until late 2020 and neither the horizon scanning process or web portal have been run. As such, the steering group’s view was that – particularly in the context of the rollover of prices and the uncertain impact of Covid-19 – it would not be appropriate to make significant changes to the lists of high cost drugs or devices for 2021/22.

NHS England said: “we intend to update our process so that high cost drugs and devices nominations can be submitted all year round, with defined cut-off dates for nominations to be considered in future tariffs …we also intend to update the lists to indicate, where possible, which commissioner would be responsible for paying”.

5. What about the medtech funding mandate?

This has been suspended until April 2021. A move to support innovative medical devices by providing funding and speeding up access to patients, originally the plan was to launch it in 2020 until Covid-19 meant the National Tariff payment system – which supports the medtech funding mandate - was suspended. Now, the tariff has been more or less supplanted by the system-based approach.

Nonetheless, the Mandate policy and the consultation outcome report will be published this winter prior to its April launch. It will confirm the final criteria, the technologies that it will cover and additional implementation support.

After the policy is lunched, a team from the Accelerated Access Collaborative (AAC) will regularly review NICE guidance on medical technologies and diagnostics to identify which medical devices, diagnostics and digital products will gain mandate support.

Conclusion

Expect more on changes to medtech funding processes – and to the decision-making units responsible for their market access, adoption and purchasing in the weeks to come. Some devices previously acquired through specialised commissioning have now had their budgets transferred over to integrated care systems for 2021/22. It’s likely many tariff-excluded devices that were paid for on ‘pass-through’ to CCGs will now be funded by ICSs, while NHSE now retains responsibility for only a small range of high specialised areas. These are all big changes compared with what was the norm before.