Oli Hudson, content director at Wilmington Healthcare, looks at the latest GIRFT report and sees what lessons it holds for the medtech industry at large.
A new report released by the Getting it Right First Time (GIRFT) programme, covering ophthalmology, was released in December.
It ‘provides an in-depth assessment of what is good practice and what could be improved’ according to RCO president Michael Burdon, and covers a variety of areas including efficient models of care, technique, procurement, staffing, and the best use of novel ideas, practices and innovations in major areas such as cataract, glaucoma, wet-AMD, and diabetes-related retinopathy.
Why is this of relevance to the whole medtech industry? The answer lies in the presumptions of the authors that it will be system change and whole-pathway working that leads the way in the next decade of practice – and the new funding environment provided by the Conservative government must be used, once and for all, to change the service model and make it sustainable at a time of unprecedented demand.
Ophthalmology is already one of the busiest specialties in the NHS, carrying out 6% of all operations and booking more than 7.5 million outpatient appointments across 120 trusts. Demand is predicted to increase by more than 50% over the next 20 years.
This means establishing improvements not just in surgical technique, but in the way the whole clinical area is approached – especially in demand management and how resources are used.
Changes to watch out for
For example, developing high-volume lists for cataract surgery to allow more patients to have their operations, training more members of the non-medical team to give intravitreal injections to patients with wet AMD, and adopting multidisciplinary teams (MDTs) working in glaucoma diagnosis and management have all been touted as key.
Establishing high volume lists for routine work is an area that is sure to be revisited in other disciplines, and is to be seen in in the context of the NHS’ reframing of hospitals into hot (emergency and critical) and cold (elective) sites. Managing these lists will require the use of dedicated MDTs.
Upskilling of non-medical staff to allow surgeons to focus on specialist and complex work is another pattern that can be seen throughout the GIRFT series, as is the use of MDTs to prep patients pre- and post- surgery, and manage them into community and even primary care.
At a time where account management in medtech sector is already treading a delicate balance between clinical, procurement, contract manager and financial stakeholders, we can now widen this even more to look at the entire panoply of clinical stakeholders involved in a pathway and explore how they need to be communicated with, accessed and educated.
Procurement
Like all the GIRFT reports, this one also takes a rather granular look at procurement prices paid and unit costs. And like others, it concludes there is wide price variation in the use of the less specialist products and this is mainly unnecessary. Efficiencies could be gained by rationalising the number of brands and suppliers used for common products across the service.
Procurement departments will also be working with expert groups – in this case the UKOA – to develop national quality criteria, after the report concluded that it is difficult to track the success of interventions with no specific patient-reported outcomes measures. Product choices tend to be made by clinicians, balancing their own perceptions of quality and cost, and in the future it is likely that more rational measures and standardisation will be brought in.
By March 2020, trusts and STPs will have worked out, with GIRFT and the new Category Towers, how to benchmark and evaluate their products and seek to rationalise and aggregate demand with other trusts to secure lower prices and supply chain costs.
Conclusion
With commissioners and providers considering ‘model pathways’, including community pathways, (as in The Way Forward and the CCEHC “SAFE” Glaucoma Service System, here), the focus is on adjusting processes accordingly to enable more patients to be seen in the right place at the right time to achieve the best outcomes.
Industry knows its patient groups well and needs to align with the NHS on what techniques and products with best serve particular cohorts. Once routine demand is actively managed, resources and surgeon time can be freed up, opening new opportunities up for investment in new frontline surgical technologies and specialised equipment.
The 2020s will be a decade where new medical technologies will transform our treatment of many major clinical areas; the task now is to help get the NHS to a place, via getting the basics of the service right, where it is ready, willing and able to invest in them.
