Southern Norfolk PCT
It is only in exceptional circumstances that individuals or parents of children requiring a cochlear implant apply for funding directly to a PCT. It is usual for the cochlear implant programme to make the funding request.
In order for a child or adult to be considered for a cochlear implant assessment, a written letter of referral from the consultant otolaryngologist or audiological physician or a GP at their local practice should be sent to the consultant ENT surgeon or co-ordinator at the cochlear implant programme.
Cathal Daly is Head of Medicines Management at Southern Norfolk Primary Care Trust and is responsible for assessing cochlear implant funding requests. Here he talks through what a PCT is looking for when those requests are made and how to put forward the very best case possible.
Funding for cochlear implants can be difficult to access for some PCTs and successful funding applications can be variable in different areas of the country for different reasons. Applications can often rely on a good relationship between the purchaser and funder (cochlear implant programme and PCT) and when a trust and understanding is built up between the two parties.
Answering all the questions up front and full disclosure can speed up the response procedure and remove any suspicion from funding applications. Meeting all the needs of funding managers makes it easier to agree finance.
Equity of care requires that PCTs have to treat funding applications for a wide range of procedures using the same standard process. So sticking to the standard approach expected is likely to stand a better change of success.
A Business Case
PCTs are just like any other business and expect a viable business case to be presented to them when they are being asked for funding. Funding decisions must be seen to be commercially robust and applications for funding must take the form of a transparent and reasoned case.
The use of a proven standard business case template can often improve the case. If the appropriate information is presented in a clear and concise way, Funding Managers are more likely to understand and approve requests. And once you adopt a standard format, the preparation of applications will be quicker and easier.
Here is a rough guide to a funding application structure
- Patient details (i.e. name, NHS number, D.O.B) and GP details
- Description of cochlear implantation and the chosen hospital/implant centre
- Details of any Service Level Agreement your NHS Trust may have with the PCT for cochlear implantation? If you do have a Service Level Agreement, specify the tertiary service agreed and which tertiary service/s is specified?
-
Name, address and designation of the patient and consultant details, details of who
referred the patient and address of the patient at the time of any previous referral - Patient diagnosis, including any hospital correspondence, definitions and test results
-
Full details of current or potential future illness or disability of the patient caused by this
condition - Is there a policy in place within the PCT regarding this diagnosis?
-
Details of other condition/s the patient has and to what extent do any of these conditions
improve or impair the chances of the patient responding to the cochlear implant operation -
Summary of previous intervention/s (such as hearing aids) for treatment of the patient’s
condition -
How successful were any previous intervention/s, with detailed information including
test results, how well it was tolerated and any reasons for failure - Specific details of the cochlear implant procedure for which the funding is requested including a ‘package of care’:pre-implant assessment;surgical procedure;scientific process of programming the implant processor;rehabilitation support/habilitation support
- Why are you requesting a cochlear implant at this particular stage in this patient’s illness?
- What are the goals and expected outcomes, i.e. quality of life? Are there any other factors which might improve or reduce the chance of achieving the goals or expected outcome of a cochlear implant in this patient?
- What criteria will you use to monitor the effectiveness of the cochlear implant
- Details on the current status of the patient according these criteria
- What is the estimated total cost for the cochlear implantation
- Preferred start date and reason
- Are there recognised national guidelines supporting cochlear implantation?
- Has any treatment panel or a health technology assessment group approved the request for a cochlear implant?
- Summary of key trials supporting cochlear implantation
- How does the above evidence relate to this patient?
- Based on the above evidence what would be the expected benefit for this patient?
- Are there any other comment, information or mitigating circumstances? (such as for meningitic patients)
- Declare any conflicts of interest with respect to any contractural arrangement. Declare any support in research projects, if any
- Sign and date the document
N.B. Supporting clinical information, letters to/from consultants, notes, etc, should be attached to enable an informed decision to be made
Clinicians should always seek prior approval for referral before the referral is send, this will reduce undue relay if a request for funding is postponed by the provider until the patient reaches the top of the waiting list and may unduly raise patient expections.
