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Keith Rigg

A single commissioning model for the organ donation and transplantation pathway – what are the pros and cons?. Keith Rigg. ‘Commissioning is the planning and purchasing of NHS services to meet the health needs of a local population.’.

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Keith Rigg

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  1. A single commissioning model for the organ donation and transplantation pathway – what are the pros and cons? Keith Rigg

  2. ‘Commissioning is the planning and purchasing of NHS services to meet the health needs of a local population.’ ‘Securing the highestquality healthcare services to meet the identified needs of apopulation within available resources.’ ‘Commissioning is the process of planning, agreeing and monitoring services.‘

  3. Commissioning ≠ Funding

  4. What is the current model? • What might a single commissioning model look like? • What are the pros and cons? • What is the likelihood?

  5. What is the current model?

  6. What is the current model? Organ Donation • Organ Retrieval commissioned by NHSBT as the OPO • Funded by grant in aid from four UK health departments Transplantation • Kidney – commissioned and funded by specialised commissioning in each UK country • Other organs – commissioned by specialised commissioning in England & Scotland as appropriate; funded by specialised commissioning in recipient country of origin

  7. Generic Patient Pathway – Organ Donation After Circulatory Death (DCD) or Brain Death (DBD) Retrieval Team arrive • Tissue typing • Liaison with national database • DBD – clinical management on ventilator • SN-OD overall co-ordination Organ retrieval Process by Retrieval Team Organ(s) retrieved Retrieval Team called Organ(s) transported to Receiving centre Contract With NHSBT Consent is given Organ(s) transplanted into recipient(s) Contract with NHSBT SN-OD liaises With family/ Coroner, alerts team and observes due process NHS England Patient and organ Post-op care NHS England Direct Funding Via NHSBT Patient pathway Clinician Alerts SN-OD Commissioning pathway

  8. What is the current model? Organ Donation • Organ Retrieval commissioned by NHSBT as the OPO • Funded by grant in aid from four UK health departments Transplantation • Kidney – commissioned and funded by specialised commissioning in each UK country • Other organs – commissioned by specialised commissioning in England & Scotland as appropriate; funded by specialised commissioning in recipient country of origin

  9. What might a single commissioning model look like?

  10. A single organisation commissioning organ donation and transplantation across UK Provisos • Which parts of the organ donation pathway would be included within the commissioning by a single body? • Commissioning model would depend on host organisation • Funding from four health departments and four specialised commissioners

  11. What are the pros and cons?

  12. Pros • Single point of contact for whole organ donation and transplant pathway • Commissioners would have a greater understanding of the synergies of the pathway • Potential for lighter touch outcome based commissioning • Savings realised could be reinvested elsewhere in the pathway

  13. Cons • Increases in funding would have to be negotiated with up to four health departments and four specialised commissioners. • Risk that overspend in one part of the pathway mean savings have to be made in another part of the pathway • Willingness of any one organisation to take on this role on behalf of four countries • Potential disconnect with wider NHS

  14. Options • NHSBT commissions organ donation and transplantation across the UK • NHS England (or other commissioner) commissions OD&T on behalf of other three specialised commissioners • Co-commissioning by NHSBT and NHS England (or other commissioner) • New organisation commissions OD&T • OD&T commissioned separately in each UK country

  15. What is the likelihood?

  16. Insert graphic of pigs flying

  17. ?

  18. How can synergies be improved? • Quarterly NHSBT/NHSE meetings • Closer links between NHSBT and relevant CRGs • Service specifications and other commissioning products • Centre specific reports • Peer review • Shared approach to TOT 2020 and LD2020 strategies

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