A snapshot of potentially much larger savings The figures for both eczema and psoriasis above demonstrate that the NHS could generate savings through wider adoption of NHS England’s guidance on referral optimisation. While the cost savings above may appear to be small in scale, it is important to note that the NHS is currently facing significant funding pressures and finding efficiencies has been identified as a key priority for the system. 46 In practice, the total savings from reducing delays to referral are likely to be higher, as the figures above do not take into account several additional cost savings that could be associated with reducing avoidable appointments and referral optimisation, including: • The costs of any investigations or diagnostic tests that could have been avoided pre-referral. • The costs of poorly controlled disease or disease progression in the period between diagnosis, referral and treatment. • The cost savings of reducing inappropriate referrals of patients whose care could be managed in primary care with appropriate training for clinicians and use of care plans. There are also a series of other costs associated with the barriers identified in other parts of the optimal pathway that require a closer examination. They include: • Cost associated with any repetition of treatments once in secondary care, that have already been prescribed and tried while in primary care. • Cost associated with variation of access to the full range of NICE approved treatments or delays to progressing as intended along the NICE approved treatment pathway. • Cost of secondary care follow-ups. If more patients are supported to utilise PIFU and reduce the number of follow up appointments, further savings could be created. It is also possible that referral optimisation could unlock wider economic benefits, due to reduced levels of absenteeism during periods of poor disease control. A recent report found that costs of work impairment, including a combination of absenteeism and presenteeism, to the economy for adult patients with moderate-to- severe eczema were between £6,741 and £14,166 per patient per year. 2 These costs increase with the severity of the condition, with higher atopic eczema severity associated with a more significant negative impact on work productivity. 47 A Work Foundation study estimates four million working days are lost in the UK per year due to moderate to severe psoriasis, at a cost of almost £0.5 billion to the economy. This increases to £1.07 billion when adding the potential cost of lost productivity from presenteeism. 15 Expanding these initial calculations to make a comprehensive financial and resource case for the wider adoption of these changes is therefore pivotal. Doing so could help to realise the ambitions of the NHS and government, such as the target of a 25% reduction in hospital-based outpatient appointments to reduce pressures on primary care, as part of the NHS’ goal of recovering access to GP appointments. 48
19
FROM NATIONAL GUIDANCE TO LOCAL ACTION
Made with FlippingBook Ebook Creator