POINT-OF-CARE TESTING
increases in raw materials, freight or levies will hit the commercial industry hard. Those costs will sometimes need to be passed on to the customer, although I’ve experienced many instances where these costs are absorbed by the supplier for long periods.
Not many scientists have business qualifications, nor do job descriptions describe anything further than ‘will be responsible for the budget’.
to competing priorities. Overspends are analysed, discussions held, and budgets reset at a higher level the next year in anticipation of the same level of overspend, or services are cut. Temporary spending freezes are a frequent feature in public healthcare, resulting in the pause of agreed projects resulting in inertia and demoralisation of teams.
The patient certainly does not benefit
from this approach. Instead of applying these control measures, services must have a better understanding of the current spend, upward trends in use of tests, increasing supplier costs and have a detailed understanding of service objectives including cost breakdown. Factors that cause budgets to spiral out of control, or be insufficient in the first place, is a lack of business planning, or allowing the unknown to derail the agreed objectives. If your service has set objectives, stick to them. If another project must be undertaken, say to address a clinical risk, this is the point to review the budget, resources needed and from where these might be funded. Knowledge of the different sources of funding within the organisation, across the network or from central funds is key to successfully navigating these challenges.
Bidding for funding
It helps to have advocates in positions of influence, and to develop relationships with the committees reviewing the bids being submitted. Procurement teams and financial officers must have a full understanding of the impact of POCT services on patient care, flow and discharge of patients.
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This sits alongside the impact of pathology laboratories, where results can take longer to generate for some of the tests available at the bedside. Organisations will have a range of committees that review new spending requests, so it is important to engage with the correct committee for your request, including revenue and capital. This may result in new funds being drawn down, other funding being redirected, or refusal. If a bid has been refused, understand why and resubmit at the earliest opportunity describing the clinical risk of not introducing the change, or providing further supporting evidence for your claims. The more successful bids you achieve,
the more likely future bids will be accepted, especially if funding previously allocated has been demonstrated to have been used effectively. Use previous successes to support your future bids, which gives confidence to those allocating funds.
Many costs will be fixed within your service, potentially due to contract agreed pricing through tender processes or other contract awards. Procurement teams must be strongly encouraged to control any increases proposed in these contracts or on products that sit outside formal contracting. National benchmarking is required to avoid paying inflated prices for products widely used across the healthcare landscape. Prices may also be different through the NHS supply chain, so it is worth checking any cost increases against any uplifts allocated to the supply chain. It is procurement’s responsibility to contest any above inflation increases. However, unforeseen
Leadership and oversight A functional business unit will have strong leadership. In the commercial world there will be individuals in designated roles such as Chief Financial Officer (CFO) and Chief Operating Officer (COO) with specific responsibilities for the delivery of the business model, and ultimately the success of the company or service. This is certainly true of the NHS structure, along with several subordinate roles delivering the oversight the CFO cannot. The issue remains that these roles are there to control spending and doesn’t necessarily assure value in spending. The clinical and operational leads who
are knowledgeable about the impact of new testing or improved pathways need to be the ones with the autonomy to act, free from the constraints of numbers on a spreadsheet.
That being said, not many scientists have business qualifications in these roles, nor do job descriptions describe anything further than, ‘will be responsible for the budget’. Person specifications in job descriptions need to state the level of knowledge and qualifications required to lead a service designated as a business unit. Those operating in these roles must be able to demonstrate significant business acumen, have a track history of delivering change within financial constraints, understand the financial framework of the organisation and the healthcare system, and be able to produce compelling business cases grounded by detailed financial data. Recruiting the right people into these roles is key to the successful delivery of a business enterprise. Individuals must be paid accordingly. A level of regulation and accountability
is required and must be described in the POC policy where the structure is defined and accountability agreed. Reporting structures must be known and adhered to. The committees reviewing bids must be well publicised, including how regularly they meet and their timelines for decisions. If there is an appeal process or resubmission process, it must be documented to reduce delays and confusion.
For end users who wish to drive change, the POCT service must have an internal application process for any new device, test or process. These
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