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NAT Policy Network Update: HIV service specification consulation

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NAT Policy Network Update: HIV service specification consulation
Posted on: December 14 2012, 04:11 pm

Dear colleagues
 
Re: Consultation on on adult and paediatric HIV service specifications.

As promised in my earlier email (12 December), I am writing with further background on the current consultation on adult and paediatric HIV service specifications - closing date 18 January. 
http://www.engage.commissioningboard.nhs.uk/consultation/ssc-area-b/

NAT strongly encourages as many organisations as possible to respond to this consultation.  The service specifications define what services will be commissioned across England in clinics for people with HIV.  They are therefore extremely important documents to get right. 
 
It is probable the number of responses will send a powerful message to the NHS Commissioning Board of the importance attached to HIV services so your response will make a big difference.

NAT aim to share our own draft response with the Policy Network by 10 January, in case it is useful in finalising your own response.  (We would also welcome any thoughts you have ahead of this time which can inform our response.)

Ahead of this, we would point out just a few issues which we think are important and which you might like to look out for and think about as you read the adult service spec document and make your own responses:

Third/voluntary sector provision - The importance of third sector provision of services such as peer support and counselling are stated a number of times in the adult service specification (see for example section 2.5 on interdependent and related services.) These services will not be commissioned by the NHS Commissioning Board but the adult service spec does state that 'The effectiveness of the specialised HIV services depends on other elements of the HIV pathway being commissioned and effectively coordinated'. 
 
Does the adult service spec refer adequately and appropriately to voluntary sector provision?  NAT will argue for explicit commitment by the NHS Commissioning Board to liaise with Local Authorities and Clinical Commissioning Groups to ensure these non-clinic support services are appropriately commissioned and in place.

BHIVA Standards of Care 2012 - The service specs were finalised before the BHIVA Standards of Care 2012 were published (and also before the publication of the corresponding CHIVA Standards of Care 2012 for children and young people living with HIV).  It will be important to call for the 2012 Standards to be formally endorsed in the service specs and for appropriate revision of the text to be made in the light of the new Standards.

Outstanding issues - There are at a number of points in the adult service spec issues which are referred to as not as yet finalised/resolved, some of them very important:
   Treatment as  Prevention - The recent BHIVA  Treatment Guidelines call for all people diagnosed with HIV to have a  conversation with their clinician about the preventive benefits of treatment  and for treatment to be provided earlier than CD4 350 should the individual  wish it - a recommendation endorsed in the HPA HIV Annual Report 2012.   The adult service spec currently states that 'agreement will need to be  reached' on this issue with the NHS Commissioning Board.  NAT will argue  strongly that the NHS Commissioning Board should commission and resource ARVs  for this purpose and we would encourage others to argue similarly.
   Primary  Care -  The adult service spec states in relation to standards that 'Work is underway  regarding shared care with primary care'.  In the section 2.4 on  exclusions from the adult service spec there is reference to 'Non HIV care  needs of adult HIV patients' where it is emphasised that referrals to  consultants in other specialties will probably now be via GP rather than from  the HIV consultant.  It states that the CRG, BHIVA and the RCGP 'are  finalising recommendations for defining shared care responsibilities between  primary care and HIV specialised services'. 
This consultation is therefore a key opportunity to submit views on what shared care between the HIV clinic and the GP should look like.   
   The Multi-Disciplinary  Team (MDT) - Section 2.2 of  the adult service spec describes the service and the care pathway.  You  will see there are important 'directions of travel' set out here: fewer  providers; an emphasis on a critical mass of expertise in a clinic to ensure  high quality care; the possibility of virtual clinics for stable patients;  very importantly clinical networks and hub and spoke models so that all  elements of care will be planned across a network rather than in each clinic  setting.
There is discussion of the components of the multi-disciplinary team which will work across such a network in the section entitled 'Service elements - Staffing and critical mass'.  It states that 'More detailed staffing profiles and critical mass of staff/patients to be agreed by the CRG'.  The consultation is a chance to input ideas as to the staffing of an MDT. For example, NAT will argue that HIV Clinical Nurse Specialists should come within the MDT.  More generally there are issues around co-location of services (e.g. sexual health services) and accessibility of care which should be explored.   
 
There are many other issues which arise from the service specs which you may be keen to comment on.  Any positive comments both on the service specs as a whole and on the fact that the NHS Commissioning Board will be commissioning HIV specialised services would also be welcome!

Kind regards
Sarah Radcliffe
Senior Policy & Campaigns Officer
NAT (National AIDS Trust)
New City Cloisters
196 Old Street
London EC1V 9FR

T: +44 (0)20 7814 6722
F: +44 (0)20 7216 0111
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Matt Williams
Member
Posts: 312
Re: NAT Policy Network Update: HIV service specification consulation
Reply #1 on: December 14 2012, 05:00 pm

Thanks for highlighting this important issue

Immediate comment:

"Apart from NICE public health guidance on expansion of HIV testing, NICE guidance does not currently exist for HIV." says the adult draft. Is this true if guidelines, eg BHIVA's Treatment of HIV-1 positive adults with antiretroviral therapy (2012) and Management of HIV infection in pregnant women (2012), are NHS (NICE) accredited guidelines? Does anyone know?

- matt
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Matt Williams
Member
Posts: 312
Re: NAT Policy Network Update: HIV service specification consulation
Reply #2 on: December 14 2012, 05:27 pm

HIV is in with "Cancer and Blood" so we need to shout loud to get heard here. - matt
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