Cardiac rehabilitation services
This is an extract from the commissioning guide. The complete commissioning guide is available at www.nice.org.uk/guidance/cmg40
6 The commissioning and benchmarking tool
- 6.1 Identify indicative local service requirements
- 6.2 Review current commissioned activity
- 6.3 Identify future change in capacity required
- 6.4 Model future commissioning intentions and associated costs
- 6.5 Potential savings
Use the commissioning and benchmarking toolfor cardiac rehabilitation to determine the level of service that might be needed locally and to calculate the cost of commissioning the service, as described below.
Available data suggest that the indicative benchmark rate for groups that may be suitable for referral for cardiac rehabilitation is:
0.3%, or 300 per 100,000, population per year.
For an average GP practice with a list size of 10,000, the average number of people requiring cardiac rehabilitation for the above conditions would be 30 per year (0.3% of the population).
For the purpose of this benchmark the following conditions have been focused on:
myocardial infarction (MI) including STEMI and NSTEMI
percutaneous coronary intervention (PCI)
coronary artery bypass graft (CABG)
chronic heart failure
implantable cardiac defibrillators (ICD)
The commissioning and benchmarking tool helps you to assess local service requirements using the indicative benchmark as a starting point. With knowledge of your local population and its demographic, you can amend the benchmark to better reflect your local circumstances. For example, if your population is significantly younger or older than the average population, or has an ethnic composition different from the national average, or has a significantly higher or lower rate of the conditions above, you may need to provide services for relatively fewer or more people.
You may already commission a cardiac rehabilitation service for your population. The tool provides tables that you can populate to help you calculate your total current commissioned activity and costs.
Using the indicative benchmark provided, or your own local benchmarks, you can use the commissioning and benchmarking tool to compare the activity that you might need to commission against your current commissioned activity. This will help you to identify the future change in capacity required. Depending on your assessment, your future provision may need to be increased or decreased.
You can use the commissioning and benchmarking tool to calculate the capacity and resources needed to move towards the benchmark level, and to model the required changes over a period of 4 years.
Use the tool to calculate the level and cost of activity you intend to commission. The tool is pre-populated with data on the potential recurrent and non-recurrent cost elements that may need to be considered in future service planning, which can be reviewed and amended to better reflect your local circumstances.
Commissioning decisions should consider both the clinical and economic viability of the service, and take into account the views of local people. Commissioning plans should also take into account the costs of monitoring the quality of the services commissioned.