Services for people at risk of developing glaucoma
This is an extract from the commissioning guide. The complete commissioning guide is available at www.nice.org.uk/guidance/cmg44
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
Use the commissioning and benchmarking tool for people at risk of developing glaucoma 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 new referrals to a service for the investigation of possible ocular hypertension (OHT) or suspected chronic open angle glaucoma (COAG) is 0.15% or 150 per 100,000 of the population aged 18 years or over per year.
The indicative benchmark for additional follow-up appointments for people with suspected COAG and OHT is 1.02% or 1,020 per 100,000 of the population aged 18 years or over per year. Of these, at least 90% or 920 per 100,000 of the population will be people with OHT or suspected COAG who can be monitored in the community.
The commissioning and benchmarking tool helps you to assess local service requirements using the indicative benchmarks as a starting point. With knowledge of your local population and its demographic, you can amend the benchmarks 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, you may need to provide services for relatively fewer or more people.
You may already commission a service for people at risk of developing glaucoma for your population. The tool provides tables that you can populate to help you calculate your current commissioned activity and costs.
Using the indicative benchmarks 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 levels, 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 and to consider the settings in which the service for people at risk of developing glaucoma may be provided, comparing the costs of commissioning the service across the various settings. 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.