Application 1

PRODUCT/SERVICE DETAILS

NAME OF PRODUCT/SERVICE:

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BRIEF DESCRIPTION (250 words max)

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TYPE OF PRODUCT/SERVICE

MEDICAL DEVICE

IN VITRO DIAGNOSTIC

X

CAPITAL MEDICAL EQUIPMENT

HEALTHCARE SERVICE

IT (CLINICAL)

IT (NON-CLINICAL)

BUSINESS SUPPORT PRODUCT OR SERVICE

PHARMACUETICAL

Other (please specify)

DO YOU HAVE REGULATORY APPROVAL?                         YES

IF CE MARKED GIVE CE NUMBER:

WHAT NEED OR PROBLEM DOES IT ADDRESS? (250 words)

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SUPPORTING INFORMATION

WHICH NHS OUTCOME Framework DOMAIN(S) DOES IT FIT WITH AND IN WHICH ONE WILL IT HAVE MOST IMPACT?

 NHS OUTCOME Framework DOMAIN

FIT

IMPACT (one only)

Domain 1 - Preventing premature death

Domain 2 - Enhancing the quality of life for people with LTCs

X

X

Domain 3 - Helping people recover from episodes of ill health and following injury

Domain 4 - Ensuring people have a positive experience of care

X

Domain 5 - Treating and caring for people in a safe environment and protecting them from avoidable harm

None of above

WILL IT

Reduce outpatient appointments

X

Reduce DNAs

Improve or offer the ability for self-care

Improve patient/carer experience

Improve diagnosis of disease in primary care

X

Improve the efficiency/productivity and/or cost of current primary care services?

None of above [tell us  below what it will achieve]

HOW WILL IT CHANGE SETTING OF CARE?

Will your product/service enable care to move from

 

Y/N/Possibly

 Comments

Community to Primary Care

Primary to self-care

Possibly

Acute to Community care

Acute to primary Care

Y

Acute to self-care

Possibly

Maintain current setting of care

Addresses unmet need

None of above (please describe)

TELL US HOW IT WILL ACHIEVE THIS (250 words)

[Tell us how it will change current practice/care]

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HOW WILL YOUR PRODUCT/SERVICE IMPROVE PATIENT OUTCOME AND EXPERIENCE OF THEIR CARE (250 words)

[Provide quantitative data on number of patients in a population of 250,000 affected and by how much their care is improved. Refer to any relevant NHS and/or CCG outcome indicators. State assumptions used]

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WHO WILL USE THIS PRODUCT/SERVICE?

[Tell us if it is a healthcare professional e.g. GP, Nurse, physiotherapist etc. and/or the patient or carer and in what setting i.e. primary/community care, acute care, at home, ]

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WHAT EVIDENCE DO YOU HAVE THAT YOUR PRODUCT/SERVICE IS BETTER THAN CURRENT PRACTICE?

Evidence

Is it Published

(yes/no/in process)

Reference/link

Published papers

Yes

See below

Audits

No

Company sponsored case studies

Yes?

Independently conducted Case studies

No

Comprehensive service evaluation (RCT)

Health economic models

Yes

NICE Appraisal or recommendation

In progress

Other (please tell us what you have)

None

SUMMARY OF EVIDENCE

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References cited:

Mauris lorem tellus, adipiscing quis metus id, adipiscing interdum mi. Quisque a mauris ornare, volutpat odio ut, fringilla lorem. Morbi velit magna, fringilla non aliquam nec, sollicitudin at ante. Aenean eget dignissim sapien, et commodo mi. Vestibulum diam libero, consectetur eu eros congue, consequat pellentesque nunc. Vivamus mattis ligula et leo facilisis, nec sagittis nisi consequat. Phasellus rutrum augue odio. Duis felis ipsum, porta vitae nulla aliquam, ullamcorper vehicula diam. Suspendisse leo felis, consectetur vitae condimentum vulputate, malesuada id felis. Donec eu tempor ipsum, ut cursus nisl. Nunc lacinia elit ut neque bibendum mattis. Nulla sollicitudin dictum felis ut vestibulum. Aliquam urna enim, lacinia in enim id, egestas venenatis risus. Aliquam erat volutpat.

ARE YOU CURRENTLY SELLING TO ANY NHS ORGANISATIONS/LOCAL AUTHORITIES/OTHER ORGANISATIONS PROVIDING OR COMMISSIONING HEALTHCARE SERVICES?                                                                                 YES

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ARE YOU ON NHS SUPPLY CHAIN OR ANY NATIONAL PROCUREMENT FRAMEWORK AGREEMENT?                                                                                YES/NO

                                                                       

IS YOUR PRODUCT/SERVICE CURRENTLY BEING EVALUATED IN A PILOT OR RESEARCH PROJECT?                                                                            YES/NO

If so please tell us by whom

FINANCIALS & HEALTH ECONOMICS

DO YOU HAVE A FINANCIAL MODEL FOR THE COST OF PURCHASING YOUR PRODUCT/SERVICE?                                                                               YES/NO

IF YES PLEASE UPLOAD IT AND COMPLETE THE SUMMARY BELOW

Value (£'s)

 Notes

COST TO IMPLEMENT per 250,000 population*

 

Cost to purchase product/service

£123456

Revenue costs

Recurrent (per annum)

£1234

£12345

Non-recurrent

£0

Capital costs

Recurrent (per annum)

£0

Non-recurrent

£0

 

 *note this is not for 250,000 patients but must take into account prevalence and incidence

 

FINANCIAL SAVINGS per 250,000 population

 

Who will see these savings?

 

Commissioner

YES

Provider

NO

Where will savings be made (insert amount in value column)

 

Primary care appointments

 

Diagnostic tests ordered by GP

   

Non-attendances to primary care appointments

 

Planned referrals to hospital (outpatients)

-£12345

£123456

-£1234

Planned admissions to hospital ( inpatients)

 

Unplanned admissions to hospital

 

Prescription costs

 

Home visits by community healthcare professionals

 

Other (please describe)

 

 

HEALTH ECONOMICS for 250,000 population

 

What is the overall cost of care compared to current practice?

 

Greater (insert amount in value column)

 

Same (insert amount in value column)

 

Less (insert amount in value column)

£123456