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 |
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IN VITRO DIAGNOSTIC |
X |
CAPITAL MEDICAL EQUIPMENT |
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HEALTHCARE SERVICE |
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IT (CLINICAL) |
|
IT (NON-CLINICAL) |
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BUSINESS SUPPORT PRODUCT OR SERVICE |
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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)
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.
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 |
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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 |
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Domain 4 - Ensuring people have a positive experience of care |
X |
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Domain 5 - Treating and caring for people in a safe environment and protecting them from avoidable harm |
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None of above |
WILL IT
Reduce outpatient appointments |
X |
Reduce DNAs |
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Improve or offer the ability for self-care |
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Improve patient/carer experience |
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Improve diagnosis of disease in primary care |
X |
Improve the efficiency/productivity and/or cost of current primary care services? |
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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 |
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Community to Primary Care |
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Primary to self-care |
Possibly |
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Acute to Community care |
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Acute to primary Care |
Y |
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Acute to self-care |
Possibly |
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Maintain current setting of care |
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Addresses unmet need |
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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? |
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Independently conducted Case studies |
No |
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Comprehensive service evaluation (RCT) |
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Health economic models |
Yes |
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NICE Appraisal or recommendation |
In progress |
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Other (please tell us what you have) |
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None |
SUMMARY OF EVIDENCE
Phasellus ultrices tristique felis et varius. Maecenas rhoncus scelerisque nisi, nec suscipit augue congue vitae. Nunc vehicula nunc interdum felis rhoncus, ac posuere lacus tincidunt. Nullam pharetra dignissim nulla in consequat. Pellentesque in imperdiet risus. Nulla facilisi. Proin quis pharetra ante. Cras eget dui orci. Cras ligula lorem, lobortis nec consectetur venenatis, feugiat ac est. Integer sed mauris neque. Nunc egestas magna et odio commodo, et molestie lorem rutrum. Praesent dolor velit, rutrum quis lectus in, commodo blandit tortor. Sed mauris risus, iaculis quis magna ut, volutpat tempor enim. Lorem ipsum dolor sit amet, consectetur adipiscing elit. |
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
Duis id suscipit lorem. Nam pellentesque mauris quam. Ut hendrerit dui nec dui mollis, sed rhoncus metus tincidunt. Cras at dui vitae quam aliquet ultrices. Cras pharetra ligula placerat ipsum malesuada, imperdiet ullamcorper tortor rutrum. Sed in velit nec mi faucibus porttitor. In molestie consectetur faucibus. Integer posuere metus tincidunt dui faucibus dapibus. Donec interdum purus et imperdiet hendrerit.
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 |
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COST TO IMPLEMENT per 250,000 population* |
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Cost to purchase product/service |
£123456 |
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Revenue costs |
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Recurrent (per annum) |
£1234 £12345 |
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Non-recurrent |
£0 |
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Capital costs |
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Recurrent (per annum) |
£0 |
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Non-recurrent |
£0 |
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*note this is not for 250,000 patients but must take into account prevalence and incidence |
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FINANCIAL SAVINGS per 250,000 population |
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Who will see these savings? |
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Commissioner |
YES |
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Provider |
NO |
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Where will savings be made (insert amount in value column) |
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Primary care appointments |
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Diagnostic tests ordered by GP |
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Non-attendances to primary care appointments |
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Planned referrals to hospital (outpatients) |
-£12345 £123456 -£1234 |
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Planned admissions to hospital ( inpatients) |
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Unplanned admissions to hospital |
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Prescription costs |
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Home visits by community healthcare professionals |
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Other (please describe) |
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HEALTH ECONOMICS for 250,000 population |
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What is the overall cost of care compared to current practice? |
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Greater (insert amount in value column) |
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Same (insert amount in value column) |
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Less (insert amount in value column) |
£123456 |