NHS SYICB - Sheff - CASES - Clinical Assessment, Support and Education Service

The ICB (Sheffield place) is seeking to optimise the potential of CASES in line with current NHS guidance around increasing community provision, including diagnostics. This is as required in the 2025 / 26 NHS Planning Guidance and the NHS Ten Year Plan https://www.england.nhs.uk/long-term-plan/

We would expect to see the provider demonstrate: 1)Engagement with primary care to develop innovative ways to increase referrals through CASES;

2)Use of CASES intelligence to develop test of concept and to evaluate options for community activity that does not require a secondary care referral, but cannot be delivered in the primary care core contract; 3)Minimise the number of referrals that are sent back to primary care with advice and guidance which are then referred back into secondary care within a specific period.

SY ICB are intending to award a contract under the PSR Direct Award Process C. The contract will run from 1 October 2025 to 31 March 2031.

Additional information: The key criteria have been considered as per the below information: Key criteria 1.

Quality and innovation Weighting - 20% Engagement to increase referrals: we have seen a consistent increase in the number of monthly referrals to CASES, including from practices which have historically been low users of the service.

The provider has a Service Development Improvement Plan which they report on every six weeks; they have been talking to practices to refresh awareness of the benefits of the service, and clarifying the arrangements for how it works (how to make a referral etc). They have scheduled an education event for practice administration staff on 17 September 2025, and a clinical learning event for January 2026.

The PCS clinicians also promote the service through clinically focussed podcasts which disseminates learning from the service. Key criteria 2.

Value - Weighting 30% CASES was externally evaluated in 2023 by ResPeo, who concluded that:

Every referral passed through CASES, saved the NHS money on a cost of CASES review versus outpatient appointments saved basis (£0.4 per referral). There are additional savings realised, based on less quantifiable areas, such as earlier cancer detection, patients attending with full work ups etc.

The full report can be found here: https://primarycaresheffield.org.uk/2024/02/09/cases-exte... The CASES service is designed to ensure that patients receive interventions which are evidence -based, within our locally agreed pathways and using medication which is prescribed according to our agreed Formulary.

Key criteria 3. Integration, collaboration and service sustainability - Weighting 20%

1) The ICB is satisfied that CASES is enhancing patient pathways and supporting the delivery of care in the right part of the system, as evidence in the narrative accounts submitted by GPs as part of fulfilling their obligations under our Quality Contract. These accounts provide evidence of advice given which has changed the planned course of care, e.g. different medication prescribed, watchful waiting approach applied, re-referral into a different speciality, self management advice given to the patient.

2) The ICB is confident that PCS are making progress in this area, for example via delivery of gynaecological interventions in community based women's hubs (intrauterine devices for heavy bleeding or as part of HRT, polyp removal, pessary fitting for prolapse and investigative pipelle biopsy). The next speciality focus is gastroenterology, with digital rectoscopy being introduced.

key criteria 4. Improving access, reducing health inequalities and facilitating choice - Weighting 20%

Access Sending a referral via CASES does not add significant additional time to a patient's journey. In 2024/25, 99.93% of referrals were processed within 2 working days (100% within 3).

In many examples, the advice provided to the referring GP will speed up the patient journey (e.g. advice on ordering tests, patient information needed by STH, or advice to refer into a different speciality). Diverting some patients away from unnecessary secondary care treatment reduces their wait and makes the queue shorter for others who need hospital services.

Choice If a referral is made into secondary care, the patient should still be able to choose their provider at that point - choice is not affected by CASES. key criteria 5.

Social value - Weighting 10% 1) Delivery of services in local hubs (as alternatives to hospital based services) reduces journeys for patients.

PCS is committed to a "Digital First" approach and where appropriate exploits remote services and hybrid digital / physical approaches (e.g. for training) 2) The CASES peer reviewers and STH clinical mentors continually develop new guidance for GPs which includes advice for self-management, for example recently in acne management.

3) The most recent "Trends and Themes" Quarterly report (April - June 2025) showed that between 8% - 17% of referrals to CASES were referred back to the GP with advice for primary care and / or self-management. 4) PCS is working with practices to promote carbon reduction schemes, promoting active travel, and working with pharmacies to explore greener prescribing and de-prescribing.

They are also working to ensure that all their educational offers can promote greener policies and raise awareness of best practice in sustainable care provision. PCS are committed to sourcing goods locally, moving away from paper, and to recycling.