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Header image for the current page Improving efficiency of the prior approval requests process through better use of Blueteq

Improving efficiency of the prior approval requests process through better use of Blueteq

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NHS Lincolnshire Integrated Care Board (ICB) engaged NHS Arden & GEM’s Clinical Support team to undertake a project which would streamline their prior approval request process, improve visibility of requests and maintain ongoing assurance.

A multidisciplinary project team including a clinical lead nurse, IFR managers, BI experts and contracting professionals was brought together to update clinical commissioning policies, develop new Blueteq templates based on the clinical commissioning criteria, deliver system-wide training and implement a new dashboard. This six month project has provided the ICB with assurance of an efficient prior approval funding request process with accurate and accessible data available to both referring clinicians and commissioners.

The challenge

Prior approval and IFR processes exist to enable healthcare professionals to request NHS funding, on behalf of their patients, for services or treatments which are outside of clinical commissioning policies or subject to eligibility criteria. Where a commissioning policy and criteria exist, treatment funding can be accessed via a prior approval request process. Where a commissioning policy doesn’t exist, or where the patient’s clinical condition falls outside of the policy’s treatment criteria, an IFR request must be made to the appropriate ICB.

NHS Lincolnshire ICB had previously engaged NHS Arden & GEM’s IFR team to manually administer the ICB’s prior approval process using the online system, Blueteq. In order to streamline the approvals process, improve visibility of requests and maintain assurance, the ICB wanted all healthcare professionals to complete their requests directly via Blueteq.

This would require a multidisciplinary team from Arden & GEM to deliver a project including:

Our approach

Arden & GEM’s extensive knowledge of existing prior approval systems and processes was used to support the delivery of the project. Engagement also took place with a wide range of stakeholders throughout the ICS including PCNs, GP practices, acute services and independent providers. As well as being cross-organisational, engagement was also multidisciplinary with contracting, business intelligence and information governance professionals all being critical to the project’s success.

Developing templates
Forty-six new, user friendly templates were created for the Blueteq system and approved by the ICB prior to implementation.

This was achieved by:

Ratification and assurance
The new Blueteq templates were incorporated into an updated prior approval policy and ratified through the ICB’s policy group. The clinical lead nurse presented the updated policies to an extraordinary meeting of the policy group – which included clinical, governance, quality and commissioning input – to keep the project within agreed timescales.

With the support of the contracting team, independent providers were engaged and timely information shared in advance of the policy and process changes brought about by the project.

System training
A bespoke virtual training programme was developed and facilitated for hundreds of staff working at secondary care sites, including NHS and independent providers, and 58 GP practices to ensure they understood and could use the Blueteq system.

Performance dashboard
The project team quickly identified that to support the new process, ensure that templates were working effectively and enable constructive engagement with services, better prior approval intelligence was needed. Arden & GEM’s BI expertise was utilised to develop a Power BI dashboard for the ICB which tracks requests, referrals and approvals by volume, area and cost to inform management of the service.

At the conclusion of the project in April 2023 a summary of activity, timelines, objectives achieved and lessons learned was presented to the ICB.


This six month project has ensured that NHS Lincolnshire ICB now has a more streamlined prior approval process which has increased efficiency and reduced the time that patients wait for approved treatments.

Accurate and accessible data has improved assurance and provides the ICB with a clear picture of prior approval cost.

Productive working relationships have been developed among stakeholders, with positive feedback received from all staff groups involved.

"There has always been a ‘can do’ attitude and a willingness to find solutions to any challenges that have arisen. The clinical expertise and knowledge has been extremely valuable in being able to provide advice and assurance to the clinicians that are going to be impacted by this project; as well as being able to distil the prior approval procedures and requirements into clear templates for the Blueteq system. Update meetings are concise and to the point, whilst ensuring all the key points are covered – I wish all my meetings could follow this example!"

Sarah Brinkworth, Planned Care and Diagnostic Programme Director at NHS Lincolnshire ICB

Arden & GEM’s embedded IFR team continues to work closely with the primary, acute and independent sectors to ensure the new process is followed. While the BI team continues to support the ongoing population and updating of the service dashboard.