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					What is: Practice Based Commissioning?
What is: Payment by Results?


         Who gives a monkey’s?
           Dr Richard More
    Agenda

    • The need for change
    • The current commissioning
      arrangements
    • The proposed changes
      – Practice based commissioning
      – Payment by Results
    • Implications

2                    (c) Xytal Health Management Ltd
                                    2005
    Practice Based Commissioning
    http://www.dh.gov.uk/assetRoot/04/09/03/59/04090359.pdf




    • 1998 “The New NHS Modern and
      Dependable”
    •   http://www.archive.official-documents.co.uk/document/doh/newnhs/newnhs.htm


    • 2004 “The NHS improvement plan”
        http://www.dh.gov.uk/assetRoot/04/08/45/22/04084522.pdf




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                                                    2005
    Why?

    • A review of the effectiveness of primary
      care-led commissioning and it’s place in
      the NHS.
    •   http://www.health.org.uk/uploadedfiles/document/2_82_Executive%20summary%20final.pdf


    • Practice-led commissioning: Harnessing
      the power of the primary care front line.
    •   http://www.kingsfund.org.uk/pdf/practiceledcommissioning.pd




4                                     (c) Xytal Health Management Ltd
                                                     2005
    Current Commissioning
    Arrangements     Taxation and PSB

Central Government


                Department Health


                              Strategic Health Authorities

                                                   Primary Care Trusts

                                                              Care Providers


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                                      2005
    Key Frameworks

    • “Practice Based Commissioning”
     http://www.dh.gov.uk/assetRoot/04/09/03/59/04090359.pdf



    • “Making practice based commissioning a
      reality - technical guidance”
     http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPo
     licyAndGuidanceArticle/fs/en?CONTENT_ID=4104152&chk=/K4etf


    • Reforming NHS financial flows
      introducing payment by results
     http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPo
     licyAndGuidanceArticle/fs/en?CONTENT_ID=4005300&chk=gWPrpL




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                                                  2005
    What is Practice Based
    Commissioning?
    • Minimum:
      – Annual feedback on use of services            Para 10



    • For volunteers: An Indicative Budget
      – "Practices or localities who wish to do so will
        receive a firm indicative budget from the PCT
        they will use to directly manage the delivery
        of services to their patients (subject to
        Paragraph 22)” Para 11

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                                   2005
    Para 22

    • Patients exercise choice [NOT choose
      and book]
    • Agree in advance how national and
      local targets will be delivered
    • Reduce inequalities in health consistant
      with “Choosing Health”
     http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance
     /PublicationsPAmpGBrowsableDocument/fs/en?CONTENT_ID=4097491&MULTIPAGE
     _ID=4925210&chk=pn5ZwT



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                                              2005
    That’s PbC
                                              Taxation and PSB

Central Government


                 Department Health


                               Strategic Health Authorities

                                                    Primary Care Trusts

                          Practices
    Other Providers
                                              Secondary Care Providers
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                                       2005
Its not Fundholding!
http://www.primarycarecontracting.nhs.uk/uploads/pbc_files/ToolkitFinal.pdf

                                     GPFH                                PbC
Services purchased National list                                         Local negotiation
Budget range                         Had to include Rx                   Local negotiation
Contract                             Individual                          Contract negotiated
management                           Provider/Practice                   & monitored PCT
Management costs                     National formula                    Local negotiation

Costs                                Local negotiation                   National tariff
Underspends                          “Savings”                           “Resources freed”
IT Softwear                          National spec.                      “PCT’s will provide”
So what’s this about “Payment
by Results?”
    “Reforming NHS financial flows: introducing
               payment by results”

  http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicy
  AndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=400
  5300&chk=gWPrpL
     PbR and the practices

     • "as new arrangements in primary care
       develop it will encapsulate all
       commissiong arrangements within the
       NHS."
     •   http://www.dh.gov.uk/assetRoot/04/06/04/76/04060476.pdf Para 1


     • "Instead of being commissioned through
       block agreements, hospitals (and other
       providers) will be paid for the activity they
       undertake"
     •   http://www.dh.gov.uk/assetRoot/04/06/04/76/04060476.pdf Para 2.0


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                                                     2005
     Acute Trust cash time line
     (traditional)
         April
     Start activity

                       May June
                      Agree budget
                                          June – December
                                            Spend Money


                                                                  Dec-Mar
                                                              Run out of money




                                      Add to waiting lists
                                        Close wards

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                                           2005
     Cash time line (PbR)
                                                     Refer patients
         April
     Start activity

                       May June
                      Agree budget
                                          June – December
                                            Spend Money

                                                                       Dec-Mar
                                                                      Run out of
                                          Cost per                      money
                                           case


                                                                  Waiting List
                                                                   Targets
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                                           2005
     Implications of PbR / National
     Tariff
     • Level playing field
     • Unstable financial system
       – The NHS costs more than the Tariff
       – Tariff set 2 years ago, NHS use has changed




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                                  2005
     Current Situation.
     http://www.dh.gov.uk/assetRoot/04/10/09/34/04100934.pdf




     • 2005/6 activity will be elective procedures
       only
     • Non elective, outpatients A&E 2006/7
     • 90% hospital activity covered 2008/9


     • Unless Foundation Trust

16                                (c) Xytal Health Management Ltd
                                                 2005
 Owner Managed                 Core General Practice
 General Practice


                       QOF Framework
                                                                   NHS Trust



         Enhanced Services

                                       Patient Need             Foundation Trust



          APMS
                                                                  Independent
                                                                   Treatment
                                                                     Centre
         SPMS
                                    Primary Care Trust




17                            (c) Xytal Health Management Ltd
                                             2005
      Examples from National Tariff
      http://www.dh.gov.uk/assetRoot/04/10/02/98/04100298.xls




                                                                        Child (U17)    Child (U17)
     Outpatient      Outpatient      Adult First    Adult Follow-up         First       Follow-up
     Specialty       Specialty       Attendance     Attendance tariff   Attendance     Attendance
       code           name             tariff (£)         (£)             tariff (£)     tariff (£)


                      General
       100            Surgery           £146              £77              £197           £104




18                                 (c) Xytal Health Management Ltd
                                                  2005
     Examples from National Tariff
     http://www.dh.gov.uk/assetRoot/04/10/02/98/04100298.xls




     • Vasectomy £973




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                                                 2005
     Implications
            Patient                          General Medical
             need                                advice

              Choice




                                                         £
            Chosen                                 Vasectomy
            Provider                                procedure




20                     (c) Xytal Health Management Ltd
                                      2005
      Deliver the benefits                    Potential of PbC




     PbC controls PbR                            Guidance framework of PbC




       PbR has risks and                       Introduced PbR
         opportunities




21                      (c) Xytal Health Management Ltd
                                       2005
     Questions




22               (c) Xytal Health Management Ltd
                                2005

				
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