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TPF02C - NHS Devon

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					                                                                                                                                                                                                                                                           FORM TP02C




                                                                                                                            PbR Flexibility Agreement
                                                                           Supply of Widgetometers                                                                                           Agreement No                                     RK9 / 09-10 / 001

        Summary of Clinical Benefits (Narrative)                                                                                                     0                                Agreement Commencment Date                         Tuesday, December 01, 2009
                                                                      Maximum Number of Patients Affected p.a.
e.g.Less discomfort to patients , better diagnosis, fewer visits to
hospital etc.etc.                                                                                                                                    0                                    Agreement Expiry Date                            Friday, November 30, 2012
                                                                      Minimum Number of Patients Affected p.a.
                                                                                                                                                     0                              Expenditure Commencement Date                         Thursday, October 15, 2009
                                                                      Most Likely Number of Patients Affected p.a.

                                                                      Risk Arrangements if Outturn Pat No > quoted                                                            Risk Arrangements if Outturn Pat No = between
                                                                                                                                   e.g. Trust bears 100% of Cost                                                                            e.g. Costs Shared 50:50
                                                                      Maximum                                                                                                              Most Likely & Max

                                                                      Type (Technology)                                                    New / Not New *                      Marginal Cost / Patient @ Est 09/10 Prices                                £0

                                                                      Patient Type                                                  Spell / Out Patient / Other *                         Reference Cost Location                              (Worksheet / Code)

                                                                      Specialties Affected                                                 Code + Narrative                                    HRGs Affected                                 Code + Short Narrative

                                                                      Service Line in Surplus                                                 Yes / No *                               Projected Y/E Surplus (if Yes)                                  £000's

                                                                      Prior Approval Needed                                                Yes / No / Split *                   Identify PCT requiring Prior Approval if Split            Code/Name e.g. 5QQ Devon

                                                                      Supported by NICE / HTA's / DES Reports *                               Yes / No *                        Report / Guidance Reference No or Title(s)                     eg CG 99, TAG 867

                                                                      Logged on NICE List of Interventional Procedures                        Yes / No *                                       Date:- (if Yes)                           Tuesday, November 03, 2009

                                                                      Notified to DH on PbrComms@dh.gsi.gov.uk ?                              Yes / No *                                       Date:- (if Yes)                           Saturday, November 21, 2009

Clinical Benefit Measure (nb preferably Numeric)                                        Before Supply                                        After Supply                                        Difference                                         Difference (%)

                                                                                                                                                                                                         0                                               0.00
1) Pain Scale? (if in existence)
                                                                                                                                                                                                         0                                               0.00
2) % Correct Diagnosis
                                                                                                                                                                                                         0                                               0.00
3) No of Visits to Hospital
                                                                                                                                                                                                         0                                               0.00
4) etc.
                                                                             Satisfies                                                                                                                                                   Satisfies
                                                                                                                           Satisfies "High Volume                            Statisfies "Limited No of
            Where Technology is NOT new:-                             "Hererogeneous within             Yes / No *                                          Yes / No *                                           Yes / No *      "Disproportionate Cost              Yes / No *
                                                                                                                            HRG" Test Criterion                              Centres" Test Criterion
                                                                       HRG" Test Criterion                                                                                                                                        within HRG" Criterion

Effect on Provider Trust Activity and Income                                PYE Activity                FYE Activity               PYE £                        FYE £                 Name                       Signature              Job Title                      Date

RK9 Plymouth Hospitals Foundation Trust
                                                                                                                                                 0                       0

Financed By:-

5F1 Plymouth PCT (Coordinator)

5QP Cornwall Ises of Scilly PCT (Associate)

5QQ Devon PCT (Associate)

TAL Torbay Care Trust

Total                                                                                           0                      0                         0                       0                                                                                     * Delete as applicable

				
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