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Urgent care cost model

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					Urgent Care Centre - Front End Registration (0910 Activity Base)

Acute Unit                                               Whittington

Annual Activity                                                80,000

Activity 9am - 9pm                                             61,395         77%

Activity 9pm - 9am                                             18,605         23%                                 21394.76


Core Hours Activity

High                                                            3,844          6%
Standard                                                        4,280          7%
Minor                                                           5,086          8%
Total Ambulance                                                13,210         22%

High                                                           10,476         17%
Standard                                                        7,752         13%
Minor                                                          29,957         49%
Total Foot                                                     48,185         78%

Check                                                                 0        0%

Streaming Activity                                             61,395

Minor Activity To Other Primary Care               10%             4,000


Core Hours Streaming
Streamed to Emergency Dept - High                 100%         14,320
Streamed to Emergency Dept - Standard              59%          7,075
Streamed to Emergency Dept - Low                    0%              0
                                                               21,395
To ED Depart                                                   40,000 check                    0
Registration (Charging Point)
High                                                                0
Standard                                                        4,957
Minor                                                          31,043
                                                               36,000

Check                                                               0
UC & Other Primary Care                                        40,000         50%




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Urgent Care Centre - Front End Registration

Streaming                                             Activity pa Activity per day
Core Hours to Emergency Dept                                 7,075                19
Core Hours to Other Primary Care                             4,000                11
Core Hours to Other UC Registration                         36,000                99
Total Streaming Activity pa                                 47,075               129


Patient registration (pay point)                            36,000
Assessment & Treatment                                      36,000


Activity                                       100%              average activity per hour                       staff required per Hour
                                                                                                                                                    Total GP &
                                                                                                           Stream                    Assessment &   Nurse WTE           Admin             Excess GP &
                                                      Streaming                           Assessment &      GP &       Registration Treatment GP     (rounded         (rounded            Nurse Staff
Activity Timing                                        per day           Registration      Treatment       Nurse          Admin         & Nurse         2dp)             0dp)              (rounding)
09:00                                          6.6%             9                     7                7       0.71            0.54          1.63          2.40             1.00              0.06
10:00                                          8.2%            11                     8                8       0.88            0.68          2.03          3.00             1.00              0.09
11:00                                          8.8%            11                     9                9       0.95            0.73          2.18          3.20             1.00              0.07
12:00                                          8.8%            11                     9                9       0.95            0.73          2.18          3.20             1.00              0.07
13:00                                          8.7%            11                     9                9       0.94            0.72          2.15          3.10             1.00              0.01
14:00                                          8.3%            11                     8                8       0.89            0.68          2.04          3.00             1.00              0.08
15:00                                          8.2%            11                     8                8       0.88            0.67          2.02          2.90             1.00              0.00
16:00                                          7.9%            10                     8                8       0.85            0.65          1.95          2.90             1.00              0.09
17:00                                          7.8%            10                     8                8       0.84            0.64          1.92          2.80             1.00              0.04
18:00                                          7.6%            10                     8                8       0.82            0.63          1.88          2.80             1.00              0.09
19:00                                          7.1%             9                     7                7       0.76            0.58          1.74          2.60             1.00              0.10
20:00                                          6.2%             8                     6                6       0.67            0.51          1.53          2.30             1.00              0.10
21:00                                          5.6%             7                     6                6       0.61            0.46          1.39          2.00             1.00              0.00
Total Per day Activity                                       129                    99               99          Staff required Per shift                  3.00             1.00
Total per annum Activity                                  47,075                36,000           36,000

NB: Activity throughout the days of the week is broadly equitable
                                                   Time Taken        Cost for Time
Streaming
Receptionist                                        0                £             -
GP                                                  5 mins           £            6.82
Practise Nurse                                      0                £             -

Registration
Receptionist / Admin                               5 mins            £            1.85
GP                                                 0                 £             -
Practise Nurse                                     0                 £             -

Assessment & Treatment
Receptionist                                       0                 £             -
GP                                                15 mins            £           20.46
Practise Nurse                                     0                 £             -
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Urgent Care Centre - Financial Summary - UCC Activity                40,000

Staff Costs
                                                                                Annual Costs
Grade                                    WTE                                   (inc On Costs)
GP                                               5.64                         £       720,636
A&E Nurse                                        2.78                         £       167,106
GP Training (assumed % of GP WTE)                0.56       10%               £        72,064
Admin                                            2.65                         £        97,236
Management Costs                                 1.00                         £        60,119
                                                                              £     1,117,161

Non Pay
Non Pay (assumed % of Pay)                        27%                         £       301,633
                                                                              £       301,633

Diagnostics
test                                     Cost per test % Activity Activity    Total Cost
ECG                                              22.00       18%          892 £       19,630


Urinanalysis                                     5.00       27%       1,338 £            6,692
Blood                                            5.00       13%         644 £            3,222
Other                                           10.00        5%         248 £            2,479
Other (includes Radiology which remain
unspecified on reports)                         20.00       37%       1,834 £           36,683
                                                                            £           68,706


Overheads
Estates Costs and IM&T (% staff costs)            45%                         £       502,722
Management - Other (% staff costs)                 5%                         £        55,858
                                                                              £       558,580

Tariff Streaming to OPC                  £      12.00                 4,000 £           48,000

Total Costs                                                                   £     2,094,081

Activity                                                                                 36,000

Cost Per Case (inc MFF)                                                       £          56.84


Staff Max
GP                                                67%
A&E Nurse                                         33%




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Urgent Care Centre

Urgent Care Activity Not In A&E                          Whitt        RKE

                                                                  Activity       PbR (1011) MFF          Total £

Activity To Other Primary Care                         Minor           4,000               59     1.30            307,116
Assessment & Treatment                                 Minor          31,043               59     1.30          2,383,441
Assessment & Treatment                                 Standard        4,957               87     1.30            561,233
Cost of UC Activity in A&E                                                                                     3,251,789

UCC Costs
Staff                                                                                                           1,117,161
Non Pay                                                                                                           301,633
Diagnostics                                                                                                        68,706
Overheads                                                                                                         558,580
Tariff Streaming to OPC                                                                                            48,000

Cost of Running UCC                                                                                            2,094,081

Cost Saving / (Higher Cost)                                                                                    1,157,708

Savings Via
Activity To Other Primary Care                                                                                     259,116
Cheaper UC service through difference service design                                                               898,593

                                                                                       Savings Total            1,157,708




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                                                                                                      Assumed Costs for Staff Resources
                                                                                                                                                      14%                                0%

                                                                                                                                                                                                           Productiv
                                                                                                                        Nat                                                                                 e Days            Productiv
                                                                spine        10/11 Basic           London           Insurance -           Pension -           Total Annual                    GROSS Annual    per    Cost per e Hours Cost per                      Cost per
Staff Grades (mid Points)                         Grade          pt              Pay              Weighting             ers                 ers               Cost per WTE   Admin            Cost per WTE Annum       Day     per Day  Hour                         Minute
Band 3 Admin                                          3                    £        17,118       £       4,036      £         1,976      £      2,962         £    26,092    £       -        £ 26,091.75           220   £   118.60          7.50    £    15.81    £     0.26
Band 4 Admin                                          4           14       £        19,993       £       4,036      £         2,344      £      3,364         £    29,737    £       -        £ 29,737.25           220   £   135.17          7.50    £    18.02    £     0.30
Band 5                                                5           19       £        24,554       £       4,911      £         3,040      £      4,125         £    36,630    £       -        £ 36,629.85           220   £   166.50          7.50    £    22.20    £     0.37
Band 6 Physio                                         6           25       £        29,464       £       5,893      £         3,794      £      4,950         £    44,101    £       -        £ 44,100.90           220   £   200.46          7.50    £    26.73    £     0.45
Band 7 Nurse                                          7           30       £        35,184       £       6,217      £         4,568      £      5,796         £    51,765    £       -        £ 51,765.23           208   £   248.87          7.50    £    33.18    £     0.55
Band 8A                                              8A           35       £        41,772       £       6,217      £         5,411      £      6,718         £    60,119    £       -        £ 60,118.53           208   £   289.03          7.50    £    38.54    £     0.64
Consultant                                       Consultant                £       130,000       £       6,217      £        16,704      £     19,070         £   171,992    £       -        £ 171,991.64          208   £   826.88          7.50    £   110.25    £     1.84
GP                                                   GP                    £        95,065       £       6,217      £        12,233      £     14,179         £   127,694    £       -        £ 127,694.06          208   £   613.91          7.50    £    81.86    £     1.36

                                                                                                                0
                                                                                                                0
NB 2: Productive days (i.e. less than the full c220 days), are due to Training needs etc. These are calculated as follows:
                                                                                                                0
                                                                                                Consultant, 7 &
                                                                                                8a Nurse        Band 4 Admin            Band 5 - 6                                            UCC Hours Open      4380 hrs pa
                                                                                                      Days                                                                                    Nurse / GP hrs      1560 hrs pa
                                                                          Days pa                           365                  365                   365                                    Admin Hrs           1650 hrs pa
                                                                          Bank Holidays                      (8)                  (8)                   (8)
                                                                          Weekends                        (104)                (104)                 (104)                                                     2.654545
                                                                          Annual Leave                     (30)                 (22)                  (22)
                                                                          Sick Leave                         (5)                  (5)                   (5)
                                                                          Training                         (10)                   (6)                   (6)

                                                                                                             208                220                   220
                                                                100% Utilisation                             208                220                   220

It was suggested by the UCC at RFH to pay GP's on an hourly "freelance" basis. This is because they consider that:-
                                    a) attracting GP's to work solely in a UCC may not attract the right calibre of staff or be veiwed as a long term career
                                    b) employing (already) working GP's will ensure they want to work. At RFH sickness etc is minimal and the shift rota is full into 2011
                                    c) "freelance" GPs do not incur 'on costs' as these are self employed. Therefore rates can be higher. At the RFH they pay:-
                                                i) £80 per hour standard time
                                                i) £85 per hour weekends
                                                i) £100 per hour bank holidays

                                                Average Wage Calculation
                                                                                                                                                                   £             £
                                                UCC Hours Open Per Year                                                        4380     hrs
                                                           Week                                                                3036     hrs   £80 £242,880
                                                          Weekend                                                              1248     hrs   £85 £106,080
                                                          Bank Holiday                                                           96     hrs  £100     £9,600
                                                                                                                                                    £358,560
                                                                                                                                  Average per hr      £81.86
                                                               The GP salary has been increased from £90k + LWA to bring in line with the hrly rate suggested (average £81.86)

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Equivalent Costs of Streaming To OPC

                         Mins Taken      Cost / Min Cost / Activity    £
Receptionist (Gr 5)                    2 £      0.37                    £   0.74
GP                                     5 £      1.36                    £   6.82
Estate & OH                                          £          4.09    £   4.09


                                                                       £ 11.65

				
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