practice based commissioning – east devon pct devolved budgets project beverly stretton-brown,...
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Practice Based Commissioning – East Devon PCT Devolved Budgets Project
Beverly Stretton-Brown, Devolved Budgets Project Manager
22 September 2004
East Devon Profile
13 Practices 7 Community Hospitals Population of c120,000 Wide Geographical Rural
Area High Elderly Population –
37% over 65’s
Why Devolved Budgets? Unsustainable Historical Growth trend in
Secondary Care Activity To enable appropriate use of future
growth in PCT resources Payment by Results Environment Acute Hospital services are at national
tariff, Orthopaedic OP Appointment cost £312 DVT Non-Elective Admission cost
£989/£1691
Why Devolved Budgets? ….Cont
Not about reducing referrals, but ensuring patient is seen in right place by right person at right time New Local Services/Avoiding Admissions
Practices are best placed to make decisions on referrals
The scheme incentivises the GPs to Look at their referrals/activity Identify Local Service Opportunities Ensure ‘we only pay for what we get’
What is included in the budget?
Inpatient ElectiveActivity
Day Case Elective Activity
Non-ElectiveActivity
Out PatientActivity
Exclusions –Intensive Care
High Cost ProceduresA&E, etc
Activity in Acute TrustsCharged at
National Tariff(RDE 92%)
Activity in CommunityHospitals
Charged at80% of National Tariff
PCTHospital Services
BudgetFor 2004/05
Elective Inpatient & Day Case
Non- ElectivesOut Patients
Divided Between
13 East DevonPractices
Based onHistoricalActivity
Basic Principles…… Optional Sign-up Participation at Various Levels & Pace No Sanctions for Budgetary over-spend Budgets set on historical activity, with move
to fair equity model Flexibility - Practices can opt out of
Emergency Admissions not referred from Practice section of Budget
New Services can be pump-primed in-year
Basic Principles …..
New Services can be introduced at various levels In-house Practice offering service to other practices Practice groups Localities PCT Wide
New Services should eventually become self-funding – under Payment by Results
Currency ‘SPELLS’
The Incentives ….. If a practice is in an overall budgetary
under-spend position at year end, they can retain 50% of their savings.
50% retained by PCT to cover potential overspends or reinvestment in the locality.
Cost of staffing, training, equipment, and full set up costs can be included in cost of new service
Savings to be used on improving patient care
Where are we now? Preparation Year - 2003/04 Launch Event May 2004 – Priorities Identified 5 Practices signed up – 2 imminent 2004/05 Practice Based Budgets set on
Historical data Monthly monitoring reports provided to
practices Showing budgetary status Activity by HRG at Patient Level
Validation of Activity at HRG Level
Current Budget Status (as at June 04)
East Devon PCT Budgetary Position as at June 2004
-£150,000
-£100,000
-£50,000
£0
£50,000
£100,000
£150,000
1 2 3 4 5 6 7 8 9 10 11 12 13
Practices
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Practices in Over-spend Position
Practices in Under-spend Position
Support for Practices Management Resource Funding
Supplying Referral Data Clinical Review of Referrals Management Time Validation
Dedicated Central Management Support Project Manager and Project Facilitator
GP Service Development ‘Can Do’ Group Validation Workshops for Data Collectors Learning Workshops for GPs/Practices Database of Services within East Devon
Support for Practices, cont
Effective Referral Programme Introduced across N&E Devon Practice Based Referral Collection
(Electronically) Central Information Service Initially –
Handling Choice at 6 Months Collect referral information from practices
Provide Robust information/Feedback Longer Term – Information on Choice At
Referral and Waiting Times
Service Developments Specialist Orthopaedic Physiotherapist Dermatology GPSIs Vasectomy GPSI ENT GPSI Gynaecology GPSI Mixed Fracture/Minor Surgery Clinic Community DVT Clinic Community Access to Echos
Lessons Learned Quality and reconciliation of secondary
care & primary care data Local links important at practice and at
DGH Investment required at practice and PCT Support required for developing local
services at locality/practice level Constant positive reinforcement from
CEO essential
Lessons Learned (cont’d)
Framework (Rules of Engagement) developed with visible GP Input
Documented detail essential, but can soon be out of date - Framework needs to remain flexible as scheme develops.
Structure in place to address Commissioning Issues
Savings made from Community Hospitals – not true savings –Block Contract Arrangement introduced
Lessons Learned (cont’d)
Scheme took longer than expected to implement – Benefits reaped next year?
Dedicated Project Management time essential
Scheme has required trust/Leap of Faith on both PCT and Practices
Building good working relations essential – Key factor for success …….
And we are still learning …..
