Practice Based Commissioning – East Devon PCT Devolved Budgets Project Beverly Stretton-Brown,...

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 …..

Thank You

Beverly Stretton-Brown01392 207492

beverly.stretton-brown@eastdevon-pct.nhs.uk