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Effects of Payment by Results on Primary Care Commissioning and New Provider Services

Effects of Payment by Results on Primary Care Commissioning and New Provider Services. Dr Tim Richardson. THE NHS PLAN / WHITE PAPER “Care out of Hospital” 2006-2008. More services in Primary/Community Care Specialist Clinics Therapies Diagnostics / Day Surgery Chronic Disease Management.

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Effects of Payment by Results on Primary Care Commissioning and New Provider Services

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  1. Effects of Payment by Results on Primary Care Commissioning and New Provider Services Dr Tim Richardson

  2. THE NHS PLAN / WHITE PAPER “Care out of Hospital” 2006-2008 More services in Primary/Community Care • Specialist Clinics • Therapies • Diagnostics / Day Surgery • Chronic Disease Management

  3. LEVERS FOR CHANGE • PBR – Tariffs • PBC – Will it Happen? • Patient CHOICE • New Healthcare Contracts • New Providers

  4. NEW CONTRACTS / NEW PROVIDERS • Specialist Personal Medical Cervices (SPMS) • Alternative Provider of Medical Services (APMS) • Independent Sector Treatment Centres (ISTCs)

  5. NECESSARY INPACT ON ACUTE PROVIDERS • Concentration of Critical Care • Larger Populations Covered • Fewer Acute Cost Centres • Improved Clinical Quality and Training Opportunities

  6. PROBLEMS WITH PBR / PBC • Total Costs of Current Activity Greater than Budgets • Market Forces Factor – Withholding Centrally • Top Slicing of PCT / PBC Budgets

  7. WHAT NEEDS TO BE DONE? • If PBC is to generate “Care Out of Hospital” then appropriate level budgets with minimum Top-Slicing or with-holding MFF, is essential, otherwise where are the incentives? • New providers can and will offer services at below acute care HRG tariffs, but not at the baseline tariff. • To reach financial balance means either rationing care or providing it more cost effectively.

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