The facts behind Practice Based Commissioning

2. The facts behind Practice Based Commissioning Approx 1500 PBC clusters in England Less than half have actively commissioned services Less than two-thirds have an agreed commissioning plan

3. Currently there are significant variations between PCTs and Practices in their understanding and implementation of: PBC Information Provision Data Validation Support Incentives

4. NHS Alliance opinion “Practice-based commissioning cannot properly get off the ground until commissioners have access to accurate, meaningful real time information” Dr Michael Dixon Chair NHSAlliance

5. Secondary Care Information Systems provided by PCTs • Ardentia • CHKS • Dr Foster • Midas • CBSA • All re-present secondary data in a form which aids easier analysis, however, they are complex and time consuming to obtain information. • Executive Viewer • PB Views • MIS • etc… • They make reference to financial accountability but cannot provide data that identifies the coding errors which currently maybe as high as 30% (Source: National Association of Clinical Coders / Audit Commission)

6. Coding Issues • There’s a 99% certainty that you are being wrongly charged for some secondary care episodes for your Patients • Exceeding your indicative budget is therefore inevitable

7. These issues are arising from interpretation of 650 codes in HRG V3.5 which will increase to 2000 codes with the launch of HRG V4 in early 2009

8. A West Midlands Practice

9. The Audit Commission is responsible for ensuring that public money is spent economically, efficiently, and effectively to achieve high quality services for the public

10. Audit Commission Recommendations All PCTs should :- • Further develop commercial, legal and contracting skills, identify gaps in line with developing World Class Commissioning competencies Adopt a robust yet proportionate approach to monitoring and challenging provider activity and costs under contract, prioritising investment in practice level information systems so that practices can engage in the planning and monitoring of hospital activity Focus on demand management (care and resource utilisation) initiatives. Ensure that sufficient resources are devoted to these initiatives

11. Reinforced by the Department of Health

12. Main Points from DH Letter • ‘For PBC and commissioning in general to deliver their full potential, accurate clinical coding is essential’ • ‘Where practices identify inaccuracies, PCTs should support and encourage the improvement of data quality by Trusts and, where inaccuracies are proved to be correct, PBC data and budget spends should be corrected by PCTs.’

13. DH Commissioning Assurance Scheme (For SHAs / PCTs) • PCT Competency 10 Level 2 ‘Data is accessible and used to monitor provider performance’ ‘Monthly data from providers is no more than one month old’

14. Trusts and PCTs have been slow to engage these recommendations believing that it will prove confrontational and difficult to administer

15. Healthcare Financial Management Association Membership comprises all Trust and PCT Financial Directors / Senior Managers

16. Return of Fundholding? Conservative Party Health Policy ‘The Conservatives also propose that the current policy of practice-based commissioning be extended to allow primary care clinicians to hold ‘real’ budgets compared with the ‘notional’ budgets under current policy’

17. iQ BUDGET MANAGER One Product – Two Vital Tasks Validating Secondary Care Charges which impact on Indicative and ‘Real’ Budgets and Analysing Demand Management Information to support Preparation and Monitoring of PBC Plans

18. Overview of key features of Budget Manager The key to understanding and managing Charge Coding (HRG and Clinic Codes) Delivers the HRG code and tariff by describing the patient condition in ordinary terms The key word search will check patient condition against 160,000+ terms in Read Code V3.0 (all clinical systems use V2.0) Also automatically references OPCS and ICD10 to filter the description System automatically displays the HRG and anticipated charge based on the National Tariff. Local and Split Tariffs can also be accommodated

19. Overview of key features of Budget Manager Continued …. Enables referrals/discharges to be analysed against HRG, provider, speciality, episode type, practitioner, patient, pathway, referral status and cost etc Numerous reports can identify areas of concern e.g. GP referring patterns, overcharging care providers, high incidence procedures, high cost procedures, incorrect charges and the reasons behind them etc.

20. Brief Demonstration of iQ Budget Manager Version 2.