Practice Based Commissioning – East Devon PCT Devolved Budgets Project

1. Practice Based Commissioning – East Devon PCT Devolved Budgets Project Beverly Stretton-Brown, Devolved Budgets Project Manager 22 September 2004

2. East Devon Profile • 13 Practices • 7 Community Hospitals • Population of c120,000 • Wide Geographical Rural Area • High Elderly Population – 37% over 65’s

3. 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

4. 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’

5. What is included in the budget? Day Case Elective Activity Non-Elective Activity Inpatient Elective Activity Out Patient Activity Exclusions – Intensive Care High Cost Procedures A&E, etc Activity in Acute Trusts Charged at National Tariff (RDE 92%) Activity in Community Hospitals Charged at 80% of National Tariff

6. Divided Between 13 East Devon Practices Based on Historical Activity PCT Hospital Services Budget For 2004/05 Elective Inpatient & Day Case Non- Electives Out Patients

7. 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

8. 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’

9. 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

10. 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

11. Current Budget Status (as at June 04)

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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 …….

19. And we are still learning …..

20. Thank You Beverly Stretton-Brown 01392 207492 beverly.stretton-brown@eastdevon-pct.nhs.uk