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 65s

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 Elective Activity Day Case Elective Activity Non-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

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

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 /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)

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 (contd) 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 (contd) 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-Brown