1. Any Willing Provider PbR - A podiatry currency Mike Townson Head of Podiatry and Equipment Services

2. Definitions Currency – the context of the ‘product’ that is being costed Cost – the actual cost of the product Tariff- the range/menu of currency and costs that are available to be bought/sold

3. What makes a ‘good’ currency Incentivise provision of good care - outcome based and avoid perverse incentives Clinically meaningful Resource homogenous – similar resource needs within a currency group Workable – build into existing systems

4. Intervention Tariff 1 Specialist intervention/m ultiple staff resource/ consumables £80+ Out- sourced orthoses (tier 3) Foot pressure measurement systems – mat or in shoe Topical Negative Pressure Nail Surgery Video gait assessment (face to face) Aircast assess/issue Slipper / contact/ serial casting What else? Versajet – single cost Time – including travel Practitioner competence/grade Consumables Case complexity Location Staff numbers Other factors? Significant for added cost ?

5. IT 2 High risk case mix/moderate cost consumables Ulceration – actively managing foot ulcer Acute foot pain Fixed goal based short course of intensive treatment. Coordinated management plan following ulceration/amputation Infected lesion requiring immediate management/ coordination to resolve / improve Video gait analysis – editing and report writing MSK team prescription and local manufacture of bespoke devices (stage 2) utilising technical equipment and robust shells. Charcot initial diagnosis, arranging imaging and referral Time – including travel Practitioner competence/grade Consumables Case complexity Location Staff numbers Other factors? Significant for added cost ?

6. IT3 Increased risk case mix/minor expense consumables Prevention of ulceration in the “At Risk” foot Monitoring and maintenance of pathological/potential exciting conditions in the “At Risk” foot Issue and review of chair side insoles (tier1) – temporary insole and wedging Paediatric review MSK review Reassessment and update of care plan for patients “At Risk” Time – including travel Practitioner competence/grade Consumables Case complexity Location Staff numbers Other factors? Significant for added cost ?

7. IT4 Low current risk intervention Short term management plan for low risk (pulses & sensation present) patients with superficial pressure/trauma related conditions. Review of stretches, strengthening and core stability Footwear assessment/alteration Foot care advice Time – including travel Practitioner competence/grade Consumables Case complexity Location Staff numbers Other factors? Significant for added cost ?

8. IT 5 Foot care - podiatrist Nail care of an increased or high risk limb by a podiatrist Time – including travel Practitioner competence/grade Consumables Case complexity Location Staff numbers Other factors? Significant for added cost ?

9. IT 6 Foot care – assistant Nail care of an increased or high risk limb by a podiatry tech/assistant Time – including travel Practitioner competence/grade Consumables Case complexity Location Staff numbers Other factors? Significant for added cost ?

10. IT 7 Prevention/EducationPublic health brief intervention by trained Prevention team. Group education session Time – including travel Practitioner competence/grade Consumables Case complexity Location Staff numbers Other factors? Significant for added cost ?

11. IT 8 Initial Assessment to service New patient assessment appointment Time – including travel Practitioner competence/grade Consumables Case complexity Location Staff numbers Other factors? Significant for added cost ?

12. Outcomes 50% Improvement in wound care using Texas score 95% patient record to have a personalised care plan 70% improvement in pain based on VAS score 70% improvement in mobility and independence using a PROM 10 days MSK referral to treatment

13. Regulation ?

14. Workshop What extra activities? Consider additional factors? Put into currency groupings – same intervention may appear in two groups if significant & justifiable reason Consider existing clinical pathways Identify expected outcomes Opportunities for fixed episodes of care? Keep it simple!!!!