Cheshire

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Cheshire Merseyside PCC and QOF Leads20th
March 2006GMS 2006/07Sam IllingworthPrimary
Care Contracting AdvisorNorth West Region
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Housekeeping

• Mobile phones
• Badges
• Toilets
• Fire drill
• Coffee break
• Lunch
• Questions

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Overview

• Finance - overview
• IM T DES
• PBC DES
• Choice and Booking DES
• Access DES
• 3rd Available Appointment Donna Davies
• QOF Dr Philip Leech

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Overview of Financial Implications

• No uplift for inflation or cost pressures
• Equivalent of 166 QOF points for no cost
• Additional Investment for
• Choice Booking 0.95 per head
• Practice Based Commissioning 1.90 per head
• IMT Adoption 1.33 per head
• QOF Allocations to PCTs
• Recycle Access DES and QOF Access Points

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Overview of Financial Implications Contd

• Gross Investment Guarantee (GIG) ceases on March
  2006
• ES Floor frozen at 2005/06
• Increase in maximum locum maternity payment
• Normalisation national and quarterly
• Formula review report expected during 2006
• Premises and IT (111M and 21M)
• Changes to VAT arrangements for personally
  administered items
• Superannuation included in all payments

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ES Floor

• Criteria on floor spend remains the same
• Implementation Coordination Group continues
• 05/06 floor frozen
• New investment (for IM T, Choice and Booking
  and PBC) is indicative over and above 05/06 floor
• PCTs will be asked to report separately within
  FIMS

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Next Steps / Future Years

• New SFE to be published 2006/07
• New DES Directions in July - retrospective
• Future contract subject to explicit annual
  efficiency savings
• QOF subject to continuous improvement
• CPI resource neutral mechanism
• Future increases to global sum to offset
  requirement for correction factor payments

8

• Questions..?
• www.primarycarecontracting.nhs.uk

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DES for the adoption of programmes delivered by
the National Programme for IT for 2006/07
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National Programme for IT GP practices

• Electronic Prescription Services (EPS)
• Electronic transfer of GP records (GP2GP)
• Choose Book
• the NHS Care Record Service

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Aims

• active implementation of EPS and preparation for
  the NHS Care Record Service
• training for all practice staff
• resources for installation and implementation of
  new technologies
• support during installation of new systems
• accreditation of the quality of electronic record
  keeping

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Payment and Implementation timings

• DES payments will reflect variations in the
  timing of deployments of programmes across the
  country and will be made available when
  deployment takes place
• Local discussions will be required!

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The DES provides practices with resources to
ensure

• protected time for team members to attend
  training
• that the practice meets, information governance,
  data quality and system operation standards
• protected time for new team members to be
  inducted to meet the practices information
  standards

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The DES provides practices with resources to
ensure

• time for practice staff to undertake necessary
  additional work
• provision of additional support to ensure
  efficient services when practices are learning
  new technology

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2006/07 DES Payments

• Implementation and cashflow may be spread
• over 2 financial years

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Component 1 (40p per patient)

• practice plan
• nominated leads (CfH and Caldicott)
• training plan for each member of the practice
  team involved with IT
• log of in-house training
• relevant practice team members should be
  authenticated and registered with a smart card

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Component 2 (44p per patient)

• preparation of data for accreditation in
  readiness to upload to the spine (e.g note
  summarisation)
• standards available in DES specification
• organisational
• information governance
• clinical data entry

• Payment made after practice is accredited

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Measurement of standards three part process

• submission of plan upon application of
  accreditation
• quantitative analysis of data
• PCT visit
• qualitative checks of a cross section of notes
  from every clinician who consults on a regular
  basis
• explore areas in evidence submitted by practice

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Component 3 (27p per patient)

• maintenance of patients addresses with
  opportunistic regular validation
• Electronic Prescription Service (EPS)
• utilise EPS Release 1 software
• where available, utilise EPS Release 2 software

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Component 4 (22p per patient)

• migration to a CfH hosted system

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PCT Preparation

• CfH will provide info to support PCTs in payment
  triggers
• PCTs could claw back a proportion of the payments
  if the practice has not made reasonable efforts
  to implement
• Liaise with SHA wide IM T leads and cluster
  support team re timescalesto future PCC Leads
  meeting?
• What would a plan look like?
• Prepare for data accreditation visits
• Consultation with LMCs

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• Questions..?
• www.primarycarecontracting.nhs.uk

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Towards Practice based commissioning achieving
universal coverage
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PBC guidance - main features

• Addresses key questions that practices and PCTs
  want answered for the next year
• What does universal coverage mean?
• Information requirements
• Budget setting and financial management
• Governance and accountability
• Advice and support

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Universal coverage by December 2006

• All practices to receive regular activity
  financial information
• An indicative budget covering agreed scope of
  services
• Support and incentives
• Governance accountability framework

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Information

• All practices will receive information on
  activity and spend
• All practices will also receive benchmarked data
  to enable them to compare themselves to other
  practices in the PCT and to the national average
• PCTs will provide this information to practices
• A template will be provided to ensure that the
  information is received in a consistent format

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Indicative budget

• All practices will receive an indicative budget
  which covers an agreed scope of services
• Indicative budgets will be based on 2005/06
  activity at 2006/07 tariff prices
• PCTs will retain accountability for financial
  balance
• Practices will have access to resources freed up
  from more effective utilisation of services
• All practices to be made aware of their fair
  share for 2006/07

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Governance

• PCTs to have clear accountability governance
  framework in place covering
• information
• budget setting
• support incentives
• process for agreeing plans
• use of freed up resources
• criteria for reaching decisions
• arbitration arrangements

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Enhanced service - PBC

• Directed Enhanced Service
• A one year scheme for engaging practices
• Reimburses clinical and practice time
• PCTs may choose to pay more
• PCTs will report to SHA on uptake in April 06 and
  Jan 07

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Enhanced service - PBC

• DES has 2 components
• Component 1. Plan for redesigning patient flows
• 95p per patient
• development implementation
• Component 2. Delivering the plan
• access to freed up resources
• minimum guarantee 95p per patient

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Practice Plan

• Practice name and details joint plan with other
  practices?
• Agreed scope of services covered by indicative
  budget, redesign activity and plans
• How quality of redesign will be assured
• Agreed baseline of referrals and/or admissions by
  speciality for 05/06
• Agreed threshold for meeting objectives in the
  DES plan to trigger award for Component 2
• Agreed monitoring requirements by PCT and
  practice
• Sowhat needs to be in the planobjectivesfreed
  up resources

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Component 2 from BMA Model Plan

• Where a practice achieves its objectives, but
  does not free up resources from the indicative
  budget it will be paid component 2
• Where practice activity results in freed up
  resources and these are less than the C2, but the
  practice has achieved its objectives, the
  difference will be met by the PCT
• Where practice activity results in freed up
  resources and these are less than the C2 and the
  practice has not achieved its objectives, the
  practice will be able to retain control of use of
  this resource

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Component 2 from BMA Model Plan

• Where practice activity results in freed up
  resources and they are equal to the C2, whether
  or not the practice has achieved its objectives,
  the practice will be able to retain control of
  use of this resource
• Where practice activity results in freed up
  resources and these exceed C2, the equivalent of
  C2 will be retained by the practice as a minimum.
  Re freed up resources in excess of C2, 70 will
  be retained by the practice. The PCT will retain
  the remaining 30

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Next Steps

• February 06
• clinical quick wins document
• business case proforma
• information template
• NPDT PBC Programme
• Summer 06
• new commissioning framework
• performance management framework for PBC
• December 06
• universal coverage in place
• PCTs will report to SHA in April 06 and Jan 07 on
  coverage

35

• Questions..?
• www.primarycarecontracting.nhs.uk

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CHOICE AND BOOKING

• Choice and Booking DES
• 2006/07

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NEW DES

• 1 Year DES, but will be reviewed
• Overall value 96p per patient
• 2 incentive components
• Component 1 - initial conversation about choice
  between GP and patient
• Component 2 - utilisation of Choose and Book
  system

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Component 1 - Choice

• 0.48 per patient
• Aspiration Part 1 - 0.24 upon receipt of
  written statement from practice
• Delivery Part 2 - 0.24 based on new patient
  survey
• 60 of survey cohort recall conversation about
  choice
• If practice does not achieve min 60, PCT can
  reclaim the Part 1 aspiration

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Choice

• Step 1 GP provides list of clinically
  appropriate providers for referral to first
  secondary care OP appointment
• Step 2 GP initiates Choice offer discussion
  with patient
• Step 3 Patient consults information (eg
  leaflets)

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Component 2 Choose and Book Utilisation

• 0.48 per patient
• Aspiration Part 1 - 0.24 written practice
  statement agreeing to use C B system
• Based on min 25 C B utilisation in June 2006
• Delivery Part 2 supra PCT calculation by CfH
• Measured 1 Sept 06 28 Feb 07
• Achievement thresholds 50 90
• Repayment of aspiration as component 1

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Choose and Book Utilisation

• Step 1 GP uses CB to generate an appointment
  request (UBRN) and a password for the patient
• Step 2 GP generates a referral letter (attached
  to appointment request or auto-generated via
  integrated system)
• So patient should leave practice with either an
  appointment or written info on choice and how to
  make their booking
• Must be done
• within 1 working day for urgent/cancer referrals
• 3 working days for routine referrals

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2006/07 DES Payments

• Cashflow aspiration in 2006/07 reward end
  2006/07 and
• start of 2007/08

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VALIDATION

• Component 1 gt60 of patients say yes to new
  surveys question on conversation about choice
  with GP full award
• Component 2 national systems report to PCTs on
  CB usage (converted UBRNs) awards on sliding
  scale 50 usage 60 award 90 usage full
  award

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Timescales for delivery

• Choice
• Will be measured through a new, national, patient
  experience survey, of patients referred for a
  consultant outpatient appointment
• Choose and Book
• Practice utilisation during June 2006 for
  aspiration payment
• Practice utilisation during the period 1
  September 2006 to 28 February 2007

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System Fall Down

• Patient Survey
• Q4 of 06/07
• If statistically valid sample cannot be achieved
  a default position will be established that will
  not disadvantage the practice
• CB Utilisation
• If by end 06/07 a practice cannot implement due
  to external circumstances they are guaranteed a
  pro-rata payment
• This payment to be determined by PCT

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Timescales for delivery

• Dont leave it until the last minute
• Early engagement across the health community,
  utilise the Cluster support team that is what
  they are there for
• To receive the maximum available incentive on
  Choose and Book utilisation work to a practical
  lead in time 2 to 3 months dont leave the
  climb too steep
• Recognise the importance of post go live support
  to GPs and practice staff

47

• Questions..?
• www.primarycarecontracting.nhs.uk

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• The New Access DES

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Access

• Current DES ceases March 2006
• Current 50 bonus QOF points cease March 2006
• New DES Total value 108m (funding from current
  DES 50 QOF pts)

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Access

• Four Components to the DES
• - Consult GP within 48hrs
• - Ability to book in advance (more than 48
  hours in advance)
• - Ease of telephone access to surgery
• - Ability to book with practitioner (GP) of
  preference
• Achievement demonstrated via practice plans, PCAS
  and new national patient satisfaction survey
• 2 parts to the payment

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Parts for Payment

• 2 parts to payment for access DES
• Part 1 demonstrate commitment to deliver the DES
  and engagement in PCAS (1/3)
• Part 2 on new survey results (2/3)
• Claw back mechanisms

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Part 1

• Part 1 Aspiration Payment (1/3)
• Paid at start of 06/07
• Practices to demonstrate commitment to deliver
  the DES (first 3 components) and engagement in
  PCAS
• Half awarded for submitting practice plan
• Half awarded when PCT receives written commitment
  to continue PCAS
• Total 0.69 per registered patient (4065 per
  average practice)

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Part 2

• Part 2 Measure of achievement against 4
  components of DES via survey (2/3)
• Weightings for the 4 components
• Paid at end of year (possibly start of 07/08)
• Minimum and maximum thresholds of satisfaction
  rating from survey
• Maximum value 1.37 per registered patient as at
  Jan 07 (8070 for average practice)

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2006/07 DES Payments

• Cashflow aspiration in 2006/07 reward in
  2007/08

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Weightings for the 4 components
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Minimum and maximum thresholds
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Claw back mechanism

• If a practices does not participate in PCAS
  half of aspiration is repayable by practice (34p)
• If a practice does not achieve minimum threshold
  in all 3 of first components of DES half of
  aspiration is repayable by practice (35p)

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New Patient Satisfaction Survey

• Still in development
• Focus on access and choice
• GPC and NHS Employers working with DH
• Operate 4th quarter 06/07
• New system will report results to PCTs
• PCTs make prompt payments to practices
• Where IT cannot support automated sampling
  alternative arrangements will be made
• Yes/No questionnaire
• System fall down position (sample size)

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Current wording

• When you last contacted the practice, were you
  able to consult with a GP within two working
  days?
• When you last contacted the practice to make an
  appointment for a problem which was not urgent,
  could you book ahead?
• Are you satisfied with the ability to get through
  to your practice on the telephone?
• When you last contacted the practice with a
  problem that was not urgent, were you able to
  make an appointment with a particular GP if you
  were prepared to wait?
• Do you recall a conversation with you GP about
  choice when you were referred for your first
  consultant outpatient appointment?

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PCAS

• PCAS for 06/07 will include a number of
  improvements
• Randomised survey date
• 3rd available appointment measure
• Further guidance awaited

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Next Steps

• Practice Plans for new DES no national
  templates
• Further guidance re new National Survey
• Payment for aspirations asap in new financial
  year
• PCTs need to financially plan for some (many)
  payments in 07/08

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• Questions..?
• www.primarycarecontracting.nhs.uk