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  1. Practice Based Commissioning East Devon PCT – How to Develop an Indicative Budget Beverly Stretton-Brown Devolved Budgets Project Manager 9 December 2004

  2. Setting Practice Based Budgets

  3. Budget Setting – where did we start? • Established Rules of Engagement for 2004/05 • Preparation Year • Consultation • Referral Information to Practices • Validation Programme & Workshops • Historical Budgets – moving to Fair Equity Model • Budgets at Practice Level

  4. Budget Setting – where did we start? • Quickly made friends with Information Dept • Gathered Historical Activity 2 Calendar Years In-Patients 3 Financial Years Out-Patients • Converted to 2004/05 Spells & Cost • Budgets set on Highest Cost Year for each practice • Matched to PCT Affordability – No Uplift

  5. What is included in the budget for 2004/05? Day Case Elective Activity Non-Elective Activity Inpatient Elective Activity Out Patient Activity Exclusions – Intensive Care High Cost Procedures A&E, etc Daycase Activity in Local Community Hospitals Charged at 80% of National Tariff Activity in Secondary Care Charged at National Tariff (RDE 92%)

  6. How does it work? • Optional Sign-up • Management Resource to Monitor Budgets, Manage and Plan • Monthly Budget Statements & Patient Level Data • More Detailed Analysis

  7. How does it work? Practice Validation • Paying for “what we get” • Influence Commissioning Quality Standards • Identify Problem/Opportunity Areas • Clinical Review of Activity/Referrals • Consider using/developing alternative Local Service Developments • Purchase most appropriate care to patients within Budget parameters

  8. Budget Statement

  9. Patient Level Data …

  10. Detailed Analysis

  11. Detailed Analysis – Zero LOS

  12. High Users of Secondary Care

  13. Some of the Issues • Managing total budget can be over-whelming & Time consuming • Anticipated incentive payment may not materialise in first year • Service Developments frustratingly slow • Acute Provider slow to respond to validation queries • Monthly Outpatient data not available

  14. What Now? • Review of 2004/05 scheme • Develop Framework for 2005/06 - Incentives • Understand DH Guidance and changing PbR Environment • Understand Impact of new National Tariff • Establish Budgets for 2005/06 – Capitation Based? • GP Sharing and Learning workshops • Validation Workshops/Training in Excel

  15. Thank You Beverly Stretton-Brown Devolved Budgets Project Manager 01392 207492 beverly.stretton-brown@eastdevon-pct.nhs.uk