A promising start More to do Where do we go from here? Chris Newton Payment by Results A promising start More to do Where do we go from here? Chris Newton

Remaining issues for our service Consistent and accurate data collection Renal Transplantation: possibly already picked up by existing PbR AKI: also being considered by Greater Manchester critical care network. More discussions on coding required RRT in the Paediatric population: a separate work stream to run alongside adult work

Remaining issues for our service Year before dialysis Supportive and Palliative kidney care Proposal Need to define currencies and costing methodologies Similar approach to RRT using a number of committed centres with expertise Your input, help and suggestions required

Opportunities for improvement? Darzi Next Steps Review – Systems and Incentives Pricing Workstream ‘Systems and Incentives’ is one of the workstreams in the Darzi Review: the DH PbR team leads on “pricing” Nee HaOW I’m afraid that’s the limit of my Mandarin Two presentations. 4 4

Key questions Building on ‘Options for the Future of PbR’, how should PbR develop in order to support desired outcomes and models of care? What would more effective payment mechanisms look like?

Issues for renal medicine What are the perverse incentives preventing delivery of high quality of care pathways across primary, secondary and tertiary care as envisaged by Darzi What would you do to fix it? 6 6

Incentives Should pricing be based on therapy costs for individual treatments or a ‘patient pathway’? How would you build in incentives to ensure that patients receive the most appropriate high quality therapy based on informed choice?