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

Setting Practice Based Budgets

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

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

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

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

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

Budget Statement

Patient Level Data …

Detailed Analysis

Detailed Analysis – Zero LOS

High Users of Secondary Care

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

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

Thank You Beverly Stretton-Brown Devolved Budgets Project Manager