PCTs working with foundation Trusts SUS Update Stockport 19th February 2007

PbR in 07/08

Transition to an on-line service SUS PbR was designed as an on-line service Initial user assurance has proved the basic extracts November 06 upgrade gave users extended ability to choose from a wide range of fields for inclusion in extracts Early adopters work just commencing Roll-out to all will take place in 07/08, but will be subject to delivery of additional capacity planned for Q1 07/08

Issues Need to improve access to extracts Need for a wider range of extracts –All attributes –Episode view –Prime Recipient –Change view –Extended open spell These added at 2006-B but not QA’d

New & Revised Extracts Commissioner extracts for responsible and resident population Episode v. Episode in spell view Derivations for extended open spells (will not be costed)

Provider Sender Commissioner PCT of residence Recipient Episode Standard Spell Non-dominant Commissioner Extended Extract Flex Freeze Monthly Current Change New & Revised Extracts

Constraints Very large number of extracts now available Need to prioritise QA process

PbR Reconciliation Processes

Background Moves to make SUS “authoritative” Need to improve payment processes Increasing scope of PbR (08/09 onward)

Reconciliation Process Local System Managed Service Extracts 2006-B On-line extracts Provider Managed Service Extracts 2006-B On-line extracts Commissioner SEM

Reconciliation techniques Best at record level Look first at subset Links by SPELL_ID and GENERATED_RECORD_ID within SUS Use CDS_UNIQUE_IDENTIFIER where possible to compare with local system

Points to note Duplicates because of primary recipient change are evident by inconsistent PbR LOS Note difference between SEM and PbR: –SEM – all episodes within dates –PbR – all episodes in Episodes with Discharge date falling in period

Front end tool

Supporting data on PbR

18 week waits Extract from brief to BT

What does the business need? Ability to identify risks to 18 weeks Retrospective - Cause of 18 week problems –Pinch points / capacity –Process problems Prospective –Warning of problems in the pipeline –Ability to identify actions to avoid breaches –…PTL = Priority Treatment List Ability to support Commissioners in delivering 18 weeks

Critical functionality - Linkage Ability to identify patient pathway S6 maintains a pathway identifier –Fundamental to SUS not just 18ww – e.g. future PbR Need to deal with transitional period – additional linkage will be required IG implications

Critical functionality - Flexibility True BI reporting functionality Flexible, easily used by non- specialists Able to access appropriate comparator for context Drill down Rapid response

(Draft) Functional Decomposition

SUS Practice Based Commissioning (PBC) Update

Objectives To deploy a national, web-based, system for the provision of GP comparator and indicator information based on existing PbR data Accessible down to GP practice Providing comparators of commissioning activity, referral patterns and outcomes Initially data refreshed quarterly

Timescales Release 1 scheduled for delivery in two drops First, and main, release will be ready by end of March and available to the Service on Monday 2 April ‘Top-up’ release will be made at the end of April Functionality limited to what’s achievable in these timescales, but additional requirements will be captured for later use

Method of Delivery Web-based access Summary level information Intuitive ‘dash board’ graphical style presentation Built-in help and supporting information First release accessed through separate web portal Initially 18 comparators provided

Functionality - Outpatients 1.OP first attendances for source of referral = GP per 1000 population for the six specialities identified for care outside hospital (ENT, trauma and orthopaedics, dermatology, urology, gynaecology and general surgery) 2.Cost for OP first attendances for source of referral = GP per 1000 population for the six specialities identified for care outside hospital (ENT, trauma and orthopaedics, dermatology, urology, gynaecology and general surgery) 3.Total outpatient attendances per 1000 population 4.Cost per 1000 population for Outpatients (at PBR tariff)

Functionality – Non Elective Admissions 5.Non-Elective admissions for 19 ambulatory care sensitive 6.Cost for Non-Elective admissions for 19 ambulatory care sensitive 7.Cost per 1000 population for Non-Elective admission (at PBR tariff) 8.Non-Elective Admissions per 1000 population 9.Four QOF area admissions per 1000 population (CHD, Asthma, COPD, diabetes), 3 of which are covered in 5 above. 10.Admissions for four QOF area per 1000 population (CHD, Asthma, COPD, diabetes)

Functionality – Elective Admissions 11.Elective IP Admissions per 1000 population 12.Cost for Elective IP Admissions per 1000 population 13.Day case Admissions per 1000 population 14.Cost for day case Admissions per 1000 population 15.Total elective admissions per 1000 population 16.Cost per 1000 population for Elective admission (at PBR tariff) 17.Admissions for five procedures with evidence of overuse / 1000 population 18.Costs for five procedures with evidence of overuse / 1000 population

Testing and User Assurance Development done through iterative prototyping and review Key user experts and reviewers have been identified Workshops planned for end of Feb for initial view and assessment Testers will be able to access online remotely

Current Status Project is on track Good progress being made List of Release 1 comparators agreed (as shown on the functionality slides) Storyboard created First version shortly ready for review