1. WP5 Outpatient and Home care WP Leader Prof. John Hutton Dept. Health Sciences and York Health Economics Consortium

2. Objectives  To identify and analyse the impact of financing systems on the quality of outpatient and home care  To assess the impact of the quality of outpatient and home care on the ability of other sectors of the health system to deliver on efficiency and equity objectives

3. General Approach  Clarify definitions of outpatient and home care  Review published evidence  Develop in-depth case study of UK  Compare UK with other European systems  Review portability of financing mechanisms to improve quality

4. Methods  Concept development and debate  Structured literature review  Selected expert interviews  Case study using published and unpublished material  International information exchange and discussion

5. Specific Tasks

6. 5.1 Definitions and Literature Review (1)  Agree definitions of outpatient care and home care e.g. does it include hospital outpatient care or just primary care?  Co-ordinate with WP4 and WP6  Align taxonomy of financing mechanisms and measures with WPs 1 and 2  Focus on feasible range of analyses

7. 5.1 Definitions and Literature Review(2)  Co-ordinate literature searching with WPs 1 and 2 to avoid duplication  Concentrate on quality/finance link in primary care  Identify “grey” literature  Draw on local knowledge of partners

8. 5.2 UK Case Study  England rather than UK  Use experience since 1983 of changes in funding mechanisms  Draw on current experience of Quality and Outcomes Framework (QOF) for GPs  Focus on impact of primary care on NHS performance

9. 5.2 Key UK Policy Changes  General management in NHS (1983)  Purchaser/provider split  GP fund-holding  National Institute for Health and Clinical Excellence (NICE)  Payment by Results (PbR)  New GP contract  GP commissioning

10. 5.2 UK Quality and Finance Initiatives  Quality and Outcomes Framework (QOF) for GPs  Quality accounts  Patient Reported Outcome Measures (PROMs)  CQUIN incentive payments

11. 5.2 General Financial and Quality Policies  Efficiency savings  Activity and service delivery targets  “Best practice” tariffs  Quality, Innovation, Productivity and Prevention (QIPP) agenda  Patient choice  Shift care from hospitals to the community

12. 5.2 New White Paper  Problem for InterQuality project  Changes already happening  New system fully in place by 2014?  No time for assessment of impact  May only show how relatively effective the old structure was?  Lay foundations for proper evaluation?

13. 5.3 International Comparison  Comparison of UK with Germany, Denmark and Poland  Use definitions and measures developed in WPs 1 and 2  Study political context of health policies  Examine transferability of differing funding mechanisms

14. 5.4 Feasibility of Mixed Financing Systems  Identify appropriate financing mechanisms to enhance quality in each area of outpatient care  Is there a generalisable model?  Examine home care and self-care expectations  Importance of social care/primary care/secondary care interfaces

15. Timetable (1)  Begin when conclusions of WPs 1 and 2 are emerging  Work in parallel with WPs 3, 4 and 6  Deliver in time for major communication activities

16. Timetable (2)  Task 5.1 begins Project month 13 and finishes in month 20  Task 5.2 months 21-25  Task 5.3 months 26-29  Task 5.4 months 28-31

17. Deliverables Series of reports on each main task:  Literature review  UK case study  International comparisons  Mixed funding systems

18. Partner Input  Clarification of measures and definitions (MUW and UI)  Co-ordination of scope (UniCT)  International comparisons (MHH, SPH, SDU)  Review and feedback (CPME, EPF)