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? 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

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