Transcript Support for practices, PCTs and SHAs

Service Categorisation
• Essential
–
must do
Global Sum
• Additional
–
Preferential right (opt-outs available)
• Enhanced
–
–
–
Directed (DES)
National (NES)
Local (LES)
Global Sum
Carr-Hill Weighting List @ 01/04/04 x Carr-Hill x [£50.00]
London Adj.
List @ 01/04/04 x [£2.18]
Temp Patients Adj. 5 yr average
Global Sum
£
X
X
X
XX
Carr-Hill formula
• Weighted capitation methodology:
–
–
–
–
–
–
Age/sex
Nursing/residential homes
List turnover
Additional needs (deprivation)
Market forces (Staff costs )
Rurality
Calculation
• Two stages – by PCT then by practice
–
–
PCT normalising factor is average weight
PCT population normalised annually
• EXETER will perform calculation
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–
Based on practice registration data
Ensure practice information is timely/accurate
PCT normalising factor
Practice
A
B
PCT Total
List Size
5,700
6,050
11,750
Carr-Hill
weighting
1.45
1.02
1.23
Weighted
List Size
8,242
6,165
14,407
Carr-Hill weighting
Determination
• Global sum determined on 1st day of quarter
(eg 01 April 2004)
– Contract discussions based on indicative figures
• Indicative figures make assumptions
– Nursing home patients
– Temp residents
– List characteristics @ 01/04/03
Global Sum Equivalent (GSE)
• Baseline data – year to 30/06/03
– Take account of GP/staff vacancies
– Practice mergers/splits
• Final GSE calculated @ 01 April 2004
– Adjust for list size change
– Uplift to 2004/05 prices
Correction Factor (CF)
• Compare Final GSE to GSC:
Global Sum
£
X
Temp Patients Adj.
Historic Opt-outs Adj
Superannuation Adj.
(X)
(X)
(X)
Global Sum Comparator (GSC)
XX
• If Final GSE > GSC, the difference is the CF
MPIG (wrong!)
350
300
200
Correction Factor
150
Global Sum
100
50
0
01
/0
4/
04
01
/0
7/
04
01
/1
0/
04
01
/0
1/
05
£'000
250
450
400
350
300
250
200
150
100
50
0
01
/0
4/
04
01
/0
7/
04
01
/1
0/
04
01
/0
1/
05
£'000
MPIG (right!)
Correction Factor
Global Sum
Quality Framework
• Points make prizes - 1050 maximum
– 2004/05 £75/point (for average practice)
– 2005/06 £120/point (for average practice)
• Weighted by relative list size
– crude list size not Carr-Hill weighted
• Disease prevalence factor
– adjusts point value in each clinical domain
Quality Framework (cont.)
• Preparation payments (QPrep)
– 03/04 - £9,000 (for average practice)
– 04/05 - £3,250 (for average practice)
• Aspiration payments
– For 04/05, aspiration payments are 1/3 of total
– From 05/06, aspiration is 60% of prior year’s achievement
• Achievement payments
– balance of income on outcome
– 04/05 achievement paid by end April 05
Quality Framework (cont.)
• Risk managed by NHS Bank
– Funding to support approx. 74% of points in 04/05
– Risk shared by high-achieving PCTs, after NHS Bank support
except
• Local variations to QOF through PMS
– PCTs need to make local risk management arrangements
– ie. no NHS Bank support