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GP Payments Calculation Service. Opening address Kemi Adenubi – Programme Director (GPIT). Introducing the Organisation. Introducing the Presenting Team. More Information…. For the Question & Answer session later submit a Bidder Question Form – one question per form

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GP Payments Calculation Service

Opening address

Kemi Adenubi – Programme Director (GPIT)


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Introducing the Organisation


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Introducing the Presenting Team


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More Information…

  • For the Question & Answer session later submit a Bidder Question Form – one question per form

  • Book a one to one supplier meeting at the Registration Desk

  • After the event, if you wish to raise any PQQ clarification queries, please use the project email account only: [email protected]


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GP Payments Calculation Service

Policy Overview

Richard Armstrong - Deputy Director Primary Medical Care and SRO

2nd November 2010


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Background – the current situation

  • Primary Medical Care

    • Primary Care consists of medical, dentistry and eye-care services

    • Most patient contact in the NHS is through Primary Medical Care via their General Practitioner

    • GPs are private contractors

    • DH negotiates main ‘GMS’ contract with General Practitioners Committee (GPC) of the BMA and has the responsibility to improve the commissioning and quality of, and access to, primary care

    • PCTs currently hold contracts with practices

  • GP remuneration

    • Approx £8bn paid to approx 8,300 GP practices

    • 15% (over £1.12bn) of which relate to quality outcomes for patients under the Quality Outcomes Framework


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Background – the current situation (2)

  • Quality Outcomes Framework

    • Incentive and reward scheme for GPs for the quality of care they provide to their patients

    • Most practices (99%) participate and achieve highly

    • GPs like the QOF

    • DH seeking to reduce process based indicators and move focus to outcome based indicators

  • QMAS

    • Payments for the QOF are currently calculated by QMAS

    • GPs like QMAS (and trust information supplied via QMAS)

    • QMAS only calculates payments for the QOF


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Government Policy – some key points

  • White Paper and Commissioning consultation

    • Govt White Paper ‘Equity and Excellence: Liberating the NHS’ published July 2010

    • Government consultation document: ’Liberating the NHS: Commissioning for Patients’ published July 2010

    • Contain four key themes

  • Putting patients first

    • Shared decision making – “No decision about me, without me”

    • NHS Information revolution

  • Improving quality and healthcare outcomes

    • Quality Standards, developed by NICE, will inform the commissioning of all NHS care and payment systems

    • Payment should reflect outcomes not activity

    • Money follows the patient and reflects quality

2nd November 2010


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Government Policy – some key points (2)

  • Increase autonomy and accountability

    • Devolve power and responsibility for commissioning services to GPs and groups of GPs working in consortia

    • Establish NHS Commissioning Board to lead on achieving health outcomes and quality improvement

  • Cutting bureaucracy and improve efficiency

    • Release £20bn of efficiency savings

    • reduce management costs by more than 45% over next four years

2nd November 2010


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Implications of Government Policy

  • Organisation changes

    • Reduced role for DH and creation of NHS Commissioning Board to:

      • provide national leadership for quality improvement

      • hold Consortia to account for outcomes and financial performance

      • Allocate and account for NHS resources

      • Hold contracts with individual GP Practices for Primary Medical Services

    • Abolish PCTs (and SHAs) and create GP Consortia

      • GP Consortia hold commissioning budgets to commission the majority of NHS Services on behalf of patients

      • Shift decision making as close as possible to patients

      • Every GP practice will be a member of a consortium


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Implications of Government Policy (2)

Accountability and Rewards

NHSCB accountable to Secretary of State..

Managing overall commissioning revenue limit

Delivering improvements against health outcomes

NHSCB in turn holds GP Consortia to account

NHS Outcomes Framework

National set of outcome goals determined by SoS

NHSCB held to account through achievement against Outcome Framework

11


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Implications of Government Policy (3)

Commissioning Outcomes Framework

Translated from NHS Outcomes Framework

A proportion of GP practice income is to be linked to the overall outcomes that practices achieve collaboratively through their role in commissioning consortium

Reform of QOF

to focus more on health outcomes

so that it better reflects individual practices’ contribution to patient health care

12


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Implications of Government Policy (4)

When will it happen

2012 – majority of reform come into effect

NHS Outcomes Framework fully implemented

NHS Commissioning Board fully established

Formal establishment of GP Consortia

Commissioning Board makes allocations to Consortia for 13/14 year

2013

PCTs and SHAs abolished

Consortium in place12/13 year and fully in operational by 2013/14

13


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Meeting the Policy Need

A new system is required to meet this policy need:

  • Continue to calculate the QOF with a greater focus on health outcomes achieved (including for individual patients or groups of patients)

  • Calculate performance of GP Consortia against the Commissioning Outcomes Framework

    • Is likely to require a wider set of data than at present

    • Ability to recognise GP practice contribution to the COF

    • Rewards made to GP Consortia not individual GP practices

  • Commissioning Outcome Framework will develop over time as will changes to QOF – therefore greater need for flexibility in introduction of new/changed indicators

  • Support more complex commissioning arrangements – for example there is no longer a straightforward relationship between one commissioning organisation and the GP practice

  • Support payments forany other commissioned service where the data is available in GP Clinical Systems


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What’s important to us

  • Generic calculating and reporting tool that is not payment specific

  • Configurable and flexible to be able to meet future needs

  • Changes to be made quickly, easily and cheaply

  • Calculate accurately

  • Service operates as we expect it to

  • Provides value for money with no surprises

  • Implemented in readiness for the 13/14 year but preferably for the 12/13 year


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More Information…

  • For the Question & Answer session later submit a Bidder Question Form – one question per form

  • Book a one to one supplier meeting at the Registration Desk

  • After the event, if you wish to raise any PQQ clarification queries, please use the project email account only: [email protected]


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GP Payments Calculation Service

GPPCS Service Requirements

David Arthur – DH Business Assurance

Martin Warden – QMAS and GPPCS Programme Manager

2nd November 2010


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Project Background

  • History of Project

    • SRO vision of a flexible calculating and reporting tool

    • Project initiated in 2008

    • High Level Requirements developed with input from end-users and key stakeholders

    • NHS CFH formally managed project from 2009

    • Detailed requirements gathering activities from summer 2009 to summer 2010

    • Outline Business Case developed and ready for Ministerial approval in March 2010

    • Election May 2010

    • Government proposals published

    • SoS approval

    • Cabinet Office and HMT approval

    • Revision of requirements to reflect Government’s proposals

  • Key stakeholders have been involved throughout

    • NHS CFH

    • End Users of system – GP practice managers, PCT commissioners, GPs

    • NHS Information Centre, NHS E, NICE and Project Sponsor

  • External Assurance has been provided by a Project Assurance Group

    • Representation from General Practitioners Committee

    • Royal College of General Practitioners

    • Joint GP IT Committee


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What are we buying?

  • We are buying a managed service consisting of:

  • A calculating and reporting system

    • a modular and configurable solution that calculates payments accurately and is quickly and cheaply adapted to meet changing business needs

  • Development capability

    • to extend the system quickly to account for changes outside of current assumptions and in doing so ensure that the new capability is re-usable


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What are we buying? (2)

  • Implementation and ongoing service delivery

    • to ensure that the service is implemented seamlessly into the business, including data transfer, and with consideration for the new business environment

    • to make changes to the following aspects of the system as instructed by the Authority: organisation structure, commissioning arrangements and payments and ensure that they are tested appropriately

  • Support and Training

    • helpdesk staffed by knowledgeable people who can swiftly resolve issues and provide informed help and guidance to users

    • provide initial training, primarily electronically, that is appropriate and cost effective so that users can use the system competently and with confidence

    • ongoing training that is kept up to date and prepares new users to the same standard as during initial implementation


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GP Practices

NHS Commissioning Board

GP Consortia

GP Systems

Agree participation

Setup Performance Schemes with both GP Practices and GP Consortia

Setup and Manage Performance Schemes with GP Practices

Other information sources

Payment notifications

Payments

WEB INTERFACE

Service Provider

Set-up Services/Schemes

Data extract or provision

Data query and extract

GPPCS System

Organisation data

Organisation data

Scheme participation data

NHS Payments Agencies

Menu

Record

participation in Services

NHS Information Centre

Analyse and format data

  • Calculate

  • Achievement and Payments

Approve/Adjust

Participation and Achievement

  • Report

  • Achievement and Payments

GPES

EXETER ‘BOXES’

Make Payment

INTERFACE

Payment notifications

Aggregated achievement data

INTERFACE

Organisation Data Service

Data Store

System Ref. Table

Proposed Future State – GPPCS system shown in blue


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1a. NHSCB setup Performance Schemes for GP Consortia and GP practices

GP Practices

NHS Commissioning Board

GP Consortia

GP Systems

1b. GP Consortia set-up Performance Schemes with GP practices

Agree participation

Setup Performance Schemes with both GP Practices and GP Consortia

Setup and Manage Performance Schemes with GP Practices

2a. Participation in Schemes is recorded through the menu on the web interface

3a. GPs record clinical care on their systems and non-clinical data through the web interface

1c. Service Provider sets up Schemes in system.

Organisation data is passed to GPPCS

3b. GP Consortia and/or NHSCB record certain outcomes through the web interface

Other information sources

Payments

Payment notifications

WEB INTERFACE

Service Provider

Set-up Services/Schemes

2b. GPPCS informs the NHS IC of the Performance Schemes that GP Consortia and GP practices participating in.

Data extract or provision

Data query and extract

GPPCS System

Organisation data

Organisation data

Scheme participation data

NHS Payments Agencies

Menu

Record

participation in Services

NHS Information Centre

Analyse and format data

  • Calculate

  • Achievement and Payments

  • Approve/Adjust

  • Participation and Achievement

  • Report

  • Achievement

GPES

EXETER ‘BOXES’

4. GPES extracts achievement data from GP systems and other sources, and aggregates it before sending to the calculating system.

Make Payment

5. The system calculates achievement/payments that are approved/adjusted through the web interface where necessary

INTERFACE

7. Exeter makes payments and sends payment notifications.

Payment notifications

Aggregated achievement data

INTERFACE

6. Reports are produced when required and payment notifications/adjustments are sent to the relevant Exeter system

Organisation Data Service

Data Store

System Ref. Table

Proposed Future State – GPPCS system shown in blue


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GPPCS – Characteristics

Characteristics

The aim is to bring to life GPPCS from a technical perspective in terms of its size and scope

The aim is also to demonstrate that GPPCS is not necessarily a hugely complex technical challenge though challenges clearly do exist.

The GPPCS Application

It’s a Calculation and Reporting application –

Other systems capture the inputs and perform payment transactions

Does not necessarily need a healthcare technology solution

Calculating and reporting performance against indicators is not a new concept - existing QMAS concepts, knowledge and experience will be retained and built on

There is no patient identifiable data - complexities around managing patient data do not arise here

23

12 March, 2014


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GPPCS – Characteristics (2)

The Data Store

GPPCS data held centrally – one data centre, no local data stores to manage

Interfaces to External Systems

Message based interface to NHAIS for sending payment notifications, receiving GP Practice details & payment reference data

Data interface from GP Clinical Systems – either the proposed message based interface from the GP Extraction Service (GPES) or direct from GP clinical systems

One way upload of organisational data from the proposed Organisational Data Service

The messaging interfaces that feed data to GPPCS will be weekly or monthly and low volume

24

12 March, 2014


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GPPCS – Characteristics (3)

Users and Volumes

Stable user numbers. Approx 40,000 registered users of system comprising of staff from 8800 GP Practices, 500+ GP Consortia, NHS Commissioning Board and DH.

Core hours are 8:00 AM to 18:00 PM Mon-Fri

Primary activity of the user base is checking their progress against QOF/COF outcomes on monthly basis and the outcome of the financial year end calculation

Average number of users on QMAS is 80-100 measured over an hour

Peak 2500 users per hour during April, May, June with users checking end of year calculations

25

12 March, 2014


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GPPCS – Technical Challenges

The payment calculation needs to be accurate

The calculations are complex but well understood

Technical solution needs to be flexible - examples

Can introduce a new set of QOF indicators without software changes

Can change Read Codes configuration without software changes

Add a new calculation that uses existing inputs and outputs without needing a full regression test

QMAS and GPPCS

Test phase to check GPPCS against QMAS end of year calculation is key

QMAS transition – data migration/parallel running

26

12 March, 2014


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GPPCS Service – Implementation Milestones

Business process is based on end of year financial year

Live Service Implementation

Live service could start as late as end Sept 2012 for fy 12/13 for QOF and COF

For GPPCS service implemented after end Sept 2012 then the live service will start for fy13/14

27

12 March, 2014


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More Information…

  • For the Question & Answer session later submit a Bidder Question Form – one question per form

  • Book a one to one supplier meeting at the Registration Desk

  • After the event, if you wish to raise any PQQ clarification queries, please use the project email account only: [email protected]


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GP Payments Calculation Service

End User View

Dr Ian Trimble

GP and Professional Executive Committee Chair, NHS Nottingham City PCT

2nd November 2010


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User Perspective

Quality matters

Brief History of Quality Schemes

Practical User issues

30


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Quality matters

  • Drivers for systematic quality schemes:

    • Evolving research / evidence base

    • Wide observed inter-practice variation

    • Implementation quantifiable (for some conditions)

  • Emerging evidence re QOF:

    • Has had some impact, but ?sustained

    • May not address holistic care / continuity of care

    • Need to avoid gaming / perverse incentives

  • Some lessons learned:

    • Need to align with NICE guidance

    • Systems need to be intuitive / easy to use

    • More flexibility required (year-on-year, and locally)

  • Future policy direction

    • Quality / outcome measures imperative

    • Commissioning quality framework

    • More local schemes likely


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Brief History

  • 1990 Contract

    • Cervical cytology

    • Immunisation

  • 2000 ‘Quality in Primary Care’ schemes

    • Ad hoc implementation

    • Wide variation

  • 2004 ‘New GMS’ – QOF / QMAS

    • Successful implementation

    • Inflexible: monolithic system, no local flexibility

  • 2010 GPPCS


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2002 version

  • Simple

  • Based on NSFs

  • Utilised MIQUEST

  • Labour intensive

  • Informed QOF


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2002 version

Small number of targets


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2002 version

Variable weights


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2002 version

Flexible targets


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2002 version

Total score should improve over time


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QOF / QMAS

  • Much more detailed

  • Very structured

  • Defined ‘business rules’

  • Automated data collection

  • User feedback mid-year

  • Adjustable end-year results

  • www.qmasweb.scot.nhs.uk/training


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User expectations – GP practice

  • Intuitive

    • Wide variation in practice staff capabilities

    • Interface must be intuitive and easy to use: log-in, inputs

    • Improved benchmarking, reporting tools

  • Good support

    • Training, guidance, and Helpdesk readily available

  • Transparent

    • System should collect data with minimal user input

    • Quick and accurate

  • Reliable

    • Outputs should be directly comparable with practice IT outputs

    • System should be on-line at all times

  • Available

    • Available almost all year, with more frequent updates if possible

    • System should provide feedback early in year to allow remedial action


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User expectations – PCT contract manager

  • Intuitive

    • Wide range of skills at PCO level also

  • Well supported

    • Training materials up to date and readily available to PCT staff and practices

  • Reliable

    • Quick and accurate, with smooth transition from existing QMAS

  • Adjustable

    • Allow for manual adjustment of practice input values following audit / challenge

  • Flexible

    • Allow for local QOF / Enhanced Service calculation

  • Accessible

    • Allow for local reporting of performance

    • Better comparative reports – ability to download all PCT data


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More Information…

  • For the Question & Answer session later submit a Bidder Question Form – one question per form

  • Book a one to one supplier meeting at the Registration Desk

  • After the event, if you wish to raise any PQQ clarification queries, please use the project email account only: [email protected]


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GP Payments Calculation Service

Procurement:

“How will we deliver this deal...?”

Matt James – Director of Procurement

Michael Entwistle – Commercial Manager & Procurement Lead


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How Will We Deliver this Deal…?

  • Commercial Principles

  • Procurement Timetable

  • PQQ Guidance


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OGC

Commercial Principles - Contract


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Commercial Principles - Flexibility

?


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Commercial Principles - Financial


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Procurement Process & Proposed Timeline

47


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PQQ Guidance


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More Information…

  • For the Question & Answer session later submit a Bidder Question Form – one question per form

  • Book a one to one supplier meeting at the Registration Desk

  • After the event, if you wish to raise any PQQ clarification queries, please use the project email account only: [email protected]


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Q & A

?


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