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Health Strategy Management

Health Strategy Management. Contracting and Commissioning 5th February 2015 Pam Kaur Group Finance Manager University Hospitals Coventry & Warwickshire NHS Trust. Some things to consider…. Commissioners and Providers NHS structure and ongoing reforms Shaping healthcare services

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Health Strategy Management

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  1. Health Strategy Management Contracting and Commissioning 5th February 2015 Pam Kaur Group Finance Manager University Hospitals Coventry & Warwickshire NHS Trust

  2. Some things to consider…. • Commissioners and Providers • NHS structure and ongoing reforms • Shaping healthcare services • Contracting • Pricing e.g. Payment by Results • Quality and best practice incentives • Conundrum between costs and quality

  3. Commissioners and Providers • Commissioners ‘buy’ healthcare on behalf of patients such as :- • Primary Care – e.g. GP, Dental, Pharmacy services • Secondary and Specialist Care – typically hospital care • Community Care – e.g. Care Homes • Mental Health Providers can be any organisation that provides care to patients (see the interactive structure chart)

  4. Interactive NHS Structure • http://webarchive.nationalarchives.gov.uk/20130805112926/http://healthandcare.dh.gov.uk/system/

  5. NHS Structure TDA

  6. Another View…

  7. Key actors in the system – roles & responsibilities • NHS England • Executive Non Departmental Public Body which has a mandate from the DH to improve outcomes through the total £96bn commissioning budget (80% of total allocation); • Oversight and development of the commissioning system; and • Directly commission Specialised Services from providers.

  8. Key actors in the system – roles & responsibilities • Clinical Commissioning Groups • Commission general acute and community services from providers. • A clinically led commissioning construct - membership organisations made up of constituent GP practices;

  9. Regulation, Accountability and Funding

  10. Funding flow from NHSE / CCGs to Secondary Care Providers • Secondary care is commissioned to provide services; • The commissioning of these services is captured in a legally binding Contract that acts as the main lever for ensuring that Providers work in line with prescribed service standards; • All aspects of service delivery – clinical, financial and operational – are negotiated on an annual basis between Commissioners and Providers; • A large majority of funding is transacted through the Payment by Results tariff.

  11. Shaping Healthcare Services • Priorities for healthcare are shaped by things like :- • National Policies and Government reforms – attempting to address health inequalities • Quality of care - e.g. 18 week targets • NHS Frameworks – e.g. Renal Services • Public health priorities - Coronary Heart Disease, Cancer • Demographics and local health needs of patients • Research and best practice – e.g. Diabetes • Collaborative working between healthcare organisations (!!!) National Policy indicates a drive towards providing integrated health and social care packages

  12. The Commissioning Cycle

  13. Contracting and Pricing • Commissioners agree ‘volumes’ and ‘budgets’ for patient care activity with Providers as part of an annual planning process. The process uses historic trends or latest actual as a baseline adjusted for any agreed local or national service changes. Contracts for delivery of patient care are agreed by both parties – can be a lengthy process for agreeing new service developments.

  14. Payment by Results • Money follows the patient • Hospital Services are paid for under a ‘national tariff’ system • Prices and payments are based on the type of procedure or care received, and appointment type (HRG’s and points of delivery) • This is uplifted depending on the complexity of care or procedure and length of stay in hospital • Further incentives for meeting best practice and quality indicators (CQUIN and QIPP)

  15. Payment by results examples

  16. Payment by results examples

  17. Payment by results – useful links • Walkthrough National Tariff Structure – see link below • https://www.gov.uk/government/consultations/national-tariff-payment-system-201516-a-consultation-notice • Chapters / HRGs / Diagnoses and Procedure Coding • Basic Income Calculation • Complexities, penalties, incentives

  18. Useful links and references Strategic and Operational Planning Process 2014 to 2019 http://www.england.nhs.uk/ourwork/sop/ UK NHS National Tariffs Guidance and proposals for 2015-16 HFMA – Introduction to NHS Finance (History and reforms etc) http://www.hfma.org.uk/publications-and-guidance/publicationitem.htm?publicationid=62&catid=2 Five Year Forward View Published 2014 NHS Constitution

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