funding streams n.
Skip this Video
Download Presentation
Funding streams

Loading in 2 Seconds...

play fullscreen
1 / 34

Funding streams - PowerPoint PPT Presentation

  • Uploaded on

Funding streams. Wellard's Academy June 2007. Objectives, challenges and hurdles. Objectives Understand primary care funding streams Improve uptake of company products Challenges Get products on to trust formularies Achieve volume potential Hurdles Drug cost implications

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about 'Funding streams' - tejano

Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
funding streams

Funding streams

Wellard's Academy

June 2007

objectives challenges and hurdles
Objectives, challenges and hurdles


  • Understand primary care funding streams
  • Improve uptake of company products


  • Get products on to trust formularies
  • Achieve volume potential


  • Drug cost implications
  • Changing customer approaches
how money flows through the system
How money flows through the system

Taxation (82 per cent)

Patient charges (2 per cent)

National Insurance (13 per cent)

Department of Health

Primary care trusts

Community services

Acute trusts



More later!

service level agreements

The provider agrees to deliver a given volume and quality of efficient, effective health services to the purchaser for three years

Service level agreements

An NHS trust


local delivery plans
Local delivery plans
  • Three-year plans
  • PCTs, NHS trusts, SHAs
  • Services needed
  • Milestones

SHAs collect PCT LDPs to make an area plan

primary care investment plan pcip
Primary care investment plan (PCIP)
  • Services
  • Staff
  • Premises
  • IM&T
pct budgets
PCT budgets
  • Full legal responsibility for finance
  • Single unified budget from DH
  • Proportion of health budget to PCTs increasing
gp contracts


Personal medical services


General medical services

GP contracts
personal medical services
Personal medical services

Four out of ten GPs prefer PMS

  • Offers opportunities for local modernisation
  • Tailored local targets
  • Salaried GP on short contracts
  • No out-of-hours
general medical services

GMS aims

  • Widen range of services
  • Meet local needs
  • Improve quality
  • Fairer funding
  • New roles for health professionals
  • Make primary care an attractive career for doctors
  • Major overhaul of GP surgeries
General medical services

GMS applies to 20,800 GPs

Funding streams:

  • Global sum
  • Quality payments
  • Seniority payments
  • Enhanced services
global sum
Global sum
  • Global sum decreases as practices get more income from quality-based elements
  • Practices must deliver service levels: essential; additional; enhanced
gms service levels
GMS service levels

Additional services

Offered by most practices

  • Eg, contraceptive services

Essential services

Provided by every practice

  • Eg, general management of long-term conditions

Enhanced services

Available at some practices

  • Eg, flu and childhood immunisations
gms in the future
GMS in the future
  • Contract negotiations continue
  • Successful practices to provide extended hours
  • Review MPIG
  • Money to follow patients if they switch practices
quality payments
Quality payments

Organisational181 points

Clinical 655 points

Quality and out comes framework Total of 1,000 points

Patient experience108 points

Plus 20 pointsHolistic care

1 point = average £124.60 in 2005/06

Additional services36 points

payment by results
Payment by results

Encourages acute trusts to manage costs efficiently

Fixed price tariff for all treatments across whole NHS

Encourages PCTs to treat patients in the community

payment by results1
Payment by results
  • Cost and volume agreements and healthcare resource groups (HRG) used to adjust funding
  • Trusts can reinvest surpluses as they see fit
payment by results2
Payment by results

Will PBR extend beyond acute hospital care?

Do information systems to support extension?

Is a tariff based on average NHS cost appropriate?

Mixed public-private provider configuration?

Care packages?

practice based commissioning1

PCTs decide how much of the savings go back to the practice

Practice based commissioning

PCT professional executive committees make these decisions

pbc progress
PBC progress
  • Fears that PBC would lead to cherry picking of easy cases seem to be unfounded
  • Uptake at 96 per cent
  • Some confusion in practices
more information
More information
  • PBR and PBC are complex topics. offers courses and presentations with more detail, and a set of PBC case studies based on interviews with practices around the country.
nhs trusts
NHS trusts

Practice-based commissioners

Primary care trusts

Education and training

Acute trusts get their money from…

NHS sanctioned R&D

Income generating schemes

pricing the service
Pricing the service
  • Trusts price their services according to the following criteria:
    • for NHS service agreements, prices must equal costs
    • no cross-subsidisation between services
    • trusts to achieve 1% efficiency savings year on year
prescribing budget
Prescribing budget

Hospital medicines spend = 20% of NHS total

Drug expenditure = 3-4% of hospital budget

Drugs budget decentralised to clinical directorates:

Budget under severe pressure because:

  • difficult to control
  • grows rapidly as new and more effective products become available
area prescribing committees


  • Prescribing advisers
  • Hospital consultants
  • GP prescribing leads
  • Hospital chief pharmacists
Area prescribing committees
  • Produce primary/secondary care treatment guidelines
    • Common policies for continuing in the community regimes started in hospital
    • Decide which drugs to be monitored by hospital staff
drug and therapeutics committee
Drug and therapeutics committee


  • consultants in major specialties
  • chief pharmacist
  • formulary pharmacist
  • local pharmaceutical advisers

Approves major changes to formulary

Enforces compliance with formulary

when drugs get more money
When drugs get more money
  • Recommended by NSF
  • Recommended by NICE
  • Save money on equipment
    • Eg, photodynamic therapy for age central blindness. NICE guidelines on it also DH issued instructions – PCTs should have made provision and funded separately
formulary and fund flow directorate example
Formulary and fund flow: directorate example

Consultant makes application to DTC

DTC inspects application form:

  • Why it's better
  • What it's replacing
  • Cost
  • Patient numbers per month
  • Clinical evidence
  • Where role of treatment
  • First line/last line, etc

Turned down because evidence lacking

Recommend to use if finance cleared

formulary and fund flow directorate example1
Formulary and fund flow: directorate example

Recommend to use if finance cleared

Band 1: £5,000 p.a. Directorate funds

Three funding bands

Band 2: £5,000-£10,000 p.a. Need to secure funds

Band 3: More than £10,000 p.a. Need to secure funds

  • Important for the NHS — important for you
  • Understanding commissioning, contracting, purchasing, procurement and financial flows will allow you to work out how to best obtain the funding required for your new medicines
  • Where do existing medicines fit in?
  • New customers?
  • And finally… note that PBR, HRGs and tariffs are still a bit mysterious even to the local NHS