Payment by Results Dr Alex Horne Medical Director NELFT.
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Transcript of Payment by Results Dr Alex Horne Medical Director NELFT.
![Page 1: Payment by Results Dr Alex Horne Medical Director NELFT.](https://reader036.fdocuments.in/reader036/viewer/2022062312/551ac33b550346b2288b54cf/html5/thumbnails/1.jpg)
Payment by Results
Dr Alex HorneMedical Director NELFT
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The White Paper
•Mandated PbR for Mental Health
•Go live April 2012
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PbR Mechanism
•Cluster all patients (eventually) using the outcome measure HONOS PbR (clustering tool)
•Agree cost per intervention within each cluster at a local level
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Promises
•To offer transparency on transactions
•Patient level detail
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Contracts
•From PCT block contract
•Interim “cluster”/mental health commissioner and MOU
•To CCG leads
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Service Delivery
•NSF 2000-10 continued to drive the move from “asylums”
•Estranged GP’s
•Led to a “behind closed doors” perception for major stakeholders
•MHS operated a kind of Wonderland
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Wonderland
•Through NSF years
•Contained
•Managed symptoms and behaviour
•Maintained
•Post NSF must also achieve Enablement
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Strategic Challenges
•Link PbR to
•Choice + Personalisation
•Reablement
•Quality Agenda
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Challenges
•Data Quality
•Interpretation of Data
•Robust mechanism for costing
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Progress in London•The London Currencies
Development Board (LCDB) chaired by Wendy Wallace
•London Health Programmes (LHP)
o Commissioner Steering Group chaired by Stuart Saw
o Programme approach
o Engaged Stakeholders
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Risks
•An unhelpful destabilisation of secondary mental health care
•Vulnerable patients are not “contained” and appropriately managed
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Managing risk, complexity and integration
•1990s•Individual teams•Limited facilities for inter agency and multi-profession working•Individual care plans – one size fits all
•2000s•Single case records•Increased co-ordination and communications•Niche needs (AOT, EIT)•Individual care plans (inter-agency)•Alternatives to inpatient care (Crisis Houses, Recovery Centres, CRT)
•2010s•Patient centred•Outcomes focused•Prevention and education•Personalisation•Increased Information Technology•Integrated Care Pathways
Institutional Care
Community Teams
Multi-disciplined inter-agency teams
Care Pathways System Management