enhanced services- programme budgeting and marginal analysis
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Enhanced Services- Programme Budgeting and Marginal Analysis. Health Economics Team. Contents. Introduction Literature Review PBMA Process Feedback Conclusion. Introduction. NHS Ayrshire & Arran provide a number of Enhanced Services to its patients - PowerPoint PPT PresentationTRANSCRIPT
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Enhanced Services-Programme Budgeting and
Marginal Analysis
Health Economics Team
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Contents
1. Introduction
2. Literature Review
3. PBMA Process
4. Feedback
5. Conclusion
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Introduction
• NHS Ayrshire & Arran provide a number of Enhanced Services to its patients
• Enhanced Service is provided by the GP in addition to their core contract
• Usually reimbursed through a per item fee – set tariff
• However issues around allocation of the Enhanced Services budget
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Introduction
• Requires a prioritisation exercise assessing the relative value for money of the services
• PBMA a technique which can support decision making regarding prioritisation
• Identify areas for investment through disinvestment
• Real life NHS resource allocation problem with multiple stakeholders
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Literature Review
• Prior to starting project commissioned a literature review examining theory and implementation of technique
• Identified the stages of a PBMA which formed structure of the project (Mitton and Donaldson, 2004)
• Some variation in the literature but appeared to follow a similar process
• Kemp and Fordham (2007) Norfolk example as one of particular relevance
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PBMA Key Stages
1. Stakeholder Group
2. Enhanced Services for Review
3. Programme Budget
4. Criteria
5. Evidence Packs
6. Scoring and Evaluating the Services
7. Analysis and Prioritisation
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Stakeholder Group
• Existing Enhanced Services Group made up of Primary Care Managers, Finance Managers, Public Health, GPs
• Included Secondary Care colleagues for wider scope
• Also included members of the public
• Recruited through appropriate department and an advert to patient groups through practice managers
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Services to Evaluate
• Diabetes • Medicines Reconciliation• H Pylori Eradication • Adults with Learning Disabilities • Contraceptive Implants • A&E Frequent Attendees • Service for Carers • Ring Pessary Fitting & Maintenance • Minor Injuries • Specialist Dermatology Service
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Programme Budget
Service Allocation
Diabetes 500,000
H Pylori 140,000
Medicines Reconciliation 96,442
Learning Disabilities 90,000
Contraceptive Implants 76,000
Dermatology 66,000
Service for Carers 40,000
Ring Pessary 35,000
Minor Injuries 32,000
A&E Frequent Attendees 0
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Programme Budget
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Criteria
• Variation in services in terms of outcomes and how they are delivered
• Need to determine a ‘global’ measure of benefit which allows comparison to be made
• Can be achieved through developing a common set of relevant criteria to judge the options against
• Can be developed either through top down or bottom up approach
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Criteria
• How important are these criteria?– Effectiveness– Patient Experience– Practicality– Impact on Sec. Care– Sustainable
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Criteria Weights
• How important are these criteria?– Effectiveness– Patient Experience– Practicality– Impact on Sec. Care– Sustainable
12
10
11
7
10
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Evidence Pack
• Next stage in the process is where all participants score each service against our criteria
• To do this need evidence/information prepare participants for scoring session
• Particularly members of the public who are reliant on information for scoring
• Coherent and systematic approach for generating pack and compiling evidence
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Scoring
Service Effective-ness
Patient Exp.
Practical. Imp on Secondary
Care
Sustain.
Diabetes
Patient Safety
H-pylori Eradication
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All group results
Service Weighted Benefit Score
Diabetes 415
Contraceptive Implants 405
H Pylori 402
Ring Pessary 383
Minor Injuries 372
Dermatology 370
Learning Disabilities 348
Medicines Rec. 344
Service for Carers 318
A&E Frequent Attend. 196
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All group results
Service Weighted Benefit Score Current Allocation
Diabetes 415 47%
Contraceptive Implants 405 7%
H Pylori 402 13%
Ring Pessary 383 3%
Minor Injuries 372 3%
Dermatology 370 6%
Learning Disabilities 348 8%
Medicines Rec. 344 9%
Service for Carers 318 4%
A&E Frequent Attend. 196 0%
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Cost value ratio
• Allocation of resources across the services very different and need to standardise for comparison
• Calculated a cost per “beneficiary” for each service under review
• Divide the cost per beneficiary by the number of points of each service
• This gives you a cost per benefit point (cost value ratio) which is a measure of cost-effectiveness
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All group results
Service Cost value ratio
Medicines Rec. 0.47
Service for Carers 1.66
H Pylori 6.22
Diabetes 6.89
Contraceptive Implants 6.94
Learning Disabilities 12.69
Ring Pessary 13.04
Minor Injuries 14.33
Dermatology 29.77
A&E Frequent Attend. 95.46
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All group results
Service Cost value ratio Current Allocation
Medicines Rec. 0.47 9%
Service for Carers 1.66 4%
H Pylori 6.22 13%
Diabetes 6.89 47%
Contraceptive Implants 6.94 7%
Learning Disabilities 12.69 8%
Ring Pessary 13.04 3%
Minor Injuries 14.33 3%
Dermatology 29.77 6%
A&E Frequent Attend. 95.46 0%
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Discussion
• Results generated much discussion regarding prioritisation, disinvestment, methodology, redesign, public involvement and GP re-imbursement
• Reflect upon results and re-review at a future Enhanced Services meeting
• Potential aim to agree a few services for investment or disinvestment
• Inform further piece of work regarding “impact assessment” outwith PBMA process
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Feedback
• Primary care expressed that technique prompted in depth discussion regarding prioritisation
• Expressed view to use technique differently to prioritise larger parts of the Primary Care budget
• Process generalisable and interest expressed in using it to prioritise other funding decisions
• Well received within NHS Ayrshire & Arran and Senior Directors
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Conclusion
• Real life resource allocation problem requiring a prioritisation process
• PBMA provided a direction of travel regarding future allocation of resource
• Challenging piece of work and time consuming/intensive
• However information provided unique and process enables a degree of transparency in decision making
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Sub-group scores
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GP results
Service Cost value ratio Current Allocation
Medicines Rec. 0.47 9%
Service for Carers 1.46 4%
H Pylori 6.42 13%
Diabetes 6.66 47%
Contraceptive Implants 6.71 7%
Ring Pessary 11.65 3%
Learning Disabilities 12.04 8%
Minor Injuries 14.87 3%
Dermatology 30.84 6%
A&E Frequent Attend. 92.21 0%
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Public results
Service Cost value ratio Current Allocation
Medicines Rec. 0.50 9%
Service for Carers 1.77 4%
H Pylori 6.20 13%
Diabetes 6.99 47%
Contraceptive Implants 7.15 7%
Learning Disabilities 13.13 8%
Ring Pessary 13.83 3%
Minor Injuries 15.05 3%
Dermatology 35.11 6%
A&E Frequent Attend. 78.47 0%
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NHS Managers results
Service Cost value ratio Current Allocation
Medicines Rec. 0.46 9%
Service for Carers 1.68 4%
H Pylori 6.10 13%
Contraceptive Implants 6.86 7%
Diabetes 6.93 47%
Learning Disabilities 12.37 8%
Ring Pessary 12.94 3%
Minor Injuries 13.63 3%
Dermatology 26.17 6%
A&E Frequent Attend. 115.75 0%