Tariffs
The London Sexual Health programme was successful in getting £66k from the Department of Health sexual health policy team for development of the tariff work. The London work is now designated by the PbR team as a project whose work is to be used to advise National roll-out and four sites out of London are being identified by DH to shadow the tariffs to advise local implementation.
Pathway Analytics have been commissioned by LSHP to carry out this work. More information can be found on their website.
Developing Tariffs for Integrated Sexual Health Services (February 2010)
The tariff programme presented to the London Sexual Health Commissioning Board for endorsement
London Sexual Health Tariff Development Work
Technical Document- Phase 1: Methodology of the Proposed Integrated Sexual Health Pricing and Currencies for London
Proposed integrated Sexual Health Pricing & Currencies for London: Sexual and Reproductive Health & Sexually Transmitted Infection Pathways included in the Pathway Pricing Model, Phase 1
Communications Plan
Definitions of communication mechanisms and methods relating to the tariff work
Terms of Reference
ToR London Sexual Health Tariffs Steering Group
ToR London Sexual Health Tariffs Commissioning Working Group
ToR London Sexual Health Tariffs Contraception Working Group
ToR London Sexual Health Tariffs STI Working Group
LSHP Tariff Development Work Update
Phase 2
February 2010
Project set up / introduction to approach
- Membership of steering group, commissioners working group, integrated sexual health working group, GUM working group and pilot sites agreed.
- Governance arrangements in place and terms of reference in the process of being signed off.
- All stakeholders have been introduced to the project approach and have had the opportunity to influence and raise issues.
Integrated Sexual Health Workstream
- Working group meeting II held 26 February represented by all pilot sites and Hong Tan; discussed ToRs and ran through approach to Phase 2 of the integrated SH pricing proposals, road test data capture requirements and timelines
- Complex SRH Pathways: initial workshop held with Chris Wilkinson and senior consultants to refine list of complex pathways, discuss potential income triggers and methodology; the SRH consultants are currently mapping out additional complex pathways using an excel tool plus 1to1s to support this process
- Complex pathways defined as: "Complex SRH work provided by healthcare professionals with additional specialist training / skill"
- Draft list of pathways identified (significant revision from Maria Griffin's list)
- 1to1 meetings held with all pilot sites managers and in most cases, data personnel, to lay the groundwork for road test requirements and extract any available retrospective demand data sets from the services existing IT systems
- All sites keen to participate in Road Test, albeit each has a different data collection system.
- Draft list of Road Test data variables to collect in process
Commissioners Workstream
- Working group meeting II held 25 February – split into two parts:
- 1st part of meeting: core group of pilot site commissioners agreed ToRs, reviewed impact assessment requirements and were shown the outline of the impact assessment tool;
- 2nd part of meeting: broader group of commissioners, taken through the key milestones of Phase 2 and a discussion was held regarding implications for London SH commissioners in terms of shadow/ implementation of the integrated tariff
- Impact assessment tool near completion: the outputs it will provide have been well received by the commissioners with comments like: “this is the first time we would have such data”
- Ongoing discussion around linking the Impact Assessment to Patient Outcomes (and the LSHP KPIs from their Strategy document) so that the impact of budget decisions on patient outcomes can be predicted - we will investigate introducing the CEQUIN payment framework which might be appropriate here
- Meetings held on the last Thursday of the month
GUM Workstream
- Working group meeting II held 24 February: discussed ToRs, went through GUM workstream plan and reviewed key milestones
- 1to1 meetings held with 3 of the GUM pilot sites
- Requests have been made for existing GUM pathway material
- Level 3 STI pathways are starting to be mapped out with clinicians
Modelling/ Analysis Workstream
- Phase 1 pricing model transitioned to appropriate framework to support Phase 2
- Impact Assessment tool designed and in process of being built
- MFF inputs in the model now stripped out
- All resource and consumable data uploaded to new framework
Stakeholder Management
- DH PbR Team: meeting with Ade and Paul Griffiths to continue dialogue/ links with national agenda for tariff development
- Attended IT meetings with SHRAD IT consultants, explained road test/ shadow data requirements
April/ early May 2010
Summary
The key headline for this period is that the majority of sexual health pathways – both standard and complex – are now mapped and reviewed at a Working Group level. A big thank you to all the clinicians across the 13 pilot sites, as well as BASHH and Faculty members, who have contributed their time and invaluable insights to the pathway mapping exercise; it is much appreciated by the LSHP team. These pathway sets, capturing benchmark service delivery across our London pilot sites, constitute a crucial building block for development of the Phase 2 pricing proposals for SRH and Integrated pathways and Phase 1 pricing proposals for STI Complex pathways.
The current focus is now on the pricing work. The Pathway Analytics team are working with finance, management and clinical teams across the pilot sites to complete the following: a) cost lever templates, b) retrospective activity data extracts, and c) Road Test (Community) data collection. The team are analysing these data inputs to ensure that the pathway pricing model accurately reflects the cost/activity profile of the pilot services. A pilot Road Test is being tested in a couple of the GUM pilot sites to help fast-track the GUM Road Test and enhance the analysis for the STI element of care pricing and currency weightings. Recommendations on pricing at element of care level with scenario analysis on pricing options will be presented to the Steering Group for review in early June.
A change management protocol is being agreed to facilitate a wider consultation on the pathway sets. LSHP is keen to ensure all stakeholders across London Sexual Health services have an opportunity to have their say. A note will be coming out shortly regarding this process from the Working Group Chairs.
Decisions from 04-May-10 Steering Group Meeting
1. Pathway Sign-off: pathway resource profiles to support this phase of the costing work must be validated/ signed-off at a Working Group level by 10-May-10 (3 week slippage to date). Wider consultation can be conducted across London, but will not be incorporated into the Phase 2 pricing proposals.
2. Timelines: the LSHP tariff development programme require initial Phase 2 recommendations to present to the DH 6-Jun meeting (Hong Tan agenda item)
3. Specialised Contraceptive pathways: as many of these pathways are not being commissioned by Gynae commissioners at the moment, we need to be clear on our definition set underpinning these pathways; a discussion in the Jun-10 SG meeting will revisit optimal ways to incorporate this work with other localised gynae costing work
4. Staffing Profiles: the SG would like to see examples of pricing per Option 1 & 2 below:
Option 1: blended staffing profile used to cost up standard STI and Contraceptive pathways to incorporate all bands of staff delivering standard EOCs (per Phase 1 Model)
Option 2: lowest appropriate band of staff used to cost up standard STI and Contraceptive pathways
5. Training: the SG would like to see the model detail on the clinical available time, in particular, the training day allocation; further discussions need to be had within the Working and Steering Groups to decide on inclusion/ exclusion (separate payment mechanism) of additional time generated by training delivered by a clinician
6. Integrated Pathways: to ensure the Technical Document v2 includes v1’s definition of what we mean by integrated pathways
Project Milestones
- Validation of Pathway Profiles: all pathways refined (Phase 1) and/ or mapped (Complex SRH/ STI), and validated at Working Group level; pathway set ready for wider consultation*
- Road Test: Community Road Test commenced at all 6 pilot sites
- Commissioners Impact Assessment: Impact Assessment tool populated with Community SH budget breakdown data sets for 4 pilot site PCTs
- Validation of Pricing Levers: requests/ template sets for cost lever and demand profile data sets has gone out to all Community and GUM pilot sites; initial meetings held with BASHH and Faculty
- Tariff Structure: P1 model transition and extension completed and rule sets reviewed internally
- Stakeholder Mgt/ Other: IT Working Group set-up with David Harkness as Chair to interface with IT development programmes relevant to the tariff development work
*awaiting validation of change management protocols
April Activities
Steering Group Meeting II
- 2nd SG meeting held: ToRs were aligned across all WG/SG and ToRs for Commissioners WG and SG were signed-off
- Agreement on pathways being setting independent
- Future meeting dates: 2nd June 3.00-5.00pm; 1st July 1.00-3.00pm
Stakeholder Management
- Meetings with Faculty and BASHH to discuss the tariff development work in more detail and agree next steps for actual/benchmark/best practice alignment
- Presented stakeholder pack at the Commissioning Network Meeting
Contraception Workstream – (formerly SRH/ISH)
- Standard SRH pathways reviewed and signed off by WG members for P2
- Complex pathways set defined, mapped and 1stsign off by pilot site lead consultants for P2 (note: further discussion to be had around these pathways, especially Medical Gynaecology pathways)
- Road Test commenced for all pilot sites
- Initial data sets returned for 5 out of 6 pilot sites
- Cleansing and analysis of Road Test data commenced
- Retrospective activity data received from all pilot sites (note: for different time periods)
- Cost lever data being updated for 2009/10 with updated information from pilot site finance teams – met with 3 pilot sites
- Met with Faculty to review complex SRH pathways and agreed on set for 1st sign-off, (note: additional comments/ revisions to come, out of scope)
- Aligned ToRs with GUM Workstream
STI Workstream - (formerly GUM)
- Continued work on pathways with 1st sign-off on some pathways
- BASHH guidelines consulted and incorporated into pathways where possible (note: gap analysis to identify any major discrepancies between actual/ guidelines)
- Cost lever meetings held with finance, service managers and some clinicians from Homerton, St Georges, Archway/MM, GSTT, Newham and Chelsea & Westminster.
- Initial information on staffing profiles from 4 out 7 clinics
- Initial data collection and analysis on drugs, pathology, consumables and indirect costs from pilot sites
- Continued discussion with team involved in development of GUM tariff, in particular cost levers
- Aligned ToRs with GUM Workstream
Commissioners Workstream
- Met with 4 Pilot PCT Commissioners: Camden & Islington, Lewisham, Barking, Dagenham, Redbridge and Havering and Lambeth
- Captured top-down budget breakdown and retrospective activity data to match against budget
- Working group meeting III held 28 April: discussed how to reflect ‘setting independence’ concept in the model and possible impact on affordability
Modelling/ Analysis Workstream
- Constructed the Road Test data cleanse and analysis framework
- Implemented demand filters in the model
- Started to introduce Case Mix facility data for different Services
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