Download Planning TAG May 2014 - Portsmouth Hospitals NHS Trust

Contract 14/15
From negotiation into action – Part 2
Peter Bray – Snr Contracts Manager
Ian Howe – Head of Financial Planning
27 May 2014
Portsmouth Hospitals NHS Trust
Contract Negotiation 14/15
New World
• New team
– DOF-down
• CCG/CSU
– Style & discipline
• New Guidance
– NHSE/Monitor
• TDA interest
• Escalation view unknown
Excellent tools
• PHT Mission & Energy
– CEO down support
• Timeliness
– Notices
– Local Prices
• Data / evidence backup
– GooRoo
– Finance
• Good ideas from CSCs
• Peer support and advice
Portsmouth Hospitals NHS Trust
Contract Structure 14/15
Specialised
Commissioning
3 Local ‘Main’
CCGs
3 Hants
£79.2m
£287.7m
IOW
2 Dental
2 Public
Health
£6.1m
£3.7m
MOD
Soton
£2.7m
Dorset
West Sussex
AQP
Non-Contract
Activity
£0.65m
£23.2m
Wiltshire
£3m
2 Surrey
Co-ordinating Commissioner
Associate Commissioner
1 Sussex
Portsmouth Hospitals NHS Trust
Contract Negotiation
Big issues
Locally resolved
• Most counting & coding
• Diagnostics growth
• Robot use
TBA signature-stoppers
• CQUIN schemes
• QIPP/RTT/IAP
Longstop
• Schedules
– Quality, Performance, Info
Arbitration
• Local prices
– 2 year transition
• Rest counting & coding
– Guidance
• MRET
– Politics
• RTT & QIPP
– Evidence before acceptance
Contract Result
• PbR
– Paid for each activity
• Good practice rewarded
• Penalty for poor quality or performance
• Step change to full cost for CCGs
– Some compromises made for 14/15
• Doable – with care and attention
Portsmouth Hospitals NHS Trust
Contract Framework
£416m
• Structure of the playing
board
• The ladders agreed
• The big waiting snakes
Portsmouth Hospitals NHS Trust
The Ladders – Counting and Coding
Devices (£614k):
• Biological mesh
• Bone Anchored hearing aids (BAHA)
• Breast Prosthesis
• Carotid, iliac and renal stents
• Drug-eluting peripheral angioplasty balloon
• Endovascular stent graft
• Nebulisers
• Home Walking Aids
Portsmouth Hospitals NHS Trust
The Ladders – Counting and Coding
Procedures (£1,534k):
• Gynae Outpatient Procedures
• Neurophysiology GP referrals
• Orthodontic Outpatient Procedures
• Stress Echos
• Pacemaker Follow ups
• Rheumatology outpatient procedures
• Botox into Bladder
• PEG Changes
• 24/48 Hour Ambulatory Electrocardiography
• Neurophysiology other referrals
Portsmouth Hospitals NHS Trust
The Ladders – Counting and Coding
Diagnostics and other (£935k):
• Paediatric Echo
• Vascular Dopplar
• Nutrition nurse appointments
• Specialist Palliative Care – Support
• Newborn hearing tests
• HPV testing
• ALL EXISTING PbR ACTIVITY
Other Material Contract Changes
• Local prices achieved 50:50 from arbitration. Avoids
deflation and secures £1.2m for 15/16.
• Patient transport removed from October (£1.9m)
• Immunosuppressants into contract from GP (£1.8m)
• Maternity pathway 50:50 risk share removed (£0.3m)
• Growth of £4.4m
• Drugs risk share of £150k
Key Risks
• Counting and coding not
recorded/incorrectly
• Chemotherapy coding
• Patient transport (other)
• AQP data collection
• The internal plan
• Penalties
The Internal Plan
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ITU bed increase
ITU West Hants
Increased ambulatory care activity
ICD increase
RTT Q3 & Q4
Dialysis growth
Fracture liaison service
Dermatology business case
CQUIN
QIPP non-achievement
£1,037k
£ 576k
£ 183k
£ 45k
£4,458k
£ 206k
£ 268k
£ 500k
£ 161k
£4,624k
________
TOTAL £12,058k
Penalties
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•
•
•
•
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Penalties now based on each failing patient
ED 4hr - £200
RTT – Admitted £400, non-admitted £100, incomplete £100
Ambulance delays – 30 mins £200, 60 mins £1000
Cancer – £200
Diagnostics – £200
C-Diff – £10,000
MRSA - £10,000
• This increases the PHT liability between 13/14 to 14/15
• Achieve the target to avoid the penalty
• Where a performance fail is required, minimise the degree to
which the target is missed
Portsmouth Hospitals NHS Trust
Conclusion
£416m
• The ladders take us
further up the board
• Beware the snakes as
they are looking to bite!