PBC Data Matters

What information is needed to make PBC work well, and who needs that data? How will budget setting and financial management work? Ardentia’s chief executive Tom Mulhern explains.

The drive for PBC is speeding up. Originally due to be rolled out by 2008, it was brought forward 18 months when Sir Nigel Crisp, then chief executive of the NHS, released the document 'Commissioning a patient-led NHS' in summer 2005.

Concerns about the effectiveness and uptake of PBC meant that the planned, incremental introduction was replaced by a hard deadline aimed at achieving total sign-up – i.e. universal coverage with PCTs – by December 2006.

PBC is placing the onus firmly on NHS organisations to achieve not just responsible spending, but excellence in financial management. Simply breaking even is no longer enough. The government has made it clear that planning for a surplus is the expected norm – and what’s more, it expects the surplus to be available in 2007.

This in turn leaves a number of key PBC questions that need answering, if organisations are fully to prepare for it.

1. What information is needed to help commissioners and providers plan for it and make it work well?
2. How will budget setting and financial management work?
3. What tools are available to manage the overall PBC process?

We will deal with the third question in a separate article, and deal here with questions 1 and 2. The starting point for answers is the DH document published in January 2006, ‘Practice-based commissioning: achieving universal coverage’. This gives clear guidance on how patient and activity data, the lifeblood that will support the entire PBC process, should flow.

Coverage matters

The data sharing arrangements between PCTs, NHS organisations and practices are the arteries and veins that will ensure the PBC system works successfully. The key data flows that need to be in place are:

• All GP practices can expect to receive a statement of activity and costs from treating patients referred from their practice. They will also receive a total of spend to date against their indicative budgets - not unlike a bank statement. However, the GP practices should be able to manipulate and analyse the data to ensure that this is consistent with their own internal data.
• All practices should get an indicative budget covering an agreed range of services, based on historic data and both current and planned services. This budget is managed by the PCT and will be reviewed after three years, which means that delivery of current and forecasted spend is critical.
• Standardised, easily comparable data sets are available to practices to ensure fairness.

Delivering this level of information means assimilating a great deal of clinical, patient and activity data, and ensuring that it flows in a structured way from providers to practices. The DH’s own guidelines state that “practices can expect to receive monthly information packs from their PCT”. This presents a massive data task for PCTs.

Tapping the source

However, this data mountain is not insurmountable. Much of this data will already exist within trusts and other organisations. Many will already have business intelligence (BI) and data warehousing solutions in place that help transform this data into useable information through reporting and analysis on most aspects of healthcare delivery.

It’s a question of applying proven, common-sense business rules and using the right tools to ensure that the data flows easily between organisations, and that it can be accessed by all that need it.

After all, comprehensive PBC reporting benefits both PCTs and practices directly in terms of helping them decide which services they continue to offer, which new ones are developed and what others may be divested to other more appropriate care settings. This will be critical as the patient choice agenda gathers pace.

We’ll cover the checklist of key points that PCTs should observe in choosing a PBC management and reporting solution in the next article.