Rob Shaw: Person-based resource allocation in practice

Person-based resource allocation in practice

Rob ShawEconomic Adviser

Why a person-basedformula?• Existing formulae used for PCT allocations

based on small area based analysis• For practice-based commissioning, we

want estimates of healthcare need for practices– But practice lists are not comprised of whole

small areas.• Options:

– Attribute, but systematic variation in registration patterns

– Move to practice or person-based…

What we did

• 2007: Tendered for research to investigate the feasibility of a person-based approach– It works!

• 2008: Tendered for research to develop PBRA methodology for PBC in 2010/11– Results were delivered summer 2009– But: regression output ≠ practice budgets

Testing the results

• Results expected to– Maintain overall patterns of need from

previous formula– More sensitive to local variations in need

CARAN PBRALeast Deprived 0.94 0.94

1.00 1.001.01 1.011.04 1.03

Most Deprived 1.03 1.03Most - Least 0.09 0.09Most / Least 1.09 1.09

CARAN PBRAYoungest age 0.81 0.80

0.95 0.951.01 1.011.05 1.05

Oldest age 1.14 1.14Old - young 0.33 0.34Old / young 1.41 1.42

And in two dimensions…

A B C D E

A

B

C

D

E

Deprivation quintles

Ave

rage

age

qui

ntile

s

PBRA

0.62

1.07 1.34

0.89

A B C D E

A

B

C

D

E

Deprivation quintles

Ave

rage

age

qui

ntile

s

CARAN

0.63

1.07 1.39

0.89

0.60-0.70 0.70-0.80 0.80-0.90 0.90-1.001.00-1.10 1.10-1.20 1.20-1.30 1.30-1.40

Ratio AA:EE= 2.20 Ratio AA:EE= 2.16

More sensitive to localvariation in need

0.00

0.50

1.00

1.50

2.00

2.50

0 5000 10000 15000 20000 25000 30000

0.00

0.50

1.00

1.50

2.00

2.50

0 5000 10000 15000 20000 25000 30000

CARAN PBRA

sum of absolute error = 5.1 sum of absolute error = 4.3

Correlations of ratio between PBRA and actual spending with respect to:o Educational attainment (r= -0.03)o Ethnicity (r = 0.16)o Life expectancy (r= 0.00)o Long term illness prevalence (r = -0.05)

o Practice size (r = -0.02)o Proportion of patients receiving free prescriptions (r = 0.10)o Disability living allowance (r = -0.03)

Identifying outliers

• Developed ‘issues list’ to identify possible reasons for outliers– Recent population changes– Student practices– Skewed or unusual age profile– Wide geographical area covered– Recent GP moves; practice mergers– Significant proportion living in Wales/Scotland– High proportion of patients in nursing homes

Research → budgets

• Responsibility for setting PBC budgets for practices sits with PCTs

• Developed interactive budget toolkit and guidance– combines benefit of this research with local

knowledge/ responsibility– Supports PCTs to set robust budgets

The toolkit

• Combines PBRA ‘fair shares’ with formulae for maternity, mental health, prescribing and inequalities

• Uses funnel plots to illustrate impact of practice size on variation

• Options to:– model impact of ‘pace of change’– Update populations and historic budgets/spend

• Works at practice or PBC ‘consortia’ level

Weights 58.6% 2.7% 15.9% 10.3% 12.5%

Practice Code Practice_Name

Acute Share

Maternity Share MH Share

Prescribing Share

Inequalities Share

Total Population

Historic Spend Share

Fair share (%)

Practice Code Practice_Name

Acute Share

Maternity Share MH Share

Prescribing Share

Inequalities Share

Total Population

Historic Spend Share 100%

E87002 VICTORIA MEDICA 5.27% 5.34% 4.48% 4.94% 4.11% 10,617 6.50% 4.97%E87005 BELGRAVIA SURG 3.10% 2.42% 2.70% 3.14% 1.26% 6,772 2.92% 2.79%E87008 PADDINGTON GRE 4.29% 3.50% 3.74% 3.70% 4.73% 8,144 3.90% 4.17%E87009 THE GARWAY MED 2.49% 1.67% 2.48% 2.54% 1.96% 5,450 2.07% 2.41%E87010 MAIDA VALE MEDI 2.92% 3.52% 3.52% 3.19% 4.38% 8,121 2.59% 3.24%E87011 LISSON GROVE HE 4.69% 4.18% 3.66% 3.75% 5.04% 8,090 4.77% 4.46%

Google: dh pbc 2011-12

Historic SpendFair share (per head)

Historic (per head)

Final Population

Fair Share (Total)

Historic (Total) change

Apply PoC?

PoC level Final allocation

£100,000,000 £409 £409 244,739 £100,000,000 £100,000,000 0.0%Apply PoC?

PoC level £100,000,000

£6,500,839 £468 £612 10,617 £4,966,783 £6,500,839 -23.6% Yes 7.8% £6,170,228£2,921,519 £413 £431 6,772 £2,793,914 £2,921,519 -4.4% Yes 9.8% £2,918,885£3,896,557 £512 £478 8,144 £4,172,854 £3,896,557 7.1% Yes 8.9% £3,893,043£2,065,545 £441 £379 5,450 £2,405,523 £2,065,545 16.5% Yes 10.9% £2,166,727£2,590,088 £399 £319 8,121 £3,244,139 £2,590,088 25.3% Yes 8.9% £2,717,140£4,774,296 £551 £590 8,090 £4,459,324 £4,774,296 -6.6% Yes 9.0% £4,769,991

Difference between "fair share" and 2010/11 budget after Pace of Change

-75%

-50%

-25%

-10%

0%

10%

25%

50%

100%

Victoria

Belgravia

Paddington GreenThe Garway Medical

Maida Vale

Lisson GroveWestminster And Pimlico

North West London

Shirland Road

Marven Medical

Connaught Square

Elgin Clinic

Covent Garden

Crompton

Nagarajan Queens Park

Soho Centre For Health And Care

Crawford Street

St Johns Wood MedicalMilne House

Fluxman Harrow Road

Mayfair

Third Floor Lanark Road

West Two

Imperial College

NewtonBayswater

Westminster School

The Royal Mews

Soho Square General

Harley Street

Lancaster Gate

New Elgin

Lai Chung Fong Queens Park

Marylebone

Millbank

The Doctor Hickey

Woodfield Road Cavendish

Srikrishnamurthy Harrow Road

Victoria Muir'S

Wellington

Ahmed N Queens Park

Lupus Street

Kings College

The Westbourne Green

Maher Shakarchi'S

Little VeniceThe Randolph

Fitzrovia

Ground Floor Lanark

0 2,000 4,000 6,000 8,000 10,000 12,000 14,000

Population

historicAfterPOCIssues

Short NamesLabels

Show Historic

Scale Axes Auto

At least 2 reasons

Issues Highlight Min PoC for outliers 5.0%

PoC threshold 10.0%