CARE IS recommends a clinically commissioned procurement route through enhanced services or single action tenders centered on quality improvement in primary care. These services, by their very nature, can only be delivered through General Practice.
As with the unplanned admissions and risk profiling DES, contracts for enhanced services incorporating the technology are awarded at a practice level, the size of the contracts are such that formal tendering for the technology is not required.
The practices purchase the technology and services, independently but supported by their CCG or federation.
In order to drive the outcomes required,
CARE IS recommends that the payment structure within a single action tender for an enhanced service are divided broadly into three categories:
- Engagement payment to support the practices in service delivery, system integration, IT implementation and facilitate information access to CCG
- Concordance payments based on patients being managed within best practice guidelines using the agreed processes
- Performance related payments such as a payment which is only made when a specific outcome is achieved such as a 20% reduction in unplanned admissions for a particular condition
CARE IS is able to provide the data necessary to establish levels of activity, concordance and outcomes at a practice level, aggregated across a GP federation or association and at a CCG level. In the proposed model, activity and concordance payments are based at a practice level. Performance related payments would be predicated on general practices in a federation or a CCG meeting the performance target on an aggregated basis with a, lower, minimum threshold being achieved at a practice level.
CARE IS can support CCGs in the generation of the necessary service specifications as well as provide the resources necessary in General Practice to ensure compliance.
The locally tailored
evidence based business cases indicates that in the majority of situations the costs are directly recuperated in year 1.