2. Why a person-based
formula?
⢠Existing formulae used for PCT allocations
based on small area based analysis
⢠For practice-based commissioning, we
want estimates of healthcare need for
practices
â But practice lists are not comprised of whole
small areas.
⢠Options:
â Attribute, but systematic variation in
registration patterns
â Move to practice or person-basedâŚ
3. What we did
⢠2007: Tendered for research to investigate
the feasibility of a person-based approach
â It works!
⢠2008: Tendered for research to develop
PBRA methodology for PBC in 2010/11
â Results were delivered summer 2009
â But: regression output â practice budgets
4. Testing the results
⢠Results expected to
â Maintain overall patterns of need from
previous formula
â More sensitive to local variations in need
CARAN PBRA CARAN PBRA
Least Deprived 0.94 0.94 Youngest age 0.81 0.80
1.00 1.00 0.95 0.95
1.01 1.01 1.01 1.01
1.04 1.03 1.05 1.05
Most Deprived 1.03 1.03 Oldest age 1.14 1.14
Most - Least 0.09 0.09 Old - young 0.33 0.34
Most / Least 1.09 1.09 Old / young 1.41 1.42
5. And in two dimensionsâŚ
CARAN PBRA
A A
0.63 0.89 0.62 0.89
B B
Average age quintiles
Average age quintiles
C C
D D
1.07 1.39 1.07 1.34
E E
A B C D E A B C D E
Deprivation quintles Deprivation quintles
0.60-0.70 0.70-0.80 0.80-0.90 0.90-1.00
1.00-1.10 1.10-1.20 1.20-1.30 1.30-1.40
Ratio AA:EE= 2.20 Ratio AA:EE= 2.16
6. More sensitive to local
variation in need
2.50 2.50
CARAN PBRA
2.00 2.00
1.50 1.50
1.00 1.00
0.50 0.50
0.00 0.00
0 5000 10000 15000 20000 25000 30000 0 5000 10000 15000 20000 25000 30000
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 Practice size (r = -0.02)
o Ethnicity (r = 0.16) o Proportion of patients receiving free
o Life expectancy (r= 0.00) prescriptions (r = 0.10)
o Long term illness prevalence (r = -0.05) o Disability living allowance (r = -0.03)
7.
8.
9. Identifying outliers
⢠Developed âissues listâ to identify possible
reasons for outliers
â Recent population changes
â Student practices
â Skewed or unusual age profile
â Wide geographical area covered
â Recent GP moves; practice mergers
â Significant proportion living in Wales/Scotland
â High proportion of patients in nursing homes
10. Research â budgets
⢠Responsibility for setting PBC budgets for
practices sits with PCTs
⢠Developed interactive budget toolkit and
guidance
â combines benefit of this research with local
knowledge/ responsibility
â Supports PCTs to set robust budgets
11. The toolkit
⢠Combines PBRA âfair sharesâ with formulae
for maternity, mental health, prescribing
and inequalities
⢠Uses funnel plots to illustrate impact of
practice size on variation
⢠Options to:
â model impact of âpace of changeâ
â Update populations and historic budgets/spend
⢠Works at practice or PBC âconsortiaâ level
13. Issues Highlight historic Min PoC for outliers 5.0%
Difference between "fair share" and 2010/11 budget after Pace of Change AfterPOC
At least 2 reasons PoC threshold 10.0%
Issues
100%
Labels Short Names
Kings College Imperial College
Show Historic
50% Ahmed N Queens Park
Scale Axes Auto
Third Floor Lanark Road
North West London Crawford Street
Harley Street Victoria Muir'S
25% Mayfair
Lai Chung Fong Queens Park Queens Park
Nagarajan Woodfield Road Cavendish
Connaught Square Maida Vale
Milne House Shirland Road Bayswater
10% Ground Floor Lanark The Garway Medical Newton
Wellington Paddington Green St Johns Wood Medical
The Royal Mews Little Venice
0% Crompton
West Two
Srikrishnamurthy Harrow Road Elgin Clinic
New Elgin The Randolph Westminster And Pimlico
Belgravia
Lisson Grove
-10% Lupus Street Marylebone
Soho CentreMaher Shakarchi'S Gate
For Health And Care
Lancaster Fitzrovia
Fluxman Harrow Road
The Westbourne Green Victoria
Soho Square General Medical
Marven
-25%
Millbank
Covent Garden
Westminster School
-50%
The Doctor Hickey
-75%
0 2,000 4,000 6,000 8,000 10,000 12,000 14,000
Population