Feature / Long-term view

Dr Mahmood Adil and Sir John Oldham examine moves to develop a ‘year of care funding’ model for patients with long-term conditions

Effective commissioning of healthcare resources requires investment of resources in a way that maximises healthcare benefits for a population while delivering value for money to the taxpayer. This is a significant challenge to all healthcare stakeholders, particularly as we are now in the first full year of QIPP (quality, innovation, productivity and prevention) delivery.

For one group of stakeholders in particular – the 15 million people in England with long-term conditions – our response to this challenge will be what defines success or failure of QIPP and the modernisation programme. 

These people are the main driver of cost and activity in the NHS. They are disproportionately higher users of health services – according to some estimates, 50% of GP appointments, 60% of outpatient and accident and emergency attendances and 70% of inpatient bed days.  

Given this position, and the forecast growth of this group, it’s imperative the service evolves and the funding system develops to support these patients’ access to appropriate care in the most appropriate setting.

Patients do not recognise organisational boundaries. Funding must flow with (or even ahead) of the patient. But in addition, the contracting and performance management system needs to evolve to support improved outcomes for patients.

Most healthcare systems in the developed world are grappling with this issue, especially given the global pressure on public finances. This is why the Department of Health’s QIPP long-term conditions workstream has commenced efforts to develop a ‘year of care’ capitated funding model, to support improved management of patients with long-term conditions. This looks to rebalance the incentives and levers in the system to ensure patients get seen by the right people in the right setting at the right time. 

High-quality specialist care remains a vital part of the equation. Greater incentives also need to be given to patients to take responsibility for managing their conditions.

All these development require a close working partnership between clinical and finance teams in both provider and commissioning organisations to create value for the whole patient care pathways. It further underlines the importance of collecting and collating cost and clinical data to create decision-making intelligence that could help improve quality and decrease cost.

The need for a partnership approach is backed by Jim Easton, the Department’s director of improvement and efficiency.

‘The current funding mechanisms have served us well to date,’ he says, ‘but to place services on a sustainable and integrated footing, we need to evolve this to delivering better overall outcomes for patients and efficiency for the health system.

‘Such developments need strong engagement between clinical and finance teams and the availability of appropriate data to lay down a good foundation for an effective future funding model.’

Minimising risk

The workstream is also conscious of the challenges and risks involved in shifting to a different model of funding. As a result, a staged approach is being taken and all key partners are being engaged to ensure that, when the time comes, implementation is made easier. 

The first stage will involve the unbundling of existing recovery, re-ablement and rehabilitation monies from existing tariffs to free up services and allow local health economies to determine how best such services should be provided for their local populations.

In the second stage, a community step-up tariff will be developed to enable the investment in capacity and capability for services for patients experiencing an exacerbation in their underlying condition. 

Given the challenges around community data, the team will work with current community providers to develop the right level of pricing.

The workstream is keen to hear from any practitioners who may have already undertaken work in this area or who would be interested in sense-checking the proposal as it evolves. 

Further information on the long-term conditions workstream can be found at www.networks.nhs.uk/commissioning-for-long-term-conditions