30 July 2004
Community health services might be cut back unless primary care trusts put proper systems in place to manage the new NHS funding system, a government watchdog has cautioned.
An Audit Commission report, Introducing payment by results: getting the balance right for the NHS and taxpayers, published on July 27, warns about poor data collection. It says that this, and the move away from locally negotiated contracts to nationally determined tariffs, mean that PCTs risk losing their control over pricing.
'Locally, data on costs and clinical activity is often inadequate for the purposes for which it will now be needed,' said Andy McKeon, managing director for health at the Audit Commission.
He added that, whereas excellent data collection and a range of GP incentives had fostered cost-effective prescribing, similar mechanisms did not exist for the purchase of acute and specialist care.
'This is potentially bad news for PCTs. There are questions about how much they can invest more generally in primary care,' McKeon said, adding that unless PCTs got on top of the new national tariff system, non-acute services could be reduced.
The report urges PCTs to invest more in their information systems and devote more energy to the recording and coding of patient activity.
The Audit Commission also reiterated the findings of its April report, which identified a lack of financial talent and capacity at PCT level, and urged trusts to focus on strengthening this before the entire health service moves over to payment by results.
'It will be quite a tough task for them but they've got four years,' McKeon said.
The pressure may be less following after the Department of Health announcement this week that the payment by results tariff will be introduced incrementally.
From 2005/06, trusts will move from local prices to the national tariff in 25% steps, until full implementation in 2008/09.
This will allay some trusts' concerns that the transition to the tariff would be too steep.
Acute trusts where prices are currently over tariff were worried they could be hit by large drops in income over a short period of time, and PCTs whose providers are under tariff were worried about similarly large increases in their commissioning costs.
PFjul2004
