Key risks and questions

Published: 22/07/2004, Volume II4, No. 5915 Page 31

Is the whole of your organisation ready for the introduction of payment by results?

Have you got non-finance colleagues who admit to remaining mystified by the whole process?

If the answers to those questions are no and yes respectively, then you could do worse than obtain several copies of the Audit Commission's Payment by Results: key risks and questions to consider for trust and PCT managers and non-executives.

The main risk inherent in payment by results is with primary care trusts that are unsure of the amount of demand for work that they have commissioned, warns the Audit Commission's booklet.

Explanations of terms are covered along with the new system's background, before listing a series of searching and vital questions that all board members must ask.The importance of having clear and accurate coding (recording what work has been done) in place is stressed.

Questions for PCTs include: what is the reference cost position of their main providers compared with the average, what baselines are they setting for elective and non-elective activity, how do their planned-for changes compare with historic trends, and what is their engagement with GPs?

Acute trusts are urged to check auditors' findings on the accuracy of costing, consider what independent reviews of activity and recording may be needed and consider how they can best engage all relevant staff in the introduction of payment by results.