Published: 18/11/2004, Volume II4, No. 5932 Page 11
In some quarters, the fact that any guidance on payment by results has been published by the Department of Health some six months ahead of implementation is cause for a little celebration.
Many primary care trusts believe the sketchiness of guidance for those pioneering the system this year has left them financially vulnerable to foundation trusts, some of which have interpreted ambiguities in their favour.
One first-wave PCT chief executive is rueful that 'those that played by the rules [of legally binding contracts] and do not have the benefit of hindsight' are suffering for their efforts this year.
But some PCTs are still concerned that the new guidance fudges some of the most contentious areas. Many believe a promised 'code of conduct' from the DoH should be used to help clear up disputes about how emergency admissions and complex work should be coded.
For one south east PCT chief executive, the beginnings of 'coding grist' are already being witnessed.
Under this year's national 'zerotolerance policy', emergency admissions exceeding the servicelevel agreement must be paid for at full, rather than marginal, cost.
'Just for the first quarter, the local district general hospital was looking to charge us£2.2m extra [for emergency admissions], then three weeks ago it became£2.8m and now they've come back with£2.1m - and That is just for the first quarter, ' says the chief executive. 'The question is how do you count? How do we make sure the data is clean? .' A lot of the early complications could be dealt with by urgent delivery of the DoH's promised 'guidance on acceptable behaviours around the new policy, ' argues a northern PCT chief executive. 'We urgently need clear codes of conduct.' Practice-based commissioning comes a close second in terms of strategic priority for PCT top brass.
Most welcome the concept; they just need, as ever, better guidance.
'I wish someone would do some more work on practice-based commissioning policy, ' says a northern PCT chief executive.
'At the moment it is so thin, almost like the executive summary without the detail.' They add that leaving to local determination decisions on issues such as whether a PCT's deficit is passed on in indicative budgets to practices could lead to 'bad feeling' and wasted national efforts afterwards to iron out differences.
HSJ understands a revised version of the guidance is imminent, following a four-week 'road-test' of the policy which closed at the end of last month.
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