Noel Plumridge states (HSJ, 22 February) that there was 'never really payment by results; it was always payment for activity' and highlighted the need for incentives for clinicians.
In the 'South Yorkshire laboratory' (an all-FT economy) it has been true that PbR was about activity until recently, when the North Trent Cancer Network agreed an overarching governance framework with all providers (all foundation trust) and commissioners. This sets out the information required from the providers of services, irrespective of location, and that explicitly includes the independent sector and primary care providers.
The information requirements will be based on:
- patient experience - satisfaction with the service, dignity surveys;
- compliance with cancer peer review standards - themselves based on National Institute for Health and Clinical Excellence,.improving outcome guidance for commissioners;
- clinical outcome information;
- entry into clinical trials;
- compliance with NICE guidance/improving outcome guidance implementation/guideline implementation;
- sustaining cancer waiting times targets delivery, including good practice implementation.
The clinical outcome information will be a small number of measures of high-quality outcomes. They may be short or medium-term measures dependent on the type of cancer but allowing for stratification of patient risk factors. Data can be collected at clinical team level.
The value of such data, once available is enormous and there are multiple wins:
- For patients - true choice based on evidence of experience of patients previously treated by that clinical team as well as meaningful outcome data;
- For trusts - much more information for internal governance systems as well as the first chance ever for inter-trust services to be assessed;
- For clinical teams - a chance to confirm they really are as good as they think they are - or where poor performance is due to resource issues, the chance to successfully bid for greater resource;
- For commissioners - the chance to confirm to SHAs they are truly commissioning quality services.
The framework explicitly anticipates services moving out of hospitals and there is the expectation that providers of cancer care in a primary care setting or the independent sector would also be part of the information collection process to ensure patients, by opting for local care, are explicitly receiving quality care.
Thus we can move to 'the right patient being seen at the right time by the right people with the right result'. There are issues about the collection of the data - much of which is already recorded but not in the same place.
At least we have taken the first steps to ensure there is a result within the PbR system - and that the explicit delivery of patient-centred, high-quality services will be rewarded with patient choice and thus the development of a patient-led NHS.
Dr David Levy, clinical oncologist, Weston Park Hospital, Sheffield; medical director, North Trent Cancer Network
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