ISSUE

ANSWER

Block contract – what’s in it?

The block contract mainly covers therapy / allied health profession services (e.g. physio, dietetics, podiatry etc). These are services for which there is currently no national tariff

Out patient DNAs – are they chargeable?

No – but if patient arrives in department and then goes home before their appointment then this is chargeable

Surgical DNAs – are they chargeable?

No – but if patient arrives at hospital and unable to have their procedure for whatever reason then this is chargeable

Tooth extractions – why are they increasing? And how can we control spend?

Has also been flagged as an issue from Bradford, suspect related to new dental contract. If this is a new pressure will need to undertake some work to manage – liase with Jini de Cruz

Patients who contract an illness while in hospital and this means they incur additional length of stay and treatment costs

Trusts can charge for this even if arguably they are in part at fault (e.g. hospital acquired infections)

Are non-mandated costs within practice budgets?

Any non-mandated activity is not within PbR and therefore not within the practice budget

Geriatric patients whose family insist on a specific home and remain in HRI until home available

Need to re-visit existing arrangements that stops us fining social services  - also are CHT willing to move people out. Needs three way discussion: commissioners, CHT, KMC

How does 3 processes during one clinic appointment generate three charges (ophthalmology)?

For patient convenience multiple appointments are arranged for the same day (e.g. ophthalmologist consultation, then orthoptist assessment). The three attendances on the same day are therefore legitimate separate out patient charges.

Patient recorded as attending when they DNAd

Normally the DNA would be put on when the clinic letters were typed following clinic.

Patient, who happens to work at HRI, attends A and E and is then charged to the practice for a minor injury that would under usual circumstances be dealt with within the workplace

Within national PbR regulations as long as it is a legitimate attendance it is chargeable. There is an issue that may be worth picking up in contract negotiations about PBC not picking up the charge for CHT employees where the employee enjoys a preferential level of access to services just because they are CHT employed.

No information received about patient episode (e.g. no clinic letter for OP attendance, no discharge letter for day case or inpatient stay)

There is nothing within Payment by Results that says that the acute Trust have to provide clinical letters regarding the episode of care in order to charge for it. This is something that could go into negotiation with an acute Trust as part of the contract

Who has responsibility for paying for temporary residents?

The problem sometimes arises because the patient gives the temporary practice and a local address and, unless the hospital already has a record of them they will allocate them to the temporary practice

Who has responsibility for paying for patients who are not registered?

If a patient is not registered then payment is the responsibility of the PCT that covers their home address

Consultant to Consultant referrals

Through PbR we are charged a New Patient tarrif price.  If a referral is generated because of a related problem, then (for the convenience of the patient) its probably appropriate for this to occur.  If, however, a referral is required for a non-related problem, then a consultant-consultant referral should not occur and a new referral should be generated by the GP if this is deemed appropriate.  PRACTICES NEED TO MONITOR THIS!  We are NOT charged if an initial referral was sent to the wrong speciality to begin with!

Data Validation

Any data discrepancies noted on the web browser should be fed back to Calum MacIver at the PCT with copies to Gawaine Carter and Sue Richardson, through the data validation proforma which is available on the 3 Valleys Consortium Website.