Best Practice Tariff can payment improve results? Dr Tabitha Randell Consultant in Paediatric Diabetes and Endocrinology

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1 Best Practice Tariff can payment improve results? Dr Tabitha Randell Consultant in Paediatric Diabetes and Endocrinology

2 Background ~23,500 children and young people under 18 with diabetes in England and Wales National Paediatric Diabetes Audit (NPDA) median HbA1C 8.7% ( Wide variation in outcomes by centre Unchanged in 10 years

3 HbA1C <7.5% by centre NPDA data

4 % with HbA1C <7.5% vs centre size

5 Germany

6 Germany

7 Germany

8 NHS changes All out-patient activity in England paid for by payment by results tariff Paediatric diabetes recognised as a specialty in its own right since end 2010 Best Practice Tariff for paediatric diabetes introduced Apr standards of care; if met, extra funding

9 Best Practice Tariff (BPT) criteria All newly diagnosed children to be discussed with a senior member (ie PDSN, consultant, speciality doctor or specialist reg with appropriate training in paediatric diabetes, as defined by BSPED, ACDC & RCN) within 24 hours of diagnosis Must be seen by a member of the team on the next working day

10 BPT criteria Minimum 4 clinic visits/yr in MDT clinic (consultant, PDSN, SpR, dietitian etc) must be offered HbA1C to be checked at least 4 times a year and result available in clinic Evidence of structured education programme, tailored to child/young person and their family s needs, with regular updates

11 BPT criteria Regular follow up contacts including phone calls, school visits, dietetic assessments etc; recommend 8 such contacts/year Annual screening as recommended by NICE Annual assessment as to whether psychology input needed, with psychology being an integral part of the team

12 BPT criteria Must participate in network, minimum 60% attendance and contribute to funding of network coordinator Must provide 24 hour access to advice, including expert advice to fellow health professionals escalation policies for diabetic emergencies Must be seen by a paediatric dietitian with training/expertise in diabetes at least once a year

13 BPT criteria Must have clear transition pathway Must submit to NPDA Must have Standard Operating Policy, including Did Not Attend/ Was Not Brought policy (taking into account local safeguarding policies), high HbA1C policy etc and evidence of patient feedback

14 Problems Centres not ready and difficulty engaging managers to invest Commissioners refusing to pay even if Trusts compliant Commissioners demanding minute detail in data

15 2013 onwards Those centres not meeting standards will see further reduction in funding ( 128/clinic attendance) Tariff reduced from 3189/pt per year to 2764/ pt per year Reduction based on data from 4 centres Reflect actual costs of delivering BPT compliant services

16 2013 onwards Market Forces Factor (MFF) added afterwards Will all centres be able to continue as they are long term? NPDA collecting patient experience data Peer review of all paediatric diabetes centres starting Autumn 2013-Summer 2014

17 BPT 2014 onwards HRG codes suggest 1:2 children with diabetes admitted/year In-patient stays to be included Emergency admissions Elective admissions BPT uplift accordingly

18 Rationale for including in-patients Data collected from 10 individual centres Data from Diabetic Medicine paper also included (further 16 centres) Acute admission rates ranged from 8-30% over 12 months Mean 14%

19 BPT plans Will include all admissions with primary diabetes HRG codes Allow 20% admission rate Reward centres with low admission rates Centres with high admission rates need to look at processes

20 and next..? Should BPT be extended to age 25?

21 The lost tribe the costs Approx year olds with diabetes in England (NDA ) people admitted with DKA 3118 in year old age group (1/3 all DKA admissions) Cost of DKA admission approx 1700 Total cost to NHS/year = 5.3 M

22 The lost tribe - costs

23

24 BPT for year olds Are current paediatric diabetes standards appropriate? What needs removing? What needs adding in?

25 Questions?