Payment by Results (PbR)
And what you need to know

The aim of this page is to give an overview of what Payment by Results (PbR) means to people who access mental health services in Dorset and most importantly how it will affect the future provision of services.

The most important thing to consider when looking at the PbR agenda is that its implementation will hold the NHS accountable for the care it provides to each individual that accesses its services. That in turn means that it will inevitably be required to put the person that is accessing that service at the very heart of it.

PbR is also an opportunity for staff to have a clear framework for an individual's care. This will allow the staff member to offer the very best level of care in line with the specific needs of the person who is accessing services. They will have an opportunity to demonstrate the effectiveness of the care they are providing as well as ensuring a positive outcome for the individual.

This is what the NHS has to say about PbR and why it is being introduced

Before PbR, commissioners tended to have block contracts with hospitals where the amount of money was fixed irrespective of the number of patients treated. PbR was introduced to:

  • support patient choice by allowing the money to follow the patient to different types of provider
  • reward efficiency and quality by allowing providers to retain the difference if they could provide the required standard of care at a lower cost than the national price
  • reduce waiting times by paying providers for the volume of work done
  • refocus discussions between commissioner and provider away from price and towards quality and innovation

This will give service providers an opportunity to better understand the needs of people that are accessing their services and ensure that their responses to those needs are high quality. They will measure the quality ensuring that it is safe, effective and a positive experience. Service providers will also need to evidence the fact that they are offering good value and this will only be able to be evidenced if they are productive and effective.

How will this be implemented and what effect will it have on my care?

PbR has been used in acute medical services (Accident and Emergency and emergency medical units) for some time. So it is reassuring to know that it has already been tested to some extent, producing positive outcomes both in standards of care and satisfaction.

In order to implement PbR all people who access secondary mental health services in Dorset will be reviewed and placed into a group of people with similar diagnoses and symptoms (this is called clustering). This process is in-depth and takes into consideration many factors to ensure that people are placed into clusters that best fit both their current circumstances and also their previous history. This process is carried out by clinical professionals with knowledge of the individual that is accessing the service.

It is important to note that clustering is not purely diagnosis led. When clustering an individual there are many factors that will be taken into consideration and the overall objective is to provide the person accessing services with the care that will best enable them to lead a purposeful and meaningful life.

After the clustering process has been completed there will be a clearly defined review process. This will vary depending on the cluster and can be anything from 4 weekly reviews to annually. This is an auditable requirement and will ensure that all individuals accessing services are given a consistent level of care.

Once a person is clustered there will be a clear care package that is designed with their specific needs identified. This will allow the professional to follow a very clear framework that is outcome focused and ensure that the individual receives the care that is required to enable them to progress through services, to a point where they can find meaning and control of their own lives.

As the focus ultimately lies in ensuring positive outcomes, it will without doubt encourage investment into proven interventions (effective treatment). A service will in the future be commissioned based on proven quality and productivity.

If implemented effectively PbR will: improve efficiency, increase value for money, facilitate choice and enable service innovation. In doing these things it will also allow people who are accessing services to work in partnership with the service provider to a clearly defined outcome. The most important point is that the desired outcome is in the best interest of the individual, enabling them to get the best from secondary mental health services and ultimately gain control over their lives.

There may be a level of anxiety amongst people who access mental health services that the introduction of a payment system based around outcomes will result in a reduced level of service and that they will not receive the quality of care that they receive currently. All indications are that the key to success will be in the development of the care packages that will fit with each cluster and this work is currently being undertaken.

The Dorset Mental Health Forum works very closely with Dorset Healthcare University NHS Foundation Trust to ensure that people who access services have their views represented at every stage of the process.

If you or anyone you know has an interest in helping to shape services you can get involved by joining the Forum. Download the Forum Information Leaflet to find out more about what we do and how you can be a part of it.