PbR – commissioning and performance.
The transition to Payment by Results for Recovery has raised key challenges for commissioners and providers alike. While such challenges are inevitable in any major transformation, our experience has made us aware of the importance of managing these with sensitivity, transparency and support to ensure PbR is a successful commissioning strategy.
PbR can be viewed as either the market place achieving the outcomes required, thereby driving up recovery, or the market place failing and not receiving the income available. PbR can also be considered as a framework where risks are devolved to providers with commissioners having limited involvement in the process. However, commissioners ultimately have a responsibility and duty of care to people who require appropriate and effective services to address their drug and alcohol problems. From the outset inEnfieldwe have considered PbR as a means to drive up quality to enable as many service users as possible to achieve full recovery and reintegration. We want our service users to receive the best care and support available as we recognise the negative effects that substance misuse has upon our community.
The establishment of the Assessment and Care Review Team (ACRT our LASARS function, independent from the providers) also means that our commissioners are increasingly finding themselves in an arbitration role to ensure all aspects of the system are fair and reasonable. The importance to both commissioner and provider of sound data cannot be under-estimated when adopting PbR as a commissioning strategy.
In Enfield we have one system-wide database which we have adapted to enable outcome measurement across three of our four outcome domains. The fourth domain not included is reducing offending as that is centrally determined. However, we had under-estimated how data errors can quickly materialise, causing potential conflict between the ACRT, PbR providers and commissioners. When it comes to finances, anxiety is perfectly understandable and we have taken action to ensure problems are resolved quickly and fairly. Strong commissioning leadership has been essential here.
We remain confident that our model is pragmatic and achievable and we have the right PbR providers and ACRT to afford PbR the best opportunity for success. Early evidence of the outcomes they are achieving remains extremely pleasing and we are very grateful to the commissioners and those directly involved with patient care for their determined commitment.