PbR: The Wigan approach
PbR has been adopted in Wigan as part of an overall commissioning strategy and development plan. A cohort approach has been adopted where payments are made relative to outcomes for 3 complexity groups. Outcome payments increase in value as the proportions achieving those outcomes increase. All outcomes are measured on a rolling 12 months.
View the Wigan Model
The outcomes being measured are: abstinence; successful completions; and non re-presentations within 6 months of being successfully completed. To encourage services to engage new clients an individual tariff payment is being made for each new presentation, again this is differentiated by complexity.
Services have a responsibility for achieving other outcomes and these include measures attached to reoffending and employment, education and training.
Commissioners have adopted the approach described as it:
- Provides a corrective to the tendency for outcomes to reflect variations either at presentation or while in service;
- Reduces potential impact of errors and data complexity;
- Reduces potential for gaming;
- Assists in predicting expenditure for commissioners and income and cash flow for providers;
- Increases partner / market confidence;
- Better suited to working with an existing provider
David Gray from Wigan DAAT commented
“PbR is an exciting opportunity to look at how we currently commission our drug and alcohol recovery services. It will allow us to test whether financial incentives on local priority outcomes will increase the chances of individuals achieving recovery and sustained drug free lifestyles, which will in turn bring huge benefits to communities in Wigan.”
The project team forged strong partnerships with all providers delivering PbR and have been transparent in all aspects of communication with them. The team felt it important to include the local workforce and expertise identified within each provider to ensure the best service could be provided and that would meet the expectations of PbR.
Co-design has provided a unique opportunity to work with a range of government departments and colleagues from local Partnerships across the country. This approach was both challenging and rewarding in working to achieve an approach that reflects local need. Each pilot has developed a model suited to their locality which if fundamental in making PbR work. These different models will ensure a strong evaluation that will support areas to take PbR forward.