A Treatment Provider’s Perspective on PbR
Stockport Community Drug and Alcohol Service has faced a number of challenges during the development and implementation of the drug and alcohol payment by results pilot.
Matthew Phoenix, Service Manager, explains more about the challenges and how they have addressed them.
The initial challenge was to gain a full understanding of the concept of payment by results itself. Word travels fast amongst service users and the workforce alike. It was important to avoid panic and to ensure the correct messages were sent out. Through effective consultation between commissioners, service users, and the workforce, we were able to give reassurances that PbR would enhance existing good practice within the treatment system, rather than present a threat.
A further challenge was to ensure that the service could stay financially viable through a PbR commissioning process. A commissioning culture of dialogue and negotiation has been developed inStockportover a number of years. This helped to ensure that our concerns around financial viability could be addressed, giving us the best chance of continuing to operate. This did not divert or detract from the core principles of PbR, and meant that the pilot stayed true to the original concept of incentivisation around abstinence and recovery.
An additional challenge was the management of change. A workforce familiar with the concept of “retention in treatment” as evidence based practise, struggled initially with the revised emphasis on abstinence and successful outcomes. Service users who had become familiar with treatment systems designed around retention also displayed a reticence to engage in abstinence focussed dialogue. These issues have been addressed through changes in various aspects of service delivery, and through enhanced emphasis on existing elements of service delivery. Changes range in scale from re-designing the premises to provide a more inviting, recovery focussed atmosphere, to setting up an ex-service user employment bank for ex-service users to work in our treatment services. The short lead-in time to the introduction of PbR set the tone for the ongoing pilot. Changes have been developed and initiated at a pace which might not have been evident outside of the pilot, and traditional project design processes have been challenged.
One of the most significant challenges we faced with PbR was developing an administrative system which monitored performance in a way which would also monitor tariff payments. The system had to be responsive enough to give an up to date, accurate financial picture. If shortfalls began to accrue, a point would be reached where the service would be unable to recover. A system of weekly scrutiny and comparison of TOPS activity has proved the most effective way of tracking payments.
PbR has had a significant impact on both the clinical and the administrative aspects of the service. Through collaborative working with commissioners and service users, the benefits are becoming evident. Abstinence and recovery have moved to the fore, butStockport’s PbR pilot recognises that for individual service users, this will be achieved over varying lengths of time. Further challenges remain, but the cultural shift which has begun suggests that these challenges will also be met successfully.