1. New developments in resource
allocation
PBRA (person-based resource allocation): A resource allocation
formula at general practice level based on individual level
characteristics
December 2011 © Nuffield Trust

2. The Person-based Resource Allocation (PBRA) project
• Team of experts working with Nuffield Trust from 2007
• Initial purpose was to develop budgets for practice-based
commissioning based on individual patient data
• Coverage: secondary care, prescribing, community
health services
© Nuffield Trust

3. Reviews of resource allocation in English NHS Hospital and
Community Health Services, 1976 to present
Year Name Allocations to Approximate Years applied
population size
1976 RAWP 14 RHAs 3m 77/78 – 90/91
1980 RoR 14 RHAs 3m 91/92 – 94/95
1993 University of York 14 RHAs 3m 95/96 – 01/02
192 DHAs 250,000
2001 AREA 303 PCTs 175,000 02/03 – 06/07
2006 CARAN 152 PCTs 350,000 07/08 –
Drawn from Bevan, and Bevan and Van der Ven
Note: RAWP = Resource Allocation Working Party
RoR = Review of RAWP
AREA = Allocation of Resources to English Areas
CARAN = Combining Age Related Additional Needs (9)
© Nuffield Trust

4. Resource allocation in the NHS, England
DH
CARAN PCT PCT
Fair
Practice Practice
shares
© Nuffield Trust

5. Person-based Resource Allocation

  
    
  
     
 Practice population

General population
@ £10,000 per person per year @ £1,000 per person per year @ £100 per person per year
© Nuffield Trust

6. Modelling principles

7. Linking the data sets for analysis
© Nuffield Trust

8. Modelling
• Hospital-based expenditure excluding maternity and
mental illness
• Modelled hospital expenditure in year t as a function of:
– Age and sex (36)
– Diagnostic categories from hospital utilisation in years
t-1 and t-2 (152)
– Attributed GP and small area needs characteristics (135)
– Attributed small area supply characteristics (63)
– PCT (152)
• Note: did not consider variables with potentially adverse
incentive effects, eg number of encounters
© Nuffield Trust

9. Results from testing various models predicting costs for 2007/08
using data from 2005/06 & 2006/07
Individual Practice
Validation Sample Validation Sample
(Individuals n=5,445,559
Individual (n=5,205,747) Practices=797)
Model Set of variables R² R²
Model 1: age and gender 0.037 0.344
Model 2: Add 152 morbidity markers 0.122 0.608
Model 3: Add 152 PCT dummies 0.122 0.744
Model 4: Add 135 attributed needs 0.123 0.785
& 63 supply
Model 5: Reduce to 7 attributed needs 0.123 0.774
& 3 supply
© Nuffield Trust

10. Using the formula to allocate to practices
• ‘Freeze’ supply variables at national levels
• For each individual, calculate predicted NHS hospital costs
• For each practice calculate average costs in each
age/sex category
• Assign age/sex specific averages to all individuals in practice
– to address data lags and changes in registration
• Share out PCT budget according to practices’ total predicted
expenditure
© Nuffield Trust

11. Comparing observed and expected costs at practice level, by
practice population size, 2007/08

12. Results applied in acute component of the Fair Shares Toolkit
Difference between "fair share" and 2009/10 budget after PoC historic
Step 1. Select your PCT's code from the drop-down list below.
AfterPOC
5PW North East Essex 88 50%
Step 2. Enter your PCT's budget to be allocated here
Total PBC budget £100,000,000 Rowhedge
Step 3. Indicate below if this total includes an amount to be allocated for prescribing.
25% Thorpe
Include prescribing? Yes
Step 4. (optional) Change the threshold for pace of change
Fronks Rd Family
Pace of Change 1.0% Minimum pace of change for outliers Epping Close
Harewood
10%
PoC Threshold 10.0% +/- at average practice size Ranworth
Caradoc Mayflower - Alldrick
Colne
Ardleigh The Hollies
Great Clacton Medical
Layer Road
The Frinton Road Med
The Riverside Health Parsons Heath
Lawford Partnership Mersea Road
Step 5. Set the value in column W to "No" for practices that should be 0% West Wivenhoe
Green Elms- Wynne
Mayflower
East HillEnd Tiptree
Mersea
Shrub
St.James
Creffield Road Ambrose Avenue
East Lynne
excluded from pace of change. Final budgets are in column AH. Bluebell
HawthornRoad
Winstree Walton
North Hill
Crusader Castle Gardens
Wimpole Road
-10%
Step 6. (optional) View a large chart showing pace of change and 'issue' practices Highwoods
Maltings GreenTollgate
Portland Road
by selecting the sheet "LargeChart" Old Road Mill Road
Step 7. (optional) Enter consortia names in column AI.
Sheet "Consortia" will then show data at this level. -25%
0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 18,000 20,000
Population
Weights 62.2% 2.0% 9.8% 12.6% 13.4%
Total Historic Fair
Practice Acute Maternity MH Prescribing Inequalitie Populatio Spend share Historic Fair share Historic Final
Code Practice_Name Share Share Share Share s Share n Share (%) Spend (per head) (per head) Population
Total Historic
Practice Acute Maternity MH Prescribing Inequalitie Populatio Spend
Code Practice_Name Share Share Share Share s Share n Share 100% £100,000,000 £311 £311 321,951
F81005 SHRUB END SURGERY 2.17% 2.86% 2.22% 2.22% 2.06% 8,486 2.21% 2.18% £2,207,332 £257 £260 8,486
F81012 WEST MERSEA SURGERY 2.55% 1.51% 2.23% 2.60% 1.16% 7,455 2.33% 2.32% £2,334,363 £311 £313 7,455
F81017 WALTON SURGERY 4.63% 2.09% 4.20% 4.82% 4.24% 11,049 4.74% 4.51% £4,738,019 £408 £429 11,049
F81019 MAYFLOWER MEDICAL CENTRE - ALLDRIC 3.31% 2.85% 3.43% 3.26% 3.33% 10,225 3.07% 3.31% £3,065,701 £324 £300 10,225
F81021 THE HOLLIES 2.86% 1.84% 2.62% 2.88% 2.29% 8,586 2.58% 2.74% £2,575,000 £320 £300 8,586
F81026 CARADOC SURGERY 3.33% 1.41% 3.13% 3.55% 2.14% 7,868 2.86% 3.14% £2,864,017 £399 £364 7,868
F81037 EAST LYNNE MEDICAL CENTRE 3.93% 3.79% 4.16% 3.86% 5.60% 10,673 4.27% 4.16% £4,267,997 £390 £400 10,673
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_111057 © Nuffield Trust

13. Phase 3 Objectives: in progress
• Refresh existing PBRA model using more recent data
(for allocations 2011/12)
• Develop improved PBRA model (for allocations 2012/13)
• Model a variety of risk sharing arrangements
(to inform shadow CCG and NHS Commissioning Board)
© Nuffield Trust

14. www.nuffieldtrust.org.uk/pbra
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December 2011 © Nuffield Trust