The document discusses developing a person-based resource allocation (PBRA) methodology for allocating healthcare budgets to general practices in England. It outlines testing a PBRA approach which aims to better account for local variations in patient need compared to existing area-based formulas. The results showed the PBRA maintained overall patterns of need but was more sensitive to local variations. An interactive budget toolkit was developed to help clinical commissioning groups set robust practice budgets combining PBRA estimates with other allocation factors.

1. Person-based resource allocation
in practice
Rob Shaw
Economic Adviser

2. Why a person-based
formula?
• Existing formulae used for PCT allocations
based on small area based analysis
• For practice-based commissioning, we
want estimates of healthcare need for
practices
– But practice lists are not comprised of whole
small areas.
• Options:
– Attribute, but systematic variation in
registration patterns
– Move to practice or person-based…

3. What we did
• 2007: Tendered for research to investigate
the feasibility of a person-based approach
– It works!
• 2008: Tendered for research to develop
PBRA methodology for PBC in 2010/11
– Results were delivered summer 2009
– But: regression output ≠ practice budgets

4. Testing the results
• Results expected to
– Maintain overall patterns of need from
previous formula
– More sensitive to local variations in need
CARAN PBRA CARAN PBRA
Least Deprived 0.94 0.94 Youngest age 0.81 0.80
1.00 1.00 0.95 0.95
1.01 1.01 1.01 1.01
1.04 1.03 1.05 1.05
Most Deprived 1.03 1.03 Oldest age 1.14 1.14
Most - Least 0.09 0.09 Old - young 0.33 0.34
Most / Least 1.09 1.09 Old / young 1.41 1.42

5. And in two dimensions…
CARAN PBRA
A A
0.63 0.89 0.62 0.89
B B
Average age quintiles
Average age quintiles
C C
D D
1.07 1.39 1.07 1.34
E E
A B C D E A B C D E
Deprivation quintles Deprivation quintles
0.60-0.70 0.70-0.80 0.80-0.90 0.90-1.00
1.00-1.10 1.10-1.20 1.20-1.30 1.30-1.40
Ratio AA:EE= 2.20 Ratio AA:EE= 2.16

6. More sensitive to local
variation in need
2.50 2.50
CARAN PBRA
2.00 2.00
1.50 1.50
1.00 1.00
0.50 0.50
0.00 0.00
0 5000 10000 15000 20000 25000 30000 0 5000 10000 15000 20000 25000 30000
sum of absolute error = 5.1 sum of absolute error = 4.3
Correlations of ratio between PBRA and actual spending with respect to:
o Educational attainment (r= -0.03) o Practice size (r = -0.02)
o Ethnicity (r = 0.16) o Proportion of patients receiving free
o Life expectancy (r= 0.00) prescriptions (r = 0.10)
o Long term illness prevalence (r = -0.05) o Disability living allowance (r = -0.03)

9. Identifying outliers
• Developed ‘issues list’ to identify possible
reasons for outliers
– Recent population changes
– Student practices
– Skewed or unusual age profile
– Wide geographical area covered
– Recent GP moves; practice mergers
– Significant proportion living in Wales/Scotland
– High proportion of patients in nursing homes

10. Research → budgets
• Responsibility for setting PBC budgets for
practices sits with PCTs
• Developed interactive budget toolkit and
guidance
– combines benefit of this research with local
knowledge/ responsibility
– Supports PCTs to set robust budgets

11. The toolkit
• Combines PBRA ‘fair shares’ with formulae
for maternity, mental health, prescribing
and inequalities
• Uses funnel plots to illustrate impact of
practice size on variation
• Options to:
– model impact of ‘pace of change’
– Update populations and historic budgets/spend
• Works at practice or PBC ‘consortia’ level

12. Google: dh pbc 2011-12
Weights 58.6% 2.7% 15.9% 10.3% 12.5%
Historic Fair
Practice Acute Maternity Prescribing Inequalities Total Spend share
Code Practice_Name Share Share MH Share Share Share Population Share (%)
Historic
Practice Acute Maternity Prescribing Inequalities Total Spend
Code Practice_Name Share Share MH Share Share Share Population Share 100%
E87002 VICTORIA MEDICA 5.27% 5.34% 4.48% 4.94% 4.11% 10,617 6.50% 4.97%
E87005 BELGRAVIA SURG 3.10% 2.42% 2.70% 3.14% 1.26% 6,772 2.92% 2.79%
E87008 PADDINGTON GRE 4.29% 3.50% 3.74% 3.70% 4.73% 8,144 3.90% 4.17%
E87009 THE GARWAY MED 2.49% 1.67% 2.48% 2.54% 1.96% 5,450 2.07% 2.41%
E87010 MAIDA VALE MEDI 2.92% 3.52% 3.52% 3.19% 4.38% 8,121 2.59% 3.24%
E87011 LISSON GROVE HE 4.69% 4.18% 3.66% 3.75% 5.04% 8,090 4.77% 4.46%
Fair share Historic Final Fair Share Historic Apply PoC
Historic Spend (per head) (per head) Population (Total) (Total) change PoC? level Final allocation
Apply PoC
£100,000,000 £409 £409 244,739 £100,000,000 £100,000,000 0.0% PoC? level £100,000,000
£6,500,839 £468 £612 10,617 £4,966,783 £6,500,839 -23.6% Yes 7.8% £6,170,228
£2,921,519 £413 £431 6,772 £2,793,914 £2,921,519 -4.4% Yes 9.8% £2,918,885
£3,896,557 £512 £478 8,144 £4,172,854 £3,896,557 7.1% Yes 8.9% £3,893,043
£2,065,545 £441 £379 5,450 £2,405,523 £2,065,545 16.5% Yes 10.9% £2,166,727
£2,590,088 £399 £319 8,121 £3,244,139 £2,590,088 25.3% Yes 8.9% £2,717,140
£4,774,296 £551 £590 8,090 £4,459,324 £4,774,296 -6.6% Yes 9.0% £4,769,991

13. Issues Highlight historic Min PoC for outliers 5.0%
Difference between "fair share" and 2010/11 budget after Pace of Change AfterPOC
At least 2 reasons PoC threshold 10.0%
Issues
100%
Labels Short Names
Kings College Imperial College
Show Historic
50% Ahmed N Queens Park
Scale Axes Auto
Third Floor Lanark Road
North West London Crawford Street
Harley Street Victoria Muir'S
25% Mayfair
Lai Chung Fong Queens Park Queens Park
Nagarajan Woodfield Road Cavendish
Connaught Square Maida Vale
Milne House Shirland Road Bayswater
10% Ground Floor Lanark The Garway Medical Newton
Wellington Paddington Green St Johns Wood Medical
The Royal Mews Little Venice
0% Crompton
West Two
Srikrishnamurthy Harrow Road Elgin Clinic
New Elgin The Randolph Westminster And Pimlico
Belgravia
Lisson Grove
-10% Lupus Street Marylebone
Soho CentreMaher Shakarchi'S Gate
For Health And Care
Lancaster Fitzrovia
Fluxman Harrow Road
The Westbourne Green Victoria
Soho Square General Medical
Marven
-25%
Millbank
Covent Garden
Westminster School
-50%
The Doctor Hickey
-75%
0 2,000 4,000 6,000 8,000 10,000 12,000 14,000
Population