Tackling unexplained variation in performance at Practice level

Many consortia shy away for even considering working in this area for fear of conformation with Practices; however, that need never be the case.

Handled well this is a relatively easy process for any Consortium Board to lead; indeed, it should be part of the Consortium Board role in leading the entire process of commissioning.

The most common mistake is in assuming that the figures simply reflect the practices performance, this is not the case. To further explain; variation normally comes down to one of five key things (please see below).

The Consortium Board therefore need to work with the PCT, and the practices, to understand why we get the outcomes we get, and then decide what we can do to drive up quality, reduce variation, improve outcomes and deliver financial balance (cost effectiveness and value for money).

Tackling unexplained variation in this way is one of a very few ways we can hope to drive the level of efficiency required. It also means Consortia are putting their own house in order while at the same time holding other providers accountable.

Additionally, it might help you when contacting the practices, if you frame the focused work at Practice level in this context as it is much less confrontational or threatening for practices.

1.Something we are doing to ourselves in the way we deploy resources

2.Something the provider is doing to us in the way they manage patients

3.Random Variation*

4.PbR rules

5.A combination of one or more of the above

Practices will need to understand, and accept, there is a finite pot of money and they must remain within it. With this in mind the goal is either to keep within the budgets set or unequivocally demonstrate why that budget is inadequate.

The process is not designed to be difficult or punitive for practices, but rather a trigger for focused examination of particular areas. In short, the work will allow Consortia to understand whether or not they can refine clinical practice as a result of what they find; if not it will allow them to explain, and if necessary defend, the position with the PCT.

This in effect will quickly become about how we start to go up one, two, three gears plus with the advent of GP Commissioning, and as we get hard budgets.

For further details or information on how SMC can work with you to develop a similar model locally to tackle unexplained variation in a constructive manner, contact us at enquiries@scottmckenzieconsultancy.com or via the contact page, or call Scott on 07980 973 596.

* Variability of a process (which is operating within its natural limits) caused by many irregular and erratic (and individually unimportant) fluctuations or chance factors that (in practical terms) cannot be anticipated, detected, identified, or eliminated.

Chris Gardner

Entrepreneur, author and inspiration for the film "The Pursuit of Happyness."

www.chrisgardnermedia.com

Salford Commissioning Group

Judy Cook

Board member Lambeth PBC