London Specialised Commissioning Group
Major Trauma Services for London
Commissioning and Finance Arrangements
10th September 2009
Sean Overett
Divisional Director
London Specialised Commissioning Group
Background
• The London Commissioning Group (LCG) has asked the
London Specialised Commissioning Group (London
SCG) to develop proposals for the commissioning of
Major Trauma for 2010-11
• New pan-London service
• SACUs only just coming on-line
• London SCG is experienced in establishing and running panLondon commissioning arrangements
• The London SCG has identified a lead commissioner to
develop proposals
• sean.overett@londonscg.nhs.uk / 020 8433 6856
• Currently consulting with stakeholders and developing
final proposals
London Specialised Commissioning Group
Fixed / Confirmed by PCTs
• Number of MTCs:
4
• Service Start Date:
01.04.10
(For 3 MTCs, I to follow)
• Patient Identification:
≥ISS 16
• Patient Activity:
c1600 pa +/-
• New PCT Funding:
£13.9m
• Funding Start Date:
01.04.10
(For 3 MTCs, I to follow)
London Specialised Commissioning Group
Establishing the incremental cost
Summary of costs included in pcb
(Slide from HfL MT programme
- Establishing the current and future economics – briefing for LSCG)
3 MTCs 4 MTCs
£m
£m
Enhanced Specification
7.8
10.4
Concentrating a loss
making service
2.4
2.4
Central Network
infrastructure
0.3
0.3
Volume reduction to PCTs
(1.1)
(1.1)
System costs arising from
changes to MFF
1.0
0.9
Ambulance costs
1.0
1.0
11.4
13.9
Overall
This is estimated at £2.6m per MTC (work still
underway) and would scale according to the
number of MTCs.
Variable cost is greater than income, ie a loss is
created for every additional unit of activity
transferred into the new MTCs, 
 The corollary of this is a small (<£0.1m)
positive effect in peripheral hospitals from not
undertaking major trauma
This does not correct baseline shortfalls and
relates only to the activity shifts under the new
system.
London Specialised Commissioning Group
Proposed Commissioning Approach
• PCT contributions
•
Contribution to £13.9M will be pro-rata to annual PCT allocations
• Identifying major trauma patients
•
•
Major trauma centres and trauma units will submit a compulsory
data set, (as agreed between the London Trauma Office, London
SCG and TARN), to the TARN Database within agreed timeframe.
Patients who TARN rates as ISS ≥16 will be considered major
trauma patients for the purposes of these commissioning
arrangements.
TARN will provide details of each major trauma patient to the
London SCG. NHS Number will be collected and provided.
SACU/PCTs will be provided with details.
London Specialised Commissioning Group
• Commissioning HRGs for MT patients
•
•
Cannot separate major from significant trauma by HRG code, so
HRG activity for all trauma will continue to be commissioned by
the PCTs – through the respective SACU. Cross referencing the
NHS number between TARN identified ISS ≥16 patients and the
PCTs should allow for detailed analysis by ICD10 and HRG to
better inform future arrangements
• Funding additional needs of MT patients
•
•
Need to take account of the additional resources used in the
treatment and care of the major trauma patient, so
For each major trauma patient, (as confirmed by TARN), above
the existing baseline activity, (and where critical care costs are
around London average), it’s proposed that the major trauma
centre will be paid a top up to the HRG of £2K per patient
London Specialised Commissioning Group
• Funding the MT service specification at MT centres
•
A ‘quality premium’, i.e. the annual payment to major trauma
centres to fund the additional costs of establishing and funding the
resources to meet the major trauma service specification, of
c£2.6M per MTC will be funded as follows:
– 70%, (c£1.82M) will be paid in April 2010 up front following
the successful assessment by the review team in January
2010 that the major trauma centre will meet the essential
requirements of the service specification to the required
timescale.
– A further 10%, (£260K) will be paid at each of three in-year
review visits by the London Trauma Office, London SCG
and relevant SACU following successful demonstration of
achieving performance indicators / implementing best
practice etc.
London Specialised Commissioning Group
•
Contracting Arrangements
•
The London SCG will develop an appropriate contract schedule for
major trauma to be included in the London SCG Specialised
Services Contract with each of the major trauma centre providers.
The schedule will include the financial values and payment
timetable; the service specification, performance and monitoring
requirements
•
SACUs will be provided with copies of the trauma specification that
relates to trauma networks and trauma units for inclusion in their
contract documentation with major trauma centres, trauma
networks and trauma units. SACUs will be involved in the
performance management of the relevant areas of the service
specification at both trauma units and major trauma centres in
conjunction with the London SCG and London Trauma Office
London Specialised Commissioning Group
•
HEMS commissioning currency may need to be adjusted to reflect new
arrangements and prevent two-tier approach to funding MT
•
The funding arrangements for patients transferred from a major trauma
centre to a trauma unit needs to be clarified and agreed so that:
– PCTs are not charged twice for the same episode of care
– Trauma units are funded for the transferred patients they take
•
There is a need to transfer patients in an effective and timely manner
through the system in order to not restrict capacity at the MTC, e.g.
– Major trauma centre to trauma unit
– Major trauma centre or trauma unit to rehabilitation
•
Implementation of the pan-London trauma model may result in
increased demand for neuro and spinal rehabilitation services
London Specialised Commissioning Group
• Sustained over or underperformance at any MTC will require a
review to be undertaken of its impact on the operation, delivery and
quality of care
• Out of London PCTs / SHAs
•
There is a need to understand the major trauma pathways being
established by neighbouring out of London PCTs/SHAs
•
Out of London PCTs will be advised that where their (TARN
identified) major trauma patients are treated at a London MTC
– from 2010-11 they will be liable to pay the HRG top up
– From 2011-12 they will be liable to pay a pro-rata share of
the quality premium. (Likely to be based on validated
activity in 2010-11)
London Specialised Commissioning Group
• Governance Arrangements
•
•
•
•
Detailed work on the governance arrangements for the London
trauma office, the major trauma centres and trauma networks
continues
Accountability for the London SCG commissioned element of the
major trauma service will be through the London SCG Chief
Operating Officer to the London SCG Executive and then through to
the London Commissioning Group
Accountability for other trauma will be through the appropriate
contract to the SACUs and the PCTs and the London
Commissioning Group, with relevant elements of performance
management through the Trauma Networks and London trauma
office as appropriate
The Joint Committee of the PCTs, (JCPCTs) will require assurance
that the agreed model and pathways have been established, and
are operating as planned
London Specialised Commissioning Group
Summary
• £13.9 M of investment by the PCTs to implement a pan-London major
trauma system
• The quality premium and the HRG top-up will be contracted and
performance managed by the London SCG in conjunction with the
London Trauma Office. The major trauma centres, trauma networks
and SACUs will be involved in the relevant elements of the
contracting and performance management process as appropriate.
• Out of London PCTs will be required to pay the HRG top-up in 201011 and a pro-rata share of the quality premium from 2011-12.
• These are the initial commissioning arrangements. These may
change in the light of experience, increased information,
developments in PbR.
• The London PCTs will want to see evidence that their investment and
that of the providers, clinicians and operational staff have resulted in
in the expected improvement in the care and outcomes of people with
London Specialised Commissioning Group
trauma