Lambeth PCT Update and Advice on Independent Sector
Diagnostics
Inhealth Netcare Ltd (an Independent Sector provider) has recently written to
GP practices confirming that primary care now has access to their diagnostics
from the 11th April (list and prices in Appendix A).
Though the PCT is committed to improving primary care direct access to
diagnostics as well encouraging choice of providers, our strong advice to
practice based commissioners is to exercise caution in using this
capacity as there are financial risks for consortia indicative budgets.
The issues are as follows:
1. Neither PCTs nor Practice Based Commissioners have received any
new money to support this initiative, so any use of this capacity needs
to come of out existing funds.
2. In many instances, the cost of these services is greater than the cost of
the equivalent service in our local NHS hospitals. (Appendix B lists the
national tariffs associated with secondary care appointments. Generally
the tariffs for these appointments include the cost of associated
diagnostics.)
3. The PCT / PBC will only be billed on a ‘pay-as-you-go’ basis for
whatever is used by primary care. There is currently no penalty to
PCTs / PBCs for not using this capacity. Neither have PCTs been ‘topsliced’ by London NHS to pay for this capacity (the project is ‘underwritten’ by the Secretary of State).
4. Lambeth’s plans for delivering 18 week pathways do not rely on the
use of Inhealth to ensure delivery. Enough capacity has already been
procured from our secondary care providers to ensure that waiting
times are reduced to the necessary levels.
Practice Based Commissioners therefore need to be sophisticated in how they
refer to this new capacity if it is not to have a negative financial impact on their
budgets.
(Additional note: please ignore approaches from other Independent Sector
providers as Inhealth is the only company approved by the Dept. of Health to
provide GP access diagnostics in SE London).
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What next:
1. To help support Practice Based Commissioners and referrers make
informed decisions about how and whether to use this new capacity the
PCT will issue further guidance at the earliest opportunity.
For further information, queries or suggestions please contact:
Tarek Iskander
Asst Director Strategy & Commissioning
Tarek.iskander@lambethpct.nhs.uk
0207 717 4739
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Appendix A
Diagnostics Available from Inhealth
MRI, one area, no contrast
MRI, one area, post contrast only
MRI, one area, pre and post contrast
MRI, 2-3 areas, no contrast
MRI, 2-3 areas, with contrast
MRI , more than 3 areas
Tariff per Diagnostic ( £) *
151
195
223
167
254
432
MRI, case requiring extensive patient re-positioning
and/or the use of more than one kind of intravenous
contrast agent
Dexa scans
Ultrasound scan 0-20 mins*
Ultrasound, scan > 20 mins*
X-ray (including digital)** no greater than
Other Echocardiogram or Cardiac Ultrasound
Screening Echocardiography
Flexible Sigmoidoscopy (including histopathology)*
Colonoscopy
ECG
24 Hour ECG
24 Hour BP Monitoring
MRI Report only
X-ray Report only
828
48
62
92
40
102
57
304
304
23
78
76
26
18
* Tariff includes diagnostic test and report back to referrer
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Appendix B
2007-08 Outpatient Mandatory Tariff
Outpatient
specialty code
Outpatient specialty name
100
General Surgery
101
Urology Outpatients
103
Breast Surgery
104
Colorectal Surgery
105
Hepatobiliary and Pancreatic Surgery
106
Upper Gastrointestinal Surgery
107
Vascular Surgery
110
Trauma and Orthopaedics
120
ENT
130
Ophthalmology Outpatients
140
Oral Surgery
143
Orthodontics
144
Maxillo-facial surgery
160
Plastic Surgery
161
Burns care
171
Paediatric Surgery*
191
Pain Management
300
General Medicine
301
Gastroenterology Outpatients
302
Endocrinology
303
Haematology [Clinical]
306
Hepatology
307
Diabetic Medicine
320
Cardiology Outpatients
321
Paediatric Cardiology*
322
Clinical Microbiology
330
Dermatology Outpatients
340
Thoracic Medicine
341
Sleep Studies
360
Genito-Urinary Medicine
370
Medical Oncology
410
Rheumatology Outpatients
420
Paediatrics*
430
Geriatric Medicine
460
Medical Opthalmology
501
Obstetrics using Bed or Delivery
502
Gynaecology Outpatients
503
Gynaecological Oncology
800
Clinical Oncology
Adult First
Adult Follow-up
Attendance Attendance tariff
tariff (£)
(£)
155
80
161
80
162
83
188
104
175
88
168
86
172
87
148
73
116
62
103
49
124
63
214
76
127
66
133
65
214
75
165
105
192
88
220
94
193
95
215
90
275
86
267
86
247
90
155
82
223
141
85
43
118
58
201
101
160
79
146
81
227
87
224
99
217
114
288
129
93
87
158
68
138
76
222
161
204
82
Outpatient
Code
Outpatient Procedure name
OPCOP1Colposcopy
OPEPI1Epidural Injections [for Pain Services, specifically not Obstetrics]
OPFNB1Fine Needle Biopsy of Breast
OPFSI1Flexible Sigmoidoscopy
OPLDL1Laser Destruction of Lesion of Skin
OPNBP1Needle Biopsy of Prostate
OPPHYS1Hysteroscopy
OPRSI1Rigid Sigmoidoscopy
OPSIS1Subcutaneous Injection / Introduction of Substance into Skin
Child (U17)
First
Attendance
tariff (£)
166
170
130
120
175
170
138
157
130
111
138
224
148
140
214
165
174
94
218
251
443
503
319
176
223
85
129
210
113
146
496
244
217
288
123
158
130
339
144
Child (U17)
Follow-up
Attendance
tariff (£)
85
107
82
79
96
87
81
85
70
57
73
83
75
74
75
105
65
79
134
131
165
226
159
113
141
43
71
123
69
81
222
135
114
129
51
68
91
218
85
Adult tariff (£)
221
202
283
304
408
291
253
205
180
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