Mental Health PBR Reviews – Consultancy

Consultancy project working jointly with Primary Care Trust and the Mental Health Trust on equitable actions for the introduction of Mental Health PBR.


Concern that the introduction of a PbR tariff for Mental Health could have significant financial implications for the PCT and emerging Practice Based Commissioning consortia.
Real concern that the difficult history of Acute PbR introduction would be repeated.
There had been little engagement with PBC consortia in the development of the Mental Health PbR and clustering methodology.
Commissioners keen to ensure that they, and through them the emerging GP Consortia, would be able to validate the output of the work being undertaken by Trust.
We were therefore engaged by the Commissioner to carry out the validation project, including clustering activity and analysis, and where feasible the local costing of pathways.
Given the nature of the project, it was essential that Trust accepted the scope of this project and cooperated fully.

Key Challenges

Engagement amongst key Stakeholders had been limited
While there was a Joint project board there were tensions surrounding the forum
Trust was feeling isolated and also wary of impact of PbR to itself
CBM commissioned to deliver validation and this caused tensions and delay in getting a final start to the process.
New Ops director in MH trust recently parachuted in was isolated and lacking impact amongst existing management team.
While Senior Team in Trust where eventually whole supportive there were barriers within the middle tiers to overcome.

Main Actions

Utilised a small team with a wide range of complementary skills  to deliver a rapid appraisal and understanding of current and future, financial, performance and operational issues with an impact on the development of PbR.
Engaged with a wide range of professional staff at all levels in both the provider, the commissioner and other stakeholders.
Quickly assimilated information to develop a detailed understanding of critical interdependencies and identify issues for consideration/resolution.
Utilised our detailed understanding of financial modelling to appraise the approach being used to develop the PbR tariffs.
Utilised our detailed understanding of focussed project planning, delivery and assurance processes to appraise the current PbR development project plan.

Main Results and Achievements

Noticeably enhanced the level of engagement overall and particularly the effectiveness of the joint board.
Introduced and drove a sub group responsible to take the whole process of price setting, amendment, shadowing and eventual progression into contract management.
Clearer triangulation and validation of issues across organisational boundaries leading to a greater system wide understanding.
Detailed Stage One report  including findings and system wide perceptions &  Monthly report on activity, issues and actions.
CBM “Model” for Expert Clustering and Clustering Validation along with Pre Planning document for “Financial Validation”.
Initial Validation of “Broad Top Down” prices work provided by MH Trust
Pricing Trackers to measure progress and confidence in development of Initial prices.
Options for improving pace of “delivery” and monitoring of clustering progress.
Final Report detailing level of comfort, areas to be reviewed and recommendation for both Organisations