Feedback from AQP Market event 22-3-1012

Introduction

Summary of coverage of AQP services across West Midlands PCT Cluster area:

- podiatry100%

- adult hearing100%

- wheelchairs78%

- diagnostics11%

- continence8%

- MSK3%

The West Midlands is pursuing a collaborative approach (sharing of capacity and capability to achieve economies of scale and in attempting meeting the challenge timeframes).

Task and finish groups established:

Remit- review national specifications

-review and analyse established price/ currency arrangements

-engage widely with clinicians /stakeholders about intentions and intended specifications

Podiatry– update from Glyn Wise

Regional coverage across the 5 clusters:

  • Core Podiatry → Arden / Black Country/ West Mercia
  • Nail Surgery only → Staffs / Birmingham and Solihull
  • Any patients diagnosed as diabetic falls outside of the AQP specification.
  • Biomechanics is also excluded
  • The specification will prescribe certain facility standards regarding infection control etc
  • National service spec to be finalised on 28th March – this has now been extended to 11-12th April (tariff not yet agreed) in time with advert deadline 16th April.

Other exclusions:

-Self referral

-Children

-Provisory of orthotics

-Dermatological conditions

Inclusions:

-Domiciliary care

Tariff / Pricing

  • Aiming to finalise imminently in order to meet April deadline

Key timings and processes

Midlands and East are the responsible QCE for:

-MSK

-Podiatry

-Wheelchairs

The name of the QCE is EMPACT (former East CSU)

The final accreditation decision will be made by individual PCTs

Market overview

NHS & Independent sector providers, new AQP contracts awarded in September and operational from October 2012.

Tariff

Local tariff yet to be confirmed idea tariff based on time of treatment

Target dates for placing adverts

Podiatry16 April

To commence by end of September

Likely turnaround time is 3 – 4 weeks from advert placement date to advert closing date

General Points

  • A mobilisation period is allowed for, post notification of registration
  • Some adverts may be placed by individual PCTs but as much as possible AQP is being done on a macro scale e.g. by Cluster / West Midlands

Accreditation

3 year period but contract may be year/requires further review

Accreditation final decision will be PCT’s

Updated national service spec

Expected to include domiciliary,

Exclude all diabetics, all children and biomechanics/provision of orthotics

Podiatry Breakout sessions

Questions from this session were to be put on the AQP website “FAQ’s”.

These following points are based on some of the questions asked;

  1. Tariff based on time only and not all costs included - labour only, difficulty deciding on tariff as past block contract difficult to strip out for AQP tariff
  2. GP’s who provide local minor surgery including nail surgery will have to be AQP accredited.
  3. Who triages referrals? Podiatry services – each PCT will need tight referral guidelines.
  4. Patient (pt) presents with one problem but then needs treatment for another as well – how is this payment made?
  5. If patient presents to GP & GP not sure if AQP or for elsewhere then GP can send to NHS podiatry services for triage then NHS has obligation to allow pt choice. GP may pay twice as pay for triage and then pay for patient treatment.
  6. Tariffs – no payment for any treatment undertaken over and above referral criteria/spec
  7. Provider needs to be on CAB
  8. Referrals from GP and health care professional only – no self referral
  9. Provider may only be able to provide part of the package of care as per service specification i.e. if patient attends and requires orthotics then clinician cannot provide this as will not be paid so will have to refer pt back to GP for onwards referral for orthotics (!). Point made that a GP & pt likely to be happier if all the treatment can be undertaken at one appointment or with the same provider for continuity of care
  10. Tariff for doms to be confirmed
  11. CQC registration – core podiatry excluded from CQC registration

Any diagnostic and screening service provided does have to be CQC registered but at present unsure whether Doppler assessment is included in diagnostics – if it is then CQC registration will be required

  1. Once approved provider remains on AQP/CAB list for 3years (ie. Accreditation period) can come off list at own choice, but contract is currently for one year – termination clause in contracts
  2. After 3years provide will need to reapply for accreditation
  3. Opportunities to develop service specs over time
  4. Who will provide education placements/opportunities for students?- to continue as present and for appropriate professional body/universities to be involved with this.
  5. Patients can only be seen by AQP approved provider
  6. AQP encourages self care and adherence to self help
  7. Allbiomechanics not included in the service spec.
  8. AQP providers cannot undertake additional tests e.g. microbiology, provider would need to refer back to GP to refer on for these tests – delaying pt treatment
  9. All diabetes excluded from spec