ALTERNATIVE PROPOSALS FOR SEVICE AGREEMENT IN MEDICAL OUTPATIENTS

The development of service agreements within the NHS has been directed towards inpatient care, with outpatient contracting remaining largely underdeveloped. Yet, outpatient care is variable and often complex, perhaps involving a long series of hospital visits and including procedures or input from other health professionals. This research centres on the need to focus contracts on patients and the treatment profiles used in clinical management. The aim of this study is to develop alternative contract models, based on referral, casemix and patient management patterns. This study was carried out in the Respiratory Medicine (RM) department in The Royal Hospitals NHS Trust, London, UK. Casenotes of a random sample of 1000 respiratory outpatients were examined to extract personal, contractual, referral and patient management data, relevant to the most recent consultant episode. Preliminary analysis established the casemix of the sample and the main referral sources. Three contract models were proposed and analysis was carried out to determine the most appropriate of the these by evaluating each model against a predetermined set of criteria. Results show RM outpatients to have a varied casemix, including complex conditions, which can require long term care and high resource input. Managing such a complex patient base successfully, necessitates robust service planning, provision and resource allocation, which are facilitated through implementing casemix based service agreements.