Evaluation, Research and Development Unit

PBC Rewards Scheme

Background

The Practice Based Commissioning Reward (PBC) Scheme for NHS County Durham and Darlington was launched on the 1st January 2009 for a period of 15 months until March 2010. It was devised to reward practices for pro-active involvement and engagement with practice based commissioning and for the development of local commissioning intentions on behalf of their local patient populations.

The reward scheme has three component sections: engagement (mandatory); obesity management (mandatory) and health improvement.  This last section focuses on two specific areas of activity, COPD and diabetes, practices can choose to carry out either one, both or neither of these options.  The objectives of the clinical components were to initiate appropriate treatment of overweight and obese people (obesity), to identify people with diabetes or impaired glucose tolerance from a high risk population (diabetes) and to reduce emergency admissions for COPD and improve quality of life (COPD).

Methods

To draw up pathways based on the Rewards scheme and to model expected resource consequences of those pathways. To incorporate data from MIQUEST data being extracted from participating practices in order to compare actual against expected resource use and outcomes. An interim report was provided in March 2010.

Conclusions

  • That the obesity element uses interventions that are broadly effective and cost effective in achieving the stated objective provided weight loss is sustained over a long period. Short term results are promising for the minority who completed the programme, but longer-term evidence that weight loss is maintained is necessary to confirm its cost-effectiveness.  
  • That screening for diabetes in at risk-populations such as the obese, those with hypertension and those aged >40 years is cost-effective. The Rewards Scheme has had a significant impact but there remains a substantial unscreened population. There is scope to improve the accuracy of the Scheme. The need for supporting services to keep pace with the growth in the diabetic population is self-evident.
  • That screening for COPD element represents good value for money, especially if additionally limited to those people with symptoms and extended to include an estimation of lung age. The principle is established of identifying those who should have pulmonary rehabilitation. It can be done more simply than the Scheme required. However, it appeared to generate a demand that could not be met.

Contact g.p.rubin@durham.ac.uk