SCoR Talk


Friday, May 17, 2013

Unbundling tariffs: Opportunity or threat?

Dr Ian Francis Radiology Managers Conference 2013

Dr Ian Francis gets down to the business of tariffs and PBR

Unbundling tarrifs and PBR. What does it all mean for radiology providers? This was the question tackled by Dr Ian Francis who talked through the new market economy of the NHS and how it will affect radiology services at this year's National Radiology Managers Conference.

“The government has created a new NHS and has created a market economy. They’ve created competition and let it go,” stated Ian.

“There is going to be rationalisation and not everybody will do everything. There will undoubtedly be winners and losers and what you need to do is make sure you’re on the winning side of this equation.”

Ian presented a slide which described where the competition can be found, recommending providers look at this and decide the areas in which their business will operate:

Unbundling and PBR: Watch this space

“Tariffs are designed to promote health policy objectives and they’re effective in elective care where there is a desire to increase activity. They’re also designed to promote increased provider activity.

“But, if you look what the government thinks of it, they’re not sure. It’s a sent cheque exercise. They’re aware it has significant potential financial risks.”

Ian noted that a leading CCG has described unbundling as one of their biggest challenges. “They say they expect to receive an increase in volume, they’re worried about poor control and duplication, and they’re worried about how they’re going to get these services delivered in the community,” continued Ian.

Ian also noted that The King’s Fund thinks that unbundling is not fit for purpose and will not mean continuity of care. All that said, Ian was clear that radiology leaders must move with the times: “But this is the NHS now. What are you going to do about it? The status quo can not persist. You have to get your business ready.”

How? Take a leap of faith!

“Given the perfect storm we’re in now, I believe it’s the perfect time to start thinking the unthinkable. I suggest we need to unify radiology departments around their geographical areas. Between you, you'll understand the local health economy and your capacity and demands. You need to dare to share!”

Ian went on to say that providers need to let go of their competitive tendencies in order to be “bigger and stronger together”, adding that progress can only occur by sharing data, resources and issues.

Ian’s most radical suggestion was to remove imaging services from existing NHS services. “I’ve yet to be convinced that acute NHS services is where we should be housed and by that I mean managed and financially controlled.”

By unifying radiology services under local umbrella groups, providers can draw on one another’s resources when necessary. "This is about insourcing, not outsourcing”.

Once the umbrella has been formed, leaders can then acquire all NHS staff groups, but incentivised on separate terms and conditions. The other benefit, argued Ian, is potential fiscal independence based on unbundled national or direct access tariffs. This, said Ian, “gives you a glimmer of hope.”

At risk of being booed off stage, Ian added: “Once you’ve got all of that, do you actually need all the management? Can you have a streamlined management that is versatile and business savvy?”

He concluded: “I believe this is the way to meet our financial and quality challenges.”

Download Ian's presentation slides here.

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