Who Pays For Advice & Guidance?

Published: 2nd March 2017
In England, the most common question we get asked after “how much does it cost?” is “who normally pays for it?”. This is a good question. Telephone Advice & Guidance benefits the entire healthcare system: Trusts can manage demand more effectively, keeping waiting lists under control. CCGs don’t pay for patients to be referred if they don’t […]

In England, the most common question we get asked after “how much does it cost?” is “who normally pays for it?”. This is a good question.

Telephone Advice & Guidance benefits the entire healthcare system: Trusts can manage demand more effectively, keeping waiting lists under control. CCGs don’t pay for patients to be referred if they don’t need to be. As there isn’t one obvious beneficiary of the service, who should pay for what?

We’ve been through this discussion in practice over 30 times now. The answer is that, in the majority of cases, the CCG pays our costs. The reason for this is that, financially at least, the CCG stands to benefit the most.

For example, let’s assume a referral costs the CCG £200. When a GP speaks to a consultant using Consultant Connect, we know there is a 68% chance that the patient will avoid an unnecessary trip to hospital. This means that every call to Consultant Connect saves the CCG £136 (£200 x 68%). It doesn’t take many calls for the savings to cover our costs and generate a surplus and, as the CCG is collecting the savings, it often makes sense for them to pay us.

There are two main exceptions where the Trust may find itself paying our costs:

  • CQUIN 2017-19: Trusts that are using Consultant Connect to meet their obligations under the CQUIN 2017-19 may find that they are expected to contribute to our costs; and
  • Trusts on a block contract (where the CCG pays a fixed amount to the Trust irrespective of activity) will benefit from reducing activity, so again may contribute to Consultant Connect costs.

Tariffs

That’s how our costs are usually settled. The next question is normally “does the Trust receive a tariff for each call that is answered?”. The answer is, not always at the beginning of a pilot – but we strongly recommend that a tariff is agreed if telephone Advice & Guidance becomes business as usual.

The reason we support a tariff being paid to the Trust is that the economics of our approach support it. If you accept the above calculation that every call to Consultant Connect is worth £136 to the CCG, it does not alter the economics materially if a tariff (normally £23-25) is paid to the Trust.

If a tariff isn’t paid, you are relying entirely on the goodwill of the participating consultants – and if they do not prioritise answering the phone, you can lose the potential savings in your system very easily. Our experience has shown that those Trusts receiving a tariff achieve higher answering rates than those projects that don’t.

The only time when we feel it is appropriate for a Trust not to receive a tariff is if a project is being piloted and CCG and Trust agree to share the risks to prove the concept. In these projects, the CCG will normally pay our costs and the Trust will pay for the consultants answering the phone, sharing the risks of trying something new. Once the system has been proven, however, we suggest adoption of a tariff as soon as practicable.

Please contact us on 01865 261467 to arrange a demonstration of Consultant Connect or if you would like to learn more about how a telephone Advice & Guidance system could be implemented in your area.

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