One of the most frequent areas of dispute is whether a provider is delivering a particular service as envisaged by the commissioner. This can occur for many reasons. Sometimes discussions will have been ongoing between clinical colleagues but these have never been formalised into a service specification and added to the contract. Sometimes a provider will change the nature of a service because of operational issues and the commissioner may not be fully aware of the consequential impact of this change on other services.
Disputes of this type will typically manifest themselves as challenges around unanticipated referral patterns or financial pressure. But, in our experience, if the desired service pathway is not agreed between the parties, these disputes are extremely difficult to resolve.
This is despite the NHS Contract Technical Guidance confirming that “service specifications are one of the most important parts of the contract, as they describe the services being commissioned”!
Bailey & Moore offers a pathway review service that can help get to the root of these issues by starting with 2 fundamental questions:
- What service does the Integrated Care System want to commission for its population?
- What service is the provider ready, willing and able to provide?
Once the skeleton of the agreed pathway has been mapped out, more productive debate can be had around issues such as the appropriate activity volume, how the activity will be recorded and what is a fair price.
Bailey & Moore also offers individual parts of the pathway review service as standalone components: