Are resources being targeted effectively by PCTs?
All PCTs should be asking questions about where they spend and what they get for their money. The programme budget information, available for all PCTs, provides a good starting point with spending information on 23 broad disease categories. This allows PCTs to look at the variation in spend for particular diseases.
One example is diabetes, a sub-category of endocrine diseases. Total spend on diabetes by PCTs in 2006/07 was £900 million and there is wide variation in expenditure. The main reason for this ought to be variation between PCTs in the diabetes prevalence and hence variation in the demand for diabetic services.
However the link between the programme budget data and prevalence for 2006/07 is poor with only around 8 per cent of the variation in spend explained by the diabetes prevalence. The figures for prevalence come from the Quality and Outcomes Framework and reflect the number of known diabetics registered with GP practices. There are two possible explanations: either PCTs are not targeting resources toward those who need them, or poor data quality of programme budget information.
Prescribing data provides an alternative source of cost information. The second exhibit shows that, for prescribing, resources are being targeted toward areas with higher diabetes prevalence. It also suggests that the cause of the lack of relationship between the more general programme budget data and prevalence in this case is primarily an issue of data quality.
It might be expected that PCTs with higher rates of intervention in primary care (as measured by prescribing spend per diabetic) would have lower emergency admissions. Sadly, this does not appear to be the case, as the final exhibit shows.
PCTs should review their spend on diabetes, access to diabetic services and how effective they have been at reducing admissions by investing in primary care.