How are individuals assigned to the groups?
The next step in establishing the grouping is to understand how individuals will be assigned to groups. Commissioners and providers will need to agree on this step because it is important for the capitated payment system to understand the process for moving in and out of groups. In order to deal with this issue, we have created a preliminary categorisation for providers and commissioners to use to assign people to groups. One of these classifications is illustrated in the exhibit below.
This is the classification for only one of the groups. For the rest of the classifications, as well as a briefing on the mental-health clusters and how they could also be used for this classification exercise, see Supporting Materials A: Discussion Paper Compendium.
Of all the groups proposed above, cancer is the most complex for assigning people to groups. This is because cancer is bimodal, and many people will likely move in and out of the group several times in their lives. This is not the case for the other groups, where the vast majority of people will not move out of the group once they are in it, and the ones that do can be dealt with on an individual basis.
Because of this, we propose that cancer be a special type of group. It will still be included in the analysis as its own group; however, anyone with an active diagnosis of cancer, or up to five years after an active treatment for cancer, will stay in their home group and receive supplementary care (this has to be decided on a local level). The supplementary care will include additional care coordination services to help the individual navigate their cancer treatment, as well as extra finances for the provider networks providing their care.
The process of how people are moved from one group to another will have two steps: a commissioner step and a provider step. The specific processes involved will need to be decided locally; however, the following section lays out the general principles that will need to be involved in this process.
Commissioners will be in charge of the initial grouping, as they will determine the final inclusion criteria together with providers. It will then be up to the specific provider networks to decide who fits the criteria in different individual circumstances.
GPs will be in charge of coordinating care for the different groups across North West London. This means that they will also have the most unencumbered access to data about individual people. Therefore, GPs will have the chance to petition commissioners to reassign people after the initial process. The provider networks will need to agree the specific criteria for inclusion in the groups that they are caring for with commissioners, who will then review any petition to change a person’s group after the initial grouping.