In order to calculate a full budget, it is essential to collect granular activity and cost data. However, it is possible to phase in a capitation programme without having already collected the necessary data.
In the data pack found in Supporting Material E: Review of Analyses During Co-design Phase, initial estimates of capitated budgets for each area based on the costs in Hammersmith and Fulham are provided. In order to calculate these figures, first a sample for each population group was taken and the total cost of care across all settings was found. This number was divided by the total to find the per person average.
Then, for each area, the average was adjusted based on the differences between Hammersmith and Fulham versus each other area. Differences considered include the relative proportion of people in each on population group, the relative prevalence of various conditions, total population sizes and relative spends n different care settings in each local area. More information about this adjustment process is available in Supporting Material E: Review of Analyses During Co-design Phase.
A shadow-capitated budget can be created based on this figure. In the first year, payment happens as normal, but performance can be compared against the shadow budget to allow fine-tuning of the capitation budgeting process before it goes live.
Initially it is not proposed that further adjustments are made by commissioners to the capitated budget for a population group. However, providers will need to prioritise the resources they receive for a population group according to the magnitudes of needs across the individuals for which they are providing care. Over time, as more data is gathered and the impact tested against shadow budgets, this initial assumption will need to be tested, particularly if there are concentrations of needs within some provider organisations but not others.
An example of the results of the capitation calculations based on the costs in Hammersmith and Fulham are below. More details can be found in Supporting Material E: Review of Analyses During Co-design Phase.