U.S. flag

An official website of the United States government

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Crane M, Joly L, Daly BJM, et al. Integration, effectiveness and costs of different models of primary health care provision for people who are homeless: an evaluation study. Southampton (UK): National Institute for Health and Care Research; 2023 Oct. (Health and Social Care Delivery Research, No. 11.16.)

Cover of Integration, effectiveness and costs of different models of primary health care provision for people who are homeless: an evaluation study

Integration, effectiveness and costs of different models of primary health care provision for people who are homeless: an evaluation study.

Show details

Appendix 7Unit costs of services

TABLE 58

Unit costs of services

Service use itemUnit cost (£)Source and dateAny details/backgrounda
GP
  At CSS66PSSRU,107 p. 125, 10.3b GPSurgery session consultation lasting 9.22 minutes (£33); doubled on team advice
  Telephone30PSSRU,107 p. 129, 10.5Telephone triage GP for average of 4 minutes (£15); doubled on team advice
  Away from CSS66As GP at CSS
Nurse
  At CSS14PSSRU,107 p. 129, 10.2 general practice nurse£42 per hour; assume 20-minute consultation
  Telephone16PSSRU,107 p. 129, 10.5 Telephone triage nurseTelephone triage nurse for average of 6.56 minutes (£8); doubled on team advice
  Away from CSS (i.e. assuming community/district nurse)21PSSRU,107 pp. 121–3, section 10, doctors and nursesBand 6. Average of £89 per hour for patient-related work (33% of time), £49 per hour working hours (67% of time) = £62 per hour. Assume 20-minute consultation
Counsellor, psychologist
  At CSS29PSSRU,107 pp. 117–19, section 9, scientific and professional staffBand 7, £58 per working hour. Assume 30-minute consultation
  Telephone15PSSRU,107 pp. 117–19, section 9, scientific and professional staffBand 7, £58 per working hour. Assume 15-minute call
Mental health nurse
  At CSS31PSSRU,107 pp. 121–3, section 10, doctors and nursesBand 6. Average of £89 per hour for patient-related work (33% of time), £49 per hour for working hours (67% of time) = £62 per hour. Assume 30-minutes consultation
  Away from CSS31As mental health nurse at CSS
HCA
  At CSS15PSSRU,107 pp. 121–3, section 10, doctors and nursesBand 4, £30 per working hour. Assume 30-minute appointment
  Telephone7PSSRU,107 pp. 121–3, section 10, doctors and nursesBand 4, £30 per working hour. Assume 15-minute call
  Away from CSS15As HCA at CSS
Specialist nurse at CSS42PSSRU,107 pp. 121–3, section 10, doctors and nursesBand 8. Average of £139 per hour for patient-related work (25% of time), £68 per hour for working hours (75% of time) = £85 per hour. Assume 30-minute appointment
Consultant at CSS39PSSRU,107 p. 158, hospital-based doctor£116 per working hour. Assume 20-minute consultation
Case managerb
  At CSS17PSSRU,107 p. 138, 11.1, social worker adult service£51 per hour; assume 20-minute appointment
  Telephone8PSSRU,107 p. 138, 11.1, social worker adult service£51 per hour; assume 10-minute call
  Away from CSS17As case manager at CSS
Pharmacist
  At CSS16PSSRU,107 pp. 117–19, section 9, scientific and professional staffBand 6, £48 per working hour. Assume 20-minute consultation
  Telephone8PSSRU,107 pp. 117–19, section 9, scientific and professional staffBand 6, £48 per working hour. Assume 10-minute call
  Dispense methadone4PSSRU,107 pp. 117–19, section 9, scientific and professional staffBand 6, £48 per working hour. Assume 5 minutes to prepare, do paperwork and supervise administrationc
Substance misuse
  At CSS30PSSRU,107 p. 53, 3.2 Alcohol worker/liaison nurse/substance misuse nurseRange £49–81 per hour (face-to-face time is 50%). Assume 30-minute consultation with mid-range worker/nurse
  Telephone10PSSRU,107 p. 53, 3.2 Alcohol worker/liaison nurse/substance misuse nurseRange £49–81 per hour (face-to-face time is 50%). Assume 10-minute call with mid-range worker/nurse
  Away from CSS30As substance misuse at CSS
Smoking cessation consultationd8PSSRU,107 p. 92, 7.4. Public health interventions10-minute brief advice session with a nurse
Dentist
  At CSS66PSSRU,107 p. 130. NHS Dentist – performer only£105 per hour; £133 per hour for patient contact. Assume 30-minute call
  Out-of-hours visitd66As Dentist at CSS
  Out-of-hours telephoned33PSSRU,107 p. 130. NHS Dentist – performer only£105 per hour; £133 per hour for patient contact. Assume 15-minute call
A&E 166National Cost Collection data 2018/19165 (index)
Walk-in/urgent care clinic148National Cost Collection data 2018/19165 (index)Outpatient cost
NHS 1117National Cost Collection data 2018/19;165 currency code: ASC1; currency description: calls £7.33
Hospital outpatient appointment135PSSRU,107 p. 87, 7.1 NHS reference costs hospital servicesWeighted average of all outpatient attendances
Physiotherapist, occupational therapistd18PSSRU,107 pp. 117–19, section 9, scientific and professional staffBand 5, £36 per working hour. Assume 30-minute consultation
Podiatrist, chiropodist18PSSRU,107 pp. 117–19, section 9, scientific and professional staffBand 5, £36 per working hour. Assume 30-minute consultation
Dietitian18Assume same as physiotherapist and occupational therapist
Optician29NHS reference costs: 2018/19; Currency code: WF01D; service code: 130; currency description: non-admitted non-face-to-face attendance, firstOphthalmology: non-consultant led
Complementary therapyd145National Cost Collection data 2018/19.165 Currency code: AB23Z (total)Acupuncture for pain management
Hospital admission, not detoxificationPSSRU,107 p. 87, 7.1 NHS reference costs hospital servicesNon-elective inpatient long stay, £3366; short stay, £602. Assume short stay is two nights or fewer; rest is long stay
Hospital night, not detoxification, ICU1932Welsh Government166Level-3 intensive care bed, per night
Hospital night, not detoxification, HDU857Welsh Government166Level-2 high-dependency bed, per night
Hospital night, not detoxification, general ward341National Cost Collection data 2018/19165 – from index section. Regular day or night admissions, per nightCurrency code: WH17B and C; currency description: admission related to social factors without interventions, with CC score 1+ and score 0: £191 and £292
Hospital night, not detoxification, psychiatric ward424PSSRU,107 2.1 NHS reference costs for mental health services£424 per bed-day
Day cases752PSSRU,107 p. 87, 7.1 NHS reference costs 2018/19,165 hospital servicesWeighted average of all stays: £752
Hospital night for detoxification510PSSRU,107 p. 52, 3.1 NHS reference costs 2018/19165Admitted by alcohol services; £510 per night
Ambulance (convey)263PSSRU,107 p. 87, 7.1 NHS reference costs 2018/19,165 hospital servicesAmbulance services, weighted average of all attendances when conveyed; £263
Ambulance (see, treat and refer)214PSSRU,107 page 87, 7.1 NHS reference costs hospital servicesAmbulance services, weighted average of all attendances when seen, treated and referred; £214
Key worker contact not at accommodatione16PSSRU,107 p. 149, 11.3 social work assistant£33 per hour. Assume 30-minute consultation
Social services personal carerd0.50 per minutePSSRU,107 p. 142, 11.5 home care worker, face-to-face£31 per hour (duration of visits in minutes known and applied)
LA housing officer17PSSRU,107 p. 149, 11.3 using social work assistant£33 per hour. Assume 30-minute consultation
Welfare benefits agent17PSSRU,107 p. 149, 11.3 using social work assistant£33 per hour. Assume 30-minute consultation
Volunteer supporter17PSSRU,107 p. 144, 11.7 support and outreach worker£25 per hour. Assume 40 minutes per contact
Well-being groupd6PSSRU,107 p. 92, 7.4 public health interventions, well-beingAverage cost: £39 per client. Assume £6 per group session
Tests
Blood test10 NICE 167
  • Phlebotomy £4
  • Blood test (at 2016 cost) £6
Cervical smear; vaginal swabd22
  • National Cost Collection data 2018/19;165 currency code = DAPS01; currency description = cytology
  • Nurse to take cervical smear, band 6 as above, 15 minutes at £62 per hour
Cytology (process of looking at cervical cells under a microscope168) £7
Electrocardiography37NICE167 (table 9; at 2016 costs)
MRI196National Cost Collection data 2018/19;165 dept code = IMAGOP; dept description = outpatient; currency code = RD06ZMagnetic Resonance Imaging Scan of more than Three Areas.
Ultrasonography75
  • National Cost Collection data 2018/19;165 dept code = IMAGOP; dept description = outpatient; currency code = RD43Z
  • Currency code: RD40Z; currency description: ultrasound scan with duration of < 20 minutes, without contrast
  • Ultrasound scan with duration of ≥ 20 minutes, with contrast: £97
  • Ultrasound scan with duration of < 20 minutes, without contrast: £52
Urine test4 NICE 169 Urology
Wound swab3Table 6 of Guest et al.,170 at 2018 pricesLaboratory tests. Cost of health care resource use associated with managing unhealed surgical wounds in clinical practice: £2.85
X-ray/DEXAd32National Cost Collection data 2018/19;165 service code = 812; service description = diagnostic imaging, £34 (consultant led); £17 (non-consultant led)Diagnostic imaging (apparently used for X-ray costs)
Stool sample5Estimate based on local financial informationFaecal immunochemical test
Sputum7NICE171 (p. 154)Sputum smear microscopy (at 2016 prices)
Colposcopy116National Cost Collection data 2018/19;165 outpatient procedures – service code = 101; service description = urology; currency code = MA38ZDiagnostic colposcopy costs used
Echocardiography76National Cost Collection data 2018/2019;165 dept code = IMAGOP; dept description = outpatient; currency code = RD51ASimple echocardiography, age ≥ 19 years

CC, complexity and comorbidity; DEXA, dual-energy X-ray absorptiometry; HDU, high-dependency unit; ICU, intensive care unit; LA, local authority; MRI, magnetic resonance imaging.

a

Durations of appointments/contacts are based on discussion within the research team, which includes practitioners who have personal experience of providing primary care to homeless people, and interviews conducted with health professionals and managers during the study. There was a consensus that many people who are homeless have complex problems; therefore, consultations are longer than for other people. It was also recognised that consultation durations could vary and that the range was potentially large. An approximate average was thus agreed for use in the cost calculations.

b

Case manager, care co-ordinator, social practitioner.

c

Pharmaceutical Services Negotiating Committee. Payment for single activity fee £1.27; controlled drug fee, schedule 2 £1.27, Schedule 3 £0.40; item-level fee, £2.50. Or, when multiple doses provided – one single activity fee + packaged item fee of £0.55 for each item.172

d

Added category from ‘other’.

e

Key worker contact not at accommodation, for example at day centre.

Notes

Unit costs have been rounded to the nearest £1. A CSS is a general practice/primary care facility. Consultations away from the CSS were largely conducted in clinics held at hostels or day centres, and are costed as consultations at the CSS. Appointments for which patients did not attend have not been included or costed.

Copyright © 2023 Crane et al.

This work was produced by Crane et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/. For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited.

Bookshelf ID: NBK596149
Contents

Views

  • PubReader
  • Print View
  • Cite this Page
  • PDF version of this title (3.2M)

Other titles in this collection

Recent Activity

ClearTurn OffTurn On

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...