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Emergency admissions target worth 25% of quality premium

CCGs will have a quarter of their quality premium tied to reducing avoidable emergency admissions, a larger proportion than any other area, the NHS Commissioning Board has announced.

In a move that GP leaders warned risked CCGs losing sight of the ‘bigger picture’, the Board said that 25% of quality premium payments would be tied to reducing avoidable emergency admissions.

This compared with 12.5% of the premium for reducing mortality and the same proportion for rolling out the ‘friends and family test’ and preventing healthcare associated infections.

The remaining 37.5% of the payment will be paid on meeting three locally determined indicators, determined by the CCG and Health and Wellbeing Boards.

In draft 2013/14 guidance for CCGs, the Board confirmed that they will reduce the payments if providers do not meet targets detailed in the NHS Constitution - as announced in planning guidance released earlier this month.

The quality premium will be reduced by 25% for each missed target, including a maximum 18-week wait from referral to treatment, maximum four-hour waits in A&E departments, maximum 62-day waits from referral to cancer treatment and maximum eight-minute responses for Category A red 1 ambulance calls.

The guidance said: ‘The NHS Commissioning Board has sought to design the 2013/14 quality premium in ways that: promote improvements against the main objectives of the NHS Outcomes Framework, ie reducing premature mortality, enhancing quality of life for people with long-term conditions, ensuring swift recovery after acute illness or injury, improving patient experience, and ensuring patient safety.’

The Board said that the value of the payments will be announced in the New Year, although it used a value of £5 per head to ‘illustrate’ how much CCGs could expect to receive. Draft regulations, determining how CCGs can spend the quality premium, including distributing it to member practices, will also be released in the New Year.

Dr Peter Swinyard, chair of the Family Doctors Association, said the targets reflected a ‘political to-do list’.

He added: ‘There is some scope for scoring points for local priorities, which is a good thing, but I’m not sure how much a CCG can influence emergency admissions. 

‘This is a bit of a game of jumping through hoops. CCGs desperately need this money from the quality premium and are going to be spending so much time pushing in the limited direction that that indicates that they may run the risk of losing the bigger picture about what might be good in terms of commissioning for their local populations.’  

Readers' comments (15)

  • Another hoop for all to jump through....If you make it this year it will be higher next year and so the maddness continues.....

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  • Practices can reduce emergency admissions, not ccg's. if a patient feels that they are sick and they need to be seen, there is little that a ccg's can do about it as they do not have relationships with patients.

    The question centrally really is are practices sufficiently resourced? If they are then yes they and the ccg's are responsible for delivery. If not then actually the answer is to resource them and performance manage them better.

    How do we determine if a practice is sufficiently funded. I am unaware of formulae for this. Supposedly this is through the existing levers of Qof enhanced services and global sum, however their has been a reduction over the years.

    We need to work with our colleagues in management to answer this central question of are practices sufficiently funded.

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  • I think it reads "CCG set to be cut 25% of funding"

    It's been shown before access to primary care make little if any difference. We've conducted a review of patients attending AED during working hours and there were little we could do to change them.

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  • Nonsense, practices have no role in influencing emergency admission, especially when normal delivery and pregnancy make up the bulk of admission.
    And funding of practices has no relations with number of emergency admission either.

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  • Vinci Ho

    (1) please read Martin Roland and Gary Abel article in BMJ 29/9/2012 volume 345 page 23-25. ' Reducing emergency admissions : are we on the right track?
    (2) The evidences are suggesting GPs had no role in influencing the whole picture in EAs
    (3) If one try to force this through , there will be risk of mislabelling appropriate admissions as inappropriate . This will risk the safety of patients. There were already complaints where GPs retrospectively sent letters of disapproval to patients when they went to hospitals for potentially serious diagnoses although the outcomes were uneventful.
    (4) The majority of the public does not know their doctors are to be paid for preventing them to be admitted in emergency. It will be 'interesting' to see the reactions in media!!
    (5) Remember , it is a fine line between 'right' and 'wrong' here. Patients' safety is still our priority. I would once again refer to what Mr Farrar from NHS Confederation said a few days ago . Population's health is well above the electoral health of politicians.....

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  • Probably best to read the draft Guidance before commenting! It's for zero growth in avoidable emergency conditions for certain conditions only so for instance pregnancy and delivery have nothing to do with it.

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  • I think that there are things practices can do to help. It is no co-incidence that the number of patients turning up at A&E spikes on thursday afternoon when practices are closed.

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  • Most practices don't close on a thursday - in fact it's relatively few that do. A practice's ED attendances are based on many factors - the most important probably being the practice's distance from the local ED.

    If this is going to improve it needs to start with the Govt ending its campaign of telling the British public that they can be seen at any time for routine (non-urgent) healthcare.

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  • The other thing we need is increased capacity in general practice. If you overload my capacity to make timely and sensible decisions i will start making mistakes and have a lower threshold for admitting patients or prescribing antibiotics. I am not a miracle worker and I need time to make the best decisions.

    Invest in primary care such that we have more GPs to see the patients and improvements will follow.

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  • I have just finished my day at 8.30pm, having started at 8am. We have been unable to get a locum so I have 287 communications to look at. In my 12 hour day I have not managed to tackle them. I hope nothing vital is buried in them. Days like this are unsustainable and unsafe. Still the press castigates us for being lazy. My morale is rock bottom.

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