A raft of out-of-hours contracts is set to expire when CCGs become statutory bodies in April 2013 and clinical commissioners are using this opportunity to reshape urgent care services.

Pulse reported last month that more than half a dozen CCGs have placed their GP out-of-hours services out to tender under revised specifications, with more CCGs set to do the same.

New criteria to help CCGs meet their QIPP targets include setting targets to reduce A&E admissions and achieve greater integration with other services.

Incorrect coding is not a new problem for the NHS. An Audit Commission report published earlier this year described the problem as national and one that ‘affected patients, skewed management information and wasted NHS funds’.

In Avon, the LMC has stepped in to tackle what it describes as ‘institutional miscoding’ with a formal complaint lodged with the Audit Commission. Coastal West Sussex CCG is looking into data that suggests they are paying double the correct amount for outpatient appointments. The CCG has said there is ‘good evidence’ that outpatient follow-up appointments are being charged as new appointments.

And with practices being given feedback as a result of increased peer review, practice managers as well as GPs are looking to see if the data is correct to determine a true picture of where their practice ‘sits’ within their CCG.

Several CCGs have asked GPs to look at C2C referrals. NHS Oxfordshire has introduced a new electronic system allowing GPs to receive copies of all non-emergency C2C referrals.

Newcastle and Rotherham CCGs have introduced protocols whereby consultants must contact GPs before making a referral to a colleague.

NHS Alliance chair Dr Mike Dixon has said the single biggest cause of rising referrals is C2C referring.

4/ Scrutinising secondary care contracts

Dr Nigel Watson, chief executive of Wessex LMCs and chair of the GP commissioning and service development subcommittee at the BMA, says he is coming across lots of examples of CCGs beginning to look at contracts with secondary care.

‘And CCGs are beginning to challenge these contracts,’ he said.

‘In Swindon they have developed an IT system where you log on in the morning and you can see who’s been admitted, who has died and patients’ whole discharge notes. You can monitor activity much more closely.

‘That leads to commissioners asking for different things and requiring changes in contracts.’

Dr Charles Alessi, interim chair of NHS Clinical Commissioners, says CCGs have started on a long road to create a health service that focuses on outcomes rather than activity.

He cites his own area, Kingston, Surrey, where the CCG has developed a currency for drug and alcohol services based on outcomes.

‘It involves some non-health determinants – whether people have a home and so on. And providers can be held to account over these. That’s the gold, the good stuff where CCGs are really already making a difference.’