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Q&A: The quality premium

Ben Dyson of the NHS Commissioning Board explains how the quality premium might become available to practices via their CCGs after April

Q. If the CCG fails to get financial balances, it won’t get the quality premium. How might this affect practices?

The quality premium is a payment to reward excellent commissioning by CCGs. Excellent commissioning means ensuring high-quality services are commissioned in a sustainable way, so if CCGs do not achieve financial balance, they cannot receive the quality premium.

This will not directly affect practices. The Quality Premium is a payment to CCGs for excellence in commissioning non-primary care services, not a payment to GP practices.

Q. Are practices in deprived areas more likely to miss out on funding through the quality premium?

The scheme has been designed to promote reductions in inequalities and to recognise the different starting points of CCGs.

The predominant focus is on rewarding CCGs for improvements against their starting position on measures of quality and outcomes, rather than having to achieve the same absolute standards.   

Q. If the quality premium requires CCGs to use the resource to improve patient outcomes rather than handing it direct to practices, how does this affect its use? Can CCGs invest it in local enhanced services (LESs) and pilots?

CCGs should use quality premium payments to improve services and outcomes across hospital, community and primary care. They would be free to set their own priorities, and to design improvement programmes which match their communities’ needs, whether through commissioning new services or through setting up their own local incentive schemes.

Q. Will CCGs have a statutory requirement to recognise any extra workload involved in commissioning-type activities? If not how might they resource practices to take on this workload?

It is for member practices to agree how best they can contribute to commissioning. 

Where practices are carrying out specific commissioning activities on behalf of their CCG, the CCG can reimburse this activity from its running costs. Where CCGs wish to fund improvement activity relating to primary care, they can seek the NHS Commissioning Board’s agreement to give them delegated authority to do this through LESs.

Q. How should GPs deal with accusations from the media or patients regarding the ethics of the quality premium? Should they deal with them directly, or refer them back to the CCG or NHSCB?

It is unfortunate that some parts of the media have portrayed the quality premium as being designed to discourage GPs from making certain referrals, as this is completely untrue.

We would encourage GPs to make clear, where necessary, that the quality premium is a payment to CCGs for improving quality of patient care – not a payment to GPs. We would encourage CCG member practices to agree among themselves how best to manage media queries.

Ben Dyson is the director of commissioning policy and primary care at the NHS Commissioning Board

Readers' comments (2)

  • andrew Field

    Practices in deprived areas should be far more likely to receive the quality premiums for a number of reasons. Firstly they receive far more money for health spend per head of population and are therefore much more likely to be able to achieve financial balance. Secondly, the money they receive for "deprivation" can be invested in projects that will reap demonstrable improvements. Presumably these areas will claim they're starting from a poor position because of the deprivation so improvements shouldn't be so hard to achieve and demonstrate. Thirdly, less well funded areas have already been significantly squeezed through various QIPP programmes and will find improvement much harder to achieve.

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  • Something I don't understand about the MRSA/c.difficile Outcome: which providers are involved?
    Take Bedfordshire (where I used to practice): it uses 2 main Trusts - Bedford and Luton & Dunstable - but patients also use many of the London hospitals as well as those in Hertfordshire, Buckinghamshire, Oxford, Milton Keynes, Cambridge - and probably others.
    Many CCGs will be in the same sort of position, with patients in many different hospitals.
    If any one of these hospitals has a single instance of a blood culture positive for MRSA, will *all* the CCGs who have had a single patient in that hospital lose 12.5% of the QP? or is there some other definition of which CCGs will be the losers?

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