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CCGs missing out on quality premium payments due to secondary care troubles

Exclusive CCGs are to miss out on millions of pounds in payments linked to quality premium measures for 2013/14 – commonly because of problems hitting targets for A&E waits and infection control.

A Pulse analysis of 39 CCGs showed that not a single one was confident of receiving its total allocation for quality premium, which is around £5 per patient.

GP leaders said that this is money that could be spent on providing practices with the £5 per patient to support vulnerable patients, after Pulse revealed last month that CCGs were struggling to find the funding.

NHS England has already said that CCGs will not be able to pass the quality premium payments directly to practices as a ‘bonus’, but the money can be used by CCGs to help fund initiatives in primary care to improve patient care.

The main reasons for missing the payments were because of problems meeting the four-hour waiting targets and targets on reducing hospital-acquired infections, Pulse has learnt.

The quality premium was introduced by NHS England to incentivise CCGs to tackle four areas of concern: reducing avoidable emergency admissions; ensuring the roll-out of the Friends and Family test; cutting amenable mortality rates; and preventing healthcare associated infections.

Payments are attached to these measures, and three locally chosen priorities agreed between the CCG and the local area team.

However, in order to receive the payments, they must also meet other targets, covering 18-week referral to treatment times, four-hour A&E waits, 62-day waits for cancer treatment following an urgent GP referral, and maximum eight-minute responses to category A Red 1 ambulance calls.

Pulse has learnt that CCGs are not expecting to receive the full premium. Of the 39 CCGs that replied to a request from Pulse, not a single one expected to receive 100% of the premium.

NHS Wokingham CCG papers relating to a Governing Body meeting on 7 January describe problems in meeting 95% of A&E waiting targets. They state: ‘It is not expected that the annual position would be recovered during quarter four, as 97% would need to be achieved each week. As a result of this, one of the pre-qualifiers for the quality premium is at risk, which reduces the quality premium allocation by 25%.’

NHS Portsmouth CCG anticipates receiving £792,000, about £264,000 less than the total available, because of A&E waiting time issues.

NHS Vale Royal CCG in Cheshire is at risk of losing 62% of quality premium payments, while Sunderland CCG is heading for a £680,000 shortfall (about 50%) because of struggles linked to A&E waiting times and the 62-day cancer target.

St Helens CCG has recorded an ‘outright fail’ regarding MRSA and c diff rates at a cost of 12.5% in Quality Premium payments, and it is also ‘off-trajectory’ on 62-day cancer waits, which could cost an additional 25% in payments.

Dr Nigel Watson, chair of the GPC commissioning subcommittee, said: ‘There is talk about £5 per patient for looking after vulnerable patient. [Any quality premium money] is certainly an opportunity to invest some money in that.’

Dr Steve Kell, a GP and chair of NHS Clinical Commissioners, said: ‘I think the way the quality premium is broken down makes it very difficult to achieve the maximum in the first year. But we have seen a lot of improvement, particularly around the local indicators. It is important that we continue to improve, but I don’t think it’s surprising in the first year.’

An NHS England spokesperson said: ‘The quality premium is intended to incentivise CCGs to set stretching ambitions to improve outcomes. It is therefore to be expected that there will be a differing degrees of success by CCGs in achieving these improvements in a single year. The levels of achievement by CCGs can only be fully assessed after the end of 2013/14.’