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Commissioners prioritising emergency admissions and dementia diagnoses for quality premium payments

GP commissioners are prioritising reductions in emergency admissions and increases in dementia diagnosis rates to achieve their quality premium payments, as figures obtained by Pulse reveal CCGs’ commissioning intensions on a national basis.

The NHS England figures reveal for the first time what CCGs are choosing - in agreement with their local area teams and health and wellbeing boards – as their localised targets, worth up to 37.5% of the quality premium total or around £420,000 to the average CCG.

The two most commonly selected indicators were emergency admissions within 30 days of discharge from hospital, selected by 29 of England’s 212 CCGs, and the estimated diagnosis rate for people with dementia, chosen by 27.

Other popular indicators include improving functional ability of people with long-term conditions, the proportion of people with diabetes who have received their nine annual care processes and enabling people to die in their preferred place of death.

The local measures have to be separate from the centrally mandated targets set out by NHS England, which include reducing potential years of lives lost through amenable mortality; reducing avoidable emergency admissions; ensuring roll-out of the Friends and Family Test; and preventing healthcare associated infection.

Taken together, the four national targets and three local targets are worth up to £5 per patient for CCGs.

Dr Naresh Kanumilli, South Manchester CCG’s GP quality and performance lead, said his CCG’s targets - which included increasing the rate of dementia diagnosis, alongside identifying more cases of atrial fibrillation and increasing the number of cancer diagnoses through the two-week pathway - came out of quarterly discussions with member practices.

He told Pulse: ‘Manchester has a particular problem with cardiovascular disease so we chose to pick up atrial fibrillation cases by feeling more patients’ pulses opportunistically.’

‘We’d also heard about a percentage of people presenting at Q&E with cancer so thought we should tackle that,’ he added.

Dr Steve Kell, co-chair of NHS Clinical Commissioners leadership group and chair of Bassetlaw CCG, said: ‘CCGs have a wide range of responsibilities outlined by the outcomes framework and will use the quality premium to assist in those areas which have most impact locally.’

‘The measures identified by [these figures] highlight important areas that CCGs are tackling and it is welcome that there is a focus on areas that measures that should have a long-term impact for patients and people who care for them.’

However, Dr Nigel Watson, chair of the GPC commissioning and service development subcommittee, warned: ‘Mid Staffs taught us that targets per se can be destructive as well as constructive. The BMA’s view is that CCGS should agree what they are aiming at but should not be financially penalised if they fail to get there.’

CCGs’ local priorities

PositionIndicator descriptionFrequency of selection
1Emergency readmissions within 30 days of discharge from hospital29
2Estimated diagnosis rate for people with dementia27
3Proportion of people feeling supported to manage their condition23
4 =Improving functional ability for people with long-term conditions22
4 =Enabling people to die at their preferred place of death - include establishing preferences and measuring achievement of preferences22
6Reducing emergency admissions from care, nursing or residential homes17
7Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults)15
8 =Patient experience of primary care i) GP services ii) GP out-of-hours services*12
8 =Risk profiling and care management scheme12
8 =(Other) Emergency Admissions attributed to alcohol12

Source: NHS England