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Revealed: CCG targets for quality premium



CCGs will have to reduce emergency admissions, tackle mortality rates and improve their performance under the ‘friends and family’ test in order to recieve a quality premium to distribute among their GP practice members, the NHS Commissioning Board has announced.

Commissioners will also have to ensure that they are not putting any restrictions on NICE-approved medicines and reduce the incidence of healthcare associated infections in order to qualify for the quality premium payment, which it is free to distribute among GP practices how it chooses.

In a wide-ranging planning document for 2013/14 released today, the NHS Commissioning Board confirmed a move to ‘Tesco-style’ seven-day care provision and that the allocation for CCGs will be increased by 2.3%, compared with their share of PCT spending in 2012/13. This will equate to an overall budget of £64.7bn for CCGs.

But the plans on how the quality premium to CCGs is likely to prove the most controversial – with the BMA already stating that it remains opposed to the plans it believes will increase health inequalities.

As part of the quality premium, CCGs will receive financial incentives by improving outcomes in: avoidable emergency admissions; potential years of life lost from causes considered amenable to healthcare; the friends and family test; and incidence of healthcare associated infections.

They will also be measured on three outcomes to be agreed locally with Health and Wellbeing Boards.

The document did not detail the value of the rewards, but it has previously been reported that it will come to around £5 per patient.

The planning guidance said: ‘A significant quality failure in-year will automatically debar a clinical commissioning group from receiving a quality premium.

‘A clinical commissioning group will not receive any quality premium reward if it has overspent its approved resource limit in 2013/14. Payment of the quality premium will also be dependent upon achieving NHS Constitution rights and pledges.’

The Board also announced further financial incentives will be paid by local commissioners to providers ‘where they deliver a level of quality over and above the norm on agreed priorities’, including improving the care of dementia. 

But Dr Mark Porter, the BMA chair, said the plans would penalise CCGs working in areas with more deprived populations.

‘We are concerned that the quality premium could exacerbate health inequalities, as CCGs in deprived populations could find it more difficult to achieve any financial award available. We therefore remain opposed to the quality premium as currently proposed.

In a shock move, the Board rejected a new funding formula for CCGs devised by the Advisory Committee on Resource Allocation. The Board said the formula accurately predicted the future spending requirements of CCGs, but the formula predominantly allocated most growth to the areas that have the best outcomes. The Board said it would conduct an urgent review in 2013/14 on what formula to introduce for future years.  

The document also reaffirmed the Board’s move towards a ‘paperless NHS’. It said: ‘[We] shall also support a move to paperless referrals in the NHS by March 2015 so that patients and carers can easily book appointments in primary and secondary care.’