This site is intended for health professionals only

Quality premium payments will not be used as GP ‘bonus’

Exclusive: CCGs will not be able to hand quality premium payments to member practices as a ‘bonus’ and will have to ensure it is used to develop programmes that directly benefit patients, says the Government’s commissioning tsar.

Dame Barbara Hakin, national director of commissioning development at the NHS Commissioning Board, said new regulations will require CCGs to use the premium to improve patient outcomes rather than handing it direct to practices.

This could include incentivising practices - or other providers, such as community services - to meet improvement targets, among other options.

The quality premium will be paid to CCGs that achieve targets set by the Board, including reducing avoidable emergency admissions, rolling out the friends and family test, reducing incidence of healthcare associated infections and reducing potential years of lives lost through amenable mortality.

Dame Barbara had suggested in August last year that CCGs could hand the quality premium payments directly to GP practices, or with ‘certain caveats’.

Speaking to Pulse last week, Dame Hakin said the Board had decided to recommend that the regulations surrounding the quality premium that will be laid before Parliament before April should block CCGs from simply handing the quality premium to practices.

She said: ‘The final definition of the regulations will be put before Parliament. But we are recommending that the quality premium can only be used to improve services for patients.

‘I don’t believe [offering bonuses to GPs in terms of direct payments] would fit that definition. We have been clear that the recommendation is that the money must be used directly to benefit patients.’

If the Board’s recommendations are approved by Parliament, CCGs will be able to develop improvement programmes from the premium payments that include financial incentives paid to practices who meet improvement targets in a specific area, such as diabetes.

A spokesperson for the NHS Commissioning Board added: “The Department of Health is due to introduce regulations shortly setting out how CCGs can use quality premium payments.

‘We anticipate that CCGs will have to be able to show that they are using quality premium payments to improve quality of care and health outcomes in their local communities. CCGs would not, therefore, be able to simply distribute the payment among member practices as a bonus for achieving the quality premium.

‘This would mean that CCGs can 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’ unique needs, whether through commissioning new services or through setting up their own local incentive schemes.’

Dr Andrew Mimnagh, chair of Sefton LMC, said: ‘Some of the correspondence has suggested that [practices would get direct payments]. The GPC were concerned that anything seen as direct payments to practices for reductions in activities without clinical justification.

‘I’d be gratified if [Dame Barbara] had clarified that area and that the operation of any quality premium would be based on true measures of quality.

‘Certainly there would need to be some mechanism for recognising any extra workload involved in commissioning-type activities but it is an evolving situation.’

GPC chair Dr Richard Vautrey said the GPC still had concerns around the quality premium. He said: ‘The fundamental problem remains that the [CCG] won’t get the quality premium money if they don’t also achieve financial balance. That’s where the potential problems will come.’

How the quality premium will work

  • CCGs will be given the payments – likely to be around £5 per patient – for meeting certain targets.
  • The payments will be broken down into: 25% for reducing or maintaining a 0% change in unnecessary emergency admissions;  12.5% for meeting targets around reducing healthcare associated infections; 12.5% for rolling out the the friends and family test;    12.5% for reducing amenable mortality rates by at least 3.2%
  • CCGs will not receive the payments if they do not achieve financial balance. Payments will be reduced if they fail to meet targets set out in the NHS Constitution, including those related to waiting times
  • CCGs must spend money received on improving patient outcomes. This could include improvement programmes that incorporate targeted incentive schemes for GPs, among other options