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Emergency admissions target worth 25% of quality premium

CCGs will have a quarter of their quality premium tied to reducing avoidable emergency admissions, a larger proportion than any other area, the NHS Commissioning Board has announced.

In a move that GP leaders warned risked CCGs losing sight of the ‘bigger picture’, the Board said that 25% of quality premium payments would be tied to reducing avoidable emergency admissions.

This compared with 12.5% of the premium for reducing mortality and the same proportion for rolling out the ‘friends and family test’ and preventing healthcare associated infections.

The remaining 37.5% of the payment will be paid on meeting three locally determined indicators, determined by the CCG and Health and Wellbeing Boards.

In draft 2013/14 guidance for CCGs, the Board confirmed that they will reduce the payments if providers do not meet targets detailed in the NHS Constitution - as announced in planning guidance released earlier this month.

The quality premium will be reduced by 25% for each missed target, including a maximum 18-week wait from referral to treatment, maximum four-hour waits in A&E departments, maximum 62-day waits from referral to cancer treatment and maximum eight-minute responses for Category A red 1 ambulance calls.

The guidance said: ‘The NHS Commissioning Board has sought to design the 2013/14 quality premium in ways that: promote improvements against the main objectives of the NHS Outcomes Framework, ie reducing premature mortality, enhancing quality of life for people with long-term conditions, ensuring swift recovery after acute illness or injury, improving patient experience, and ensuring patient safety.’

The Board said that the value of the payments will be announced in the New Year, although it used a value of £5 per head to ‘illustrate’ how much CCGs could expect to receive. Draft regulations, determining how CCGs can spend the quality premium, including distributing it to member practices, will also be released in the New Year.

Dr Peter Swinyard, chair of the Family Doctors Association, said the targets reflected a ‘political to-do list’.

He added: ‘There is some scope for scoring points for local priorities, which is a good thing, but I’m not sure how much a CCG can influence emergency admissions. 

‘This is a bit of a game of jumping through hoops. CCGs desperately need this money from the quality premium and are going to be spending so much time pushing in the limited direction that that indicates that they may run the risk of losing the bigger picture about what might be good in terms of commissioning for their local populations.’