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Quality premium to be based on 5-10 measures from NHS Outcomes Framework

The quality premimum for CCGs is likely to be a sub-set of between five and 10 measures drawn from the NHS Outcomes Framework.

The sub-set of measures, for which CCGs will able to qualify for a £5 per head quality premium amounting to £1.25 million for an average CCG , are to be called ‘CCG outcome measures’.

The proposals, if approved by the NHS Commissioning Board next week, would become secondary legislation in January next year and provide the quality premium for 2013/14.

Alison Westmacott, strategic programme lead for the NHS Commissioning Board, told yesterday’s pre-NHS Alliance conference NHSCC commissioning event: ‘I think it’s safe to say the mandate (published last week] has set the NHS Commissioning Board ‘the targets’ of what has to be delivered in the NHS Outcomes Framework so the quality measures are likely, one would think, to be aligned to those five domains.’

Some parts of the NHS Outcome framework were too big to be measured at a CCG level, she said.

‘That’s where the Commissioning Outcomes Framework – what we’re now calling CCG outcomes measures is about – these are measures which are appropriate to the NHS outcomes framework measure but are available at a CCG level.

‘Now from that sub-set will take a group that would then become the measures of the quality premium.’

The measures chosen would be based on those with data already available and collated, she said, so practices would not have to commit resource to collecting data.

The domains were ‘broad brush’ enough -  for example ‘patients with long term conditions’ - she said for CCGs to still localise the measures to most meet the needs of their population.

In terms of numbers, Ms Westmacott, said the feedback from CCGs was ‘small number equals high impact’. Ms Westmacott said she personally was looking at ‘eight in my head’ and added ‘so maximum 10, but think looking at 5-8 probably.’

CCGs would still have to achieve the measures within some sort of financial envelope to satisfy the Treasury, which has not yet signed off this quality premium money.

Because of historical overspends, inherited deficits and the allocation formula that CCGs will have to work with, the financial envelope could be agreed year end position or delivery of QIPP savings, she suggested.

In terms of what CCGs could spend the quality premium on, Ms Westmacott said the RCGP, BMA and other bodies had ethical concerns about the money going into GPs pockets and so the NHS Commissioning Board would be looking for it to be spent on improving health outcomes, the quality of care and reducing inequalities- but that the CCG would not have to spend it outside primary care.

‘It could be the CCG could say ‘well actually we could use it as an incentive scheme for primary care to improve the quality of our primary care and have a CQUIN for primary care, they could have additional CQUINs for secondary care. They could use the money to pump prime innovation.’

Dr David Jenner, lead, North, East, West Devon CCG, requested the quality premium avoid a ‘cliff edge’ financial gateway to deter gaming for an all-or-nothing pay-out. He said: ‘Learning from QOF, don’t have a cliff-edge gateway, have a percentage so even people who overspend by a percentage could get the quality premium but it’s reduced by a multiplier so that there’s a range and not a cliff edge.’

One CCG lead said: ‘ This whole notion of financial incentives for delivering quality is a really dismal interpretation of what motivates us to do what we do and I’d just get rid of it all together.’