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What is the quality premium and what does it mean for practices?

Last year the NHS Commissioning Board (NHSCB) released detail of a new practice payment mechanism, the quality premium, but how does it work? Neil Durham reports.

CCGs will have to spend the money on initiatives that improve patient care or outcomes
CCGs will have to spend the money on initiatives that improve patient care or outcomes

How much is the quality premium worth?

Full detail of its value is expected this year but the indications are that it could be worth £5 per patient, or up to £30,000 annually for the average practice in England with 6,000 patients.

Why is it being introduced?

The coalition government wants to incentivise CCG performance against a number of outcomes targets and this is the method it has chosen to focus CCG and practice minds.

What are the targets?

There are four national targets and three additional targets are able to be negotiated locally. The national ones are (with percentage value in brackets):

  • Reducing avoidable emergency admissions (25%). To earn this there needs to be a reduction or no change in emergency admissions for a CCG population between 2013/14 and 2014/15.
  • Reducing potential years of lives lost through amenable, or responsive, mortality (12.5%). To earn this potential years of life lost (adjusted for sex and age) should reduce by 3.2% between 2013 and 2014.
  • Ensuring friends and family test roll-out and improving patient experience of hospital services (12.5%). Improvement in average scores for acute inpatient care and A&E services between quarter 1 2013/14 and quarter 1 2014/15 needed.
  • Preventing healthcare-associated infections (12.5%). Earned if there are no cases of MRSA bacteraemia for the CCG’s population and C. difficile cases are at or below defined thresholds for CCGs.

How do the local targets (worth the remaining 37.5%) work?

Should be agreed with NHSCB after consideration with health and wellbeing boards and key stakeholders, including patients and community representatives.

Can quality premium payments be docked even if all the above targets are met?

Yes. Examples include if providers don’t meet NHS Constitution requirements for the following rights or pledges. A reduction of 25% for each relevant NHS Constitution measure will be made:

  • Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting for no more than 18 weeks from referral.
  • Patients should be admitted, transferred or discharged within four hours of their arrival at A&E.
  • Maximum two-month (62-day) wait from urgent GP referral to first definitive treatment for cancer.
  • Category A red 1 ambulance calls resulting in an emergency response arriving within eight minutes.

Are there any other ways CCGs/practices can lose the quality premium?

Yes, in cases of serious quality failure or if it has failed to manage within its total resources.

When will the quality premium be paid?

In 2014/15.

What do the critics say?

The GPC fears that the public will perceive it as GPs profiting from a rationed NHS. Others say at a time when income increases have flatlined it is merely performance-managing any rises.

What happens after the initial year?

The design of the quality premium will evolve.

What can practices spend their quality premium on?

The NHSCB will decide how CCGs can spend the premium early this year. A spokesman said CCGs would be free to use it in any way that improves 'patient care and/or health outcomes'.

It is likely that practices would receive the money via their CCG to spend on particular initiatives to improve patient care or to incentivise practices or other providers to meet specific targets.

It is by no means certain that practices will receive any extra funding, even if their CCG receives a quality premium payment as it will be up to the CCG how they use and distribute the money.

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