The document discusses Quality Premiums, which are financial rewards provided to Clinical Commissioning Groups (CCGs) for improvements in healthcare quality and achievement of targets. It summarizes the CCG's past achievements in earning Quality Premiums, noting rewards received for 2013/14 through 2015/16, and projected rewards for 2016/17. The CCG is currently failing to meet targets for referral to treatment times, A&E wait times, and ambulance response times. The document also outlines actions being taken to improve performance, such as performance reviews with providers and improvement projects. It suggests coordinating targets and utilizing Quality Premium rewards to further incentivize achievement of NHS constitutional standards. Finally, it provides an overview of the Quality Premium scheme for

1. Agenda item 2.2.1: Governing Body Assurance Framework deep dive GBAF03
Quality Premiums
Deep Dive
NHS Eastern Cheshire CCG Governing Body meeting in public 30 November 2016
Sally Rogers
Quality Director/Executive Nurse

2. Quality Premiums
• What are Quality Premiums
• CCQ Achievement past and present
• Actions being taken
• What more could be done?

3. Quality Premiums – What?
• First introduced in 2013/14
• Nationally designed
• Reward CCGs for improvements in the quality of services
• Value = £5 per head of population registered with a CCG
GP i.e. £1.02m available 2015/16
• Achievement relies on Provider performance
/appropriate commissioning.
• Reward also reliant on providers achieving 4 National
Constitutional targets i.e. A&E, Cancer and Ambulance
waiting times, and RTT (incomplete)

4. Quality Premiums – CCG Achievements
• Rewarded £740k for 2013/14 achievements
• Rewarded £347k for 2014/15
• 2015/16 Forecast reward £396k – confirmed late
November
• 2016/17 status - Constitutional Targets:
– Referral to Treatment (18 weeks) - failing
– A&E Wait (4 hours) - failing
– Cancer Wait (62 days) - achieving
– Ambulance Wait (8 minutes/Red 1) - failing

5. Quality Premiums – CCG Achievements
2016/17 Status:
4 Antimicrobial resistance (AMR) Improving antibiotic prescribing in primary care
Projected RAG Key:
<5% adverse
=5%<10% adverse
=>10% adverse
73 -37
£103,188.50 £0
6
Other - Increase the proportion of
people dying in their preferred
place of care
Data currently not available £103,188.50
£51,594.25
5
Mental Health - Access to IAPT
services: People entering IAPT
services as a % of those estimated
to have anxiety/depression
3.75% 2.76% 0.99%
3
4a
Reduction in the number of
antibiotics prescribed in primary
care
1.161 1.035
£103,188.50
N/A
£103,188.507
Other - The number of children
being admitted to hospital for 0-1
day length of stay
441
4b
Reduction in the proportion of
broad spectrum antibiotics
prescribed in primary care
10% 98.72% £51,594.257.80%
-12.17% £51,594.25 £51,594.25
£206,377.00 £0
2
Overall experience of making a GP
appointment
85% 82% 3%
34% £206,377.00 £0
£206,377.00 £01
Increase in the proportion of GP
referrals made by e-referrals
76% 42%
Cancers diagnosed at early stage 48.3% 44.2% 4%
Margin RAG
Proj.
RAG
Total Quality
Premium Amount
Achievable
Current Quality
Premium Amount
Achievable
Domain Name Target
Current
YTD

6. Quality Premiums – Actions Being Taken
• Regular performance reviews
• Exec to Exec Team meetings
• Contract levers
• NHS Improvement input
• Improvement Projects, i.e:
– Time to go home
– A&E Improvement Plan
– SSAFER Bundle

7. Quality Premiums – What More?
• Joined-up performance reviews:
– CCG
– NHSI
– CQC
• Co-ordinated targets to achieve the weakest
– Local CQUINs however no local CQUINs 2017/19
– Quality Schedule within Standard Contract
– Utilise Quality Premium reward to incentivise
Constitutional achievement

8. Quality Premiums – 2017/2019
• Two year Quality Premium Scheme
• Five national (85%) and one local (15%) measure
• Consistent four NHS Constitutional Requirements
# Indicator Name Weighting
1 Early Cancer Diagnosis 17%
2 GP Access and Experience 17%
3 Continuing Healthcare 17%
4 Mental Health 17%
5 Bloodstream Infections 17%
6 Local Measure (to be agreed) 15%