Deepdive presentation to NHS Eastern Cheshire CCG Governing Body on quality premiums

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%