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Additional planning guidance documents published

Today the NHS Commissioning Board has published a number of documents to further support clinical commissioning groups (CCGs) and the wider NHS in planning for 2013/14. These documents follow the publication earlier this week of Everyone Counts: Planning for Patients 2013/14 which outlined the incentives and levers that will be used to improve services from April 2013 – the first year of the new NHS, where improvement is driven by clinical commissioners.

Supporting Planning 2013/14 for CCGs, the technical guidance for Everyone Counts: Planning for Patients 2013/14, describes the processes that will be used to support planning for the next financial year.  The aim of the document is to support CCGs in ensuring that every plan is as strong as it can be by designing an approach that aims to strike a balance between local determination of priorities and the NHS Commissioning Board’s responsibility for oversight.

Other supporting documents include a near-final draft of the 2013/14 NHS standard contract – the responsibility of which has passed from the Department of Health to the NHS Commissioning Board this year. The contract is for use by commissioners when commissioning healthcare services (other than those commissioned under primary care contracts) and is adaptable for use for a broad range of services and delivery models.

Further documents to support the CCG Outcomes Indicator Set are now also available. These include a table setting out the relationship of the CCG Outcomes Indicator Set with the NHS Outcomes Framework, technical guidance on the CCG Outcomes Indicator Set, setting out definitions of indicators and data sources and a summary factsheet.

Also of interest to CCGs is guidance on the Quality Premium. The Health and Social Care Act 2012 gives the NHS CB powers to reward CCGs for the quality of services they commission, associated outcomes for patients and reductions in inequalities. The Quality Premium will be set at up to £5 per head for each CCG and can be spent as CCGs wish, provided it can be shown to improve services for patients.

Finally, draft guidance on the Commissioning for Quality and Innovation (CQUIN) payment framework has been made available. The CQUIN framework enables commissioners to reward excellence by linking a proportion of a provider’s income to the achievement of local and national quality improvement goals. Some of these will be local priorities and some national, such as improving the care of people with dementia.

All these documents can be found on the Everyone Counts section of the NHS Commissioning Board website.

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16 comments

  1. Ciara Scarff says:

    Please can you confirm if the Model Collaborative Commissioning Agreement can include Local Authority signatories?

    • Simon@NHS CB says:

      Hi Ciara
      Thank you for your comment.

      The information given in this response has been updated in March 2013.

      Please find the updated information below:

      CCGs may wish to enter into collaborative agreements or Memorandums of Understanding with Local Authorities where they wish to collaborate in relation to initiatives to improve and encourage integrated working without delegating commissioning responsibility to each other. Depending upon what any such agreements are intended to achieve, they may be stated to be legally binding or non-legally binding. The NHSCB has not developed a template agreement for this purpose.

      Where CCGs and Local Authorities wish to delegate functions to one another for the purposes of Section 75 partnership arrangements, agreements should be entered into in accordance with the requirements of the NHS Act 2006 (as amended) and the NHS Bodies and Local Authorities Partnership Regulations 2000 (as amended). CCGs have a duty to promote integration of services where this will improve quality or reduce inequalities – and will wish to consider the scope for section 75 agreements in this context. This could be a key part of the joint health and wellbeing strategies that CCGs develop with local authorities and other partners on Health and Wellbeing Boards.

      Kind regards
      Simon

      Digital Communications Officer
      NHS Commissioning Board

  2. Ciara Scarff says:

    Thank you for clarifying that if only one national indicator applies to the Trust the weighting should be 0.125%. In the case of Mental Health Trusts the one applicable national CQUIN is Improvement against the NHS Safety Thermometer. Our local provider Trust is eligible for indicator 2 (the improvement CQUIN) but the very low numbers of pressure ulcers, UTIs and falls make it difficult to set meaningful improvement targets. If the Trust decides not to sign up to this national CQUIN, do they lose the opportunity to claim the 0.125% or can we agree to reassign the 0.125% to locally agreed CQUINs?

    • Simon@NHS CB says:

      Hi Ciara
      Thank you for your comment. Commissioner and provider have the opportunity to set what they feel to be reasonable improvement trajectories for the NHS Safety Thermometer CQUIN, but, if the Trust decides not to sign up to this national CQUIN, they do lose the opportunity to claim the 0.125%.

      Kind regards
      Simon

      Digital Communications Officer
      NHS Commissioning Board

  3. Ruth Waldron says:

    Hello
    I submitted a query last week but have not yet had a response and I have noticed that it is not appearing on your website. I would be grateful if you could please clarify the following:

    1. Will the pre-qualification criteria apply to specialist services including secure mental health services?
    2. There is only one national CQUIN (NHS Safety Thermometer) which applies to mental health. Last year Forensic services were excluded. Will this be the case again for 2013/14?

    Also I note a comment above which states that there are 3 pre-qualification targets applicable to mental health. We are of the understanding that there are 4 (3 Million Lives, International and Commercial, Digital Lives, and Dementia Carers). Please can you confirm which is correct?

    Thanks

    Ruth

    • Simon@NHS CB says:

      Hi Ruth
      Thank you for your comment. Please accept my apologies for the delay in responding, the answers to your queries are below:

      1) Yes, where they apply
      2) Yes – detailed Safety Thermometer guidance sets this out
      3) Dementia carers is specifically aimed at acute trusts. It may be appropriate for an equivalent CQUIN within mental health if providers and commissioners agree.

      Kind regards
      Simon

      Digital Communications Officer
      NHS Commissioning Board

      • David Palmer says:

        Commissioners are responsible for assessing achievement, are they also responsible for assessing whether the criteria apply? For example where the acute provider is an orthopaedic specialist trust it seems unlikely that carers for people with dementia would apply.

        • Simon@NHS CB says:

          Hi David
          Thank you for your question. Yes, commissioners need to make this assessment. For a specialist orthopaedic trust, the national pre-qualification and/or CQUIN may apply. For example, if that Trust received emergency admissions from frail elderly patients (e.g. fractured neck of femur), where a proportion may have diagnosed or undiagnosed dementia, is the commissioner content that the Provider is doing their bit to ensure carers are signposted to relevant help and advice and that undiagnosed dementia is identified and, where appropriate, referred on or treated.

          Kind regards
          Simon

          Digital Communications Officer
          NHS Commissioning Board

  4. David Palmer says:

    Two more questions on the CQUINs guidance, can you clarify please:

    1) The guidance states “CQUIN for 2013/14 is set at a level of 2.5 per cent value for all healthcare services commissioned through the NHS Standard Contract. One fifth of this value (0.5 per cent of overall contract value) is to be linked to the national CQUIN goals, where these apply.”

    How is this applied? For example Mental Health Trusts only qualify for 1 national CQUIN, do they therefore have the full 0.5% linked to that 1 CQUIN?

    2) The guidance also states “Non-participation in any applicable national CQUIN scheme should result in non-payment of that proportion of CQUIN funding” and “In order for providers to qualify for CQUIN payments, they will need to satisfy at least 50 per cent of the pre-qualification criteria that apply to them. The table below sets out the pre-qualification criteria and which criteria apply to which service type”

    Is this 50% of the indicators or 50% of each indicator, i.e. there are 6 indicators that apply to Acute so do they need to meet 3 out of the 6 or 50% of all 6?
    For Mental Health there are 3 qualifying criteria so again how is this applied?

    • Simon@NHS CB says:

      Hi David
      Thank you for your comment. Please find responses to your specific questions below:

      Question 1: The Mental Health Trusts should apply a minimum of 0.125 (which is a quarter of 0.5%) to the 1 national CQUIN that applies – if 4 applied it should be 0.125% for each totalling 0.5%. The remaining part of the 0.5% can be used for local CQUINs or they can increase the value of the National CQUIN scheme up from 0.125% to whatever they agree (e.g. maximum would be 2.5% if there were no other local or national CQUIN goals though it’s not recommended to just have one goal).

      Question 2: Pre Qualification Criteria – it is 50% of the schemes that apply. Therefore if 3 of the 6 apply they will need to ensure they fulfil the criteria for 2 of the 3 as you cannot realistically complete only one and a half of the 3 criteria because of the nature of them (e.g. you cant have half a plan).

      Hope this helps,
      Kind regards
      Simon

      Digital Communications Officer
      NHS Commissioning Board

      • David Palmer says:

        Thanks Simon. As always the devil is in the detail and there’s precious little time for further guidance before the pre-qualification criteria need to be assessed for all providers, so have some more queries:

        – On the answer to my question 1 above, you state it CAN be used – is this optional on our part or MUST we offer the remaining 0.375 by making up to 0.5% for the 1 National indicator or adding the 0.375% to the 2% local CQUIN value?

        – On your answer to my question 2 above, Some of the criteria will be less of a stretch for Trusts to meet. Who chooses the indicators, the trust or the commissioning CCG?

        – Pre-qualification criteria on dementia requires that ‘plans be put in place’ around information for carers, with achievement for all qualification criteria measured as at 31 March. Is it acceptable, as part of their plans to meet the pre-qualification criteria, to use plans based on local 2013-14 CQUINs that won’t commence until after that date?

        – In the case of mental health trusts, it appears that they need to meet the dementia pre-qualification requirement around, but are not expected to deliver the dementia CQUIN. Is that correct?

        • Simon@NHS CB says:

          Hi David
          Thank you for your comment, please find the answers to your questions below.

          Quesion: On the answer to my question 1 above, you state it CAN be used – is this optional on our part or MUST we offer the remaining 0.375 by making up to 0.5% for the 1 National indicator or adding the 0.375% to the 2% local CQUIN value?
          Answer: The Provider should be able to achieve 2.5% CQUIN so remaining % must be attached to CQUIN goal/s

          Question: On your answer to my question 2 above, Some of the criteria will be less of a stretch for Trusts to meet. Who chooses the indicators, the trust or the commissioning CCG?
          Answer: The National goals either apply or they don’t – regarding Prequalification the Provider may choose 50% of those that apply to them.

          Question: Pre-qualification criteria on dementia requires that ‘plans be put in place’ around information for carers, with achievement for all qualification criteria measured as at 31 March. Is it acceptable, as part of their plans to meet the pre-qualification criteria, to use plans based on local 2013-14 CQUINs that won’t commence until after that date?
          Answer: Yes that is acceptable.

          Question: In the case of mental health trusts, it appears that they need to meet the dementia pre-qualification requirement around, but are not expected to deliver the dementia CQUIN. Is that correct?
          Answer: Yes, the National CQUIN for dementia only applies to the acute trusts.

          Hope that helps, kind regards
          Simon

          • David Palmer says:

            Thanks Simon, two more queries…

            Due to the timescales and the need to get contracts signed before the end of March, what happens if the pre-qualification criteria haven’t been pulled together/agreed. Does that make the Provider ineligible for CQUINs? What is the dispute resolution mechanism?

            Can you clarify if there are any situations where the dementia requirement would apply to a mental health trust? At the risk of contradicting my previous comment, the guidance does state that carers for people with dementia applies to mental health?

            • Simon@NHS CB says:

              Hi David
              You’re welcome. Please find the answers to your queries below:

              The pre-qualification requirements expect providers to have agreed plans with commissioners in most case. It is a joint responsibility of both parties to deliver this. If there is a legitimate reason that this can’t be delivered, they may jointly decide to complete this work in the first quarter in good faith. If a dispute arises that can’t be resolved at Board level, the usual dispute resolution process would apply (area teams for NHS Trusts, usually CEDR for FTs/IS).

              For dementia there is a pre-qualification criteria for carers which applies to mental health trusts (to have a plan to support carers). This is separate from the national CQUIN, which doesn’t apply to mental health (to audit whether carers feel supported).

              Kind regards
              Simon

              Digital Communications Officer
              NHS Commissioning Board

  5. Jonathan Elf says:

    In the Who Pays draft guidance please can you clarify who will pay for the emergency care is it based on the geographic area where the patient lives or the patient’s GP Practice. Is it fair to say as a general rule elective treatment is practice based, emergency care is geographic?

    • Simon@NHS CB says:

      Hi Jonathan
      Thank you for your comment. As set out in paragraphs 3 of the draft guidance, a clinical commissioning group (CCG) is responsible for commissioning emergency care for anyone present in its geographic area, regardless of where the person in question is usually resident or which GP practice (if any) they are registered with. In general responsibility for paying for elective treatment is based on GP practice registration, or where the patient is not registered with a GP the responsible commissioner will be in whose geographic area the patient is ‘usually resident’. The rules on payment for emergency care is set out at paragraph 5 as follows:

      • For A&E attendances and emergency admissions, the CCG who would ordinarily be the responsible commissioner for a patient (ie. where is patient is registered with a GP, or if they are not registered with a GP, where they are usually resident) will be responsible for paying the provider for the costs of that patient’s care;
      • The costs of all other emergency care will be met by the CCG that commissions the care, except where cost-sharing arrangements have been agreed voluntarily by CCGs.

      Kind regards
      Simon

      Digital Communications Officer
      NHS Commissioning Board