CCG performance and payment regime allowed to include 'process' measures
Clinical commissioning groups will be given “at least monthly” updates on their performance – on “processes” as well as outcomes – by the NHS Commissioning Board, it has been confirmed.
The Commissioning Outcomes Framework will in part decide the performance bonuses paid to practices, according to an engagement paper published by the commissioning board, setting out how the framework will work.
Working Together for a Stronger NHS says the commissioning board will decide the indicators, although some will be taken from the NHS outcomes framework - on which the board itself will be judged – and from recommendations by the National Institute for Health and Clinical Excellence.
It says the framework will be part of “a wider system of accountability [which will] also cover CCGs’ financial performance, their contribution to joint health and wellbeing strategies, and fulfilment of other statutory duties such as patient and public involvement”.
The document says: “In its annual assessment of CCGs, the NHS Commissioning Board would look both at progress against the commissioning outcomes framework and at the CCG’s contribution towards local priorities agreed in the joint health and wellbeing strategy. The board would also take both these factors into account in determining quality rewards for CCGs, subject to regulations made under the [Health Bill].”
The bill currently proposes paying a “quality premium” to CCGs or practices for commissioning performance. But the measure is controversial and the government may be forced to change or abandon it in the Lords.
The outcomes framework document, which has been sent to some staff and interest groups, says the framework will be used to assess CCGs’ “duty of continuous quality improvement”, and publish information of their performance.
It will also “seek to measure how far the services commissioned by CCGs are contributing to reductions in health inequalities… This will mean breaking down performance against the indicators, as far as possible, by the protected equality characteristics and socio-economic group”.
The document confirms not all the indicators will have to measure outcomes. It says: “Some indicators will measure outcomes directly… Other outcomes, however, may not be sufficiently attributable to the influence of CCGs as commissioners, for instance because of size of population, or there may be long time-lags before the outcomes are achieved. The framework will also, therefore, need to include some proxy indicators of outcomes that are nonetheless good predictors of improvement. These could be ‘intermediate’ outcome indicators or healthcare processes that are shown to have a strong link to outcomes.”
The commissioning board will publish the first framework in October 2012.
The DH is also procuring a new information system to analyse and provide information on performance against the framework, and calculate performance pay. The document says: “[The Calculating Quality Reporting Service] will provide at least monthly reports of in-year performance to CCGs and the NHS Commissioning Board, with projections of end of year achievement.”
About performance of the board itself – which will commission primary care and some specialised services – the document says: “The board will set up robust systems for measuring the quality of services that it commissions directly… We propose that the board will publish information on the quality of directly commissioned services alongside [CCG performance].”