Clinical commissioning groups with financial problems or a major reconfiguration in their area will be subject to additional checks by the NHS Commissioning Board, guidance says.
The commissioning board has published details of the planning and assurance process, adding to proposals in its main planning document Everyone Counts: Planning for Patients 2013-14.
It includes some national measures not mentioned in the main planning guidance: The number of people waiting a year or more for treatment, 12 hour hospital trolley waits, cancellation of urgent operations, and delayed ambulance handovers.
The additional guidance says CCGs must also supply the commissioning board with planned trajectories for improved dementia diagnosis rates and people entering Improving Access to Psychological Therapies treatment.
The guidance also reveals that some CCGs will be subject to “greater scrutiny” of their planning for 2013-14 and performance during that year.
It says: “There are some CCGs where [commissioning board local area teams] and regions will need to exercise greater scrutiny.”
The guidance says these include “where there are conditions of authorisation on planning and or finances”, “there are significant financial or quality problems”, “there is to be a major service reconfiguration that requires multi-commissioner commitment”, and where “CCGs volunteer - say because they are not confident of producing a plan that resolves all the issues they face”.
It indicates that in these cases the commissioning board will have greater oversight and closer involvement with the CCG. They will be expected to submit more information than others, including a “larger suite of activity measures and trajectories”, “QIPP transformational milestones” and “on-going quality assurance of provider [cost improvement plans]”.
The guidance says: “For these CCGs there will be a more detailed assurance process. [Area teams] will work with CCGs to assure the CCG plan and assurance.”
The commissioning board is expected to publish further details of the approach for these CCGs – and details of the future assurance and escalation regime for CCGs – in coming months.
Meanwhile, the commissioning board also published details of CCGs’ quality premium performance bonus.
More than 60 per cent of each CCG’s bonus will be decided based on whether it achieves four nationally-set measures.
- Reducing potential years of lives lost through amenable mortality (12.5 per cent of quality premium)
- Reducing avoidable emergency admissions (25 per cent of quality premium)
- Ensuring rollout of the friends and family test (12.5 per cent of quality premium)
- Preventing healthcare associated infections (12.5 per cent of quality premium)
The remaining proportion will be decided based on three “local priorities identified in joint health and wellbeing strategies”.
However, a CCG will also lose a quarter of its quality premium, as decided by the above measures, for each of the four waiting time targets it does not meet. They are for elective treatment, in accident and emergency, for urgent cancer GP referrals, and for response to urgent ambulance calls. If a CCG failed to meet all of them, it would not receive any bonus.
The government is due to confirm the value of the premium in coming weeks, although it is expected to be £5 per head of population, around £250m across England.