PERFORMANCE: Commissioners in Bath and Wiltshire have agreed a plan to spend cash withheld from their local acute trust following a rise in emergency activity on helping it move towards seven day working.

In May NHS England ordered all health economies to draw up a plan for spending the cash saved on the marginal tariff under which commissioners are only required to pay 30 per cent of the cost of emergency admissions above 2008-09 levels.

The policy was introduced in 2010-11 to release cash for commissioners to spend on demand management schemes but is widely regarded as having been unsuccessful.

However, the governing bodies of Wiltshire and Bath and North East Somerset clinical commissioning groups have both approved a bid from Royal United Hospital Bath Trust to spend it on a number of initiatives. These include increasing consultant cover in the emergency department and setting up a “frailty unit”.

The money will be used to fund improvements including an additional consultant during the peak noon to 6pm period to enable rapid assessment, and additional consultant cover on weekends.

Royal United has struggled with accident and emergency performance over the last 12 months. Its business case for the money was based on recommendations from NHS Interim Management and Support’s emergency care intensive support team.

A report to the BANES’s July board meeting said: “The CCGs are requested initially to fund the [intensive support team’s] improvement projects and support initial steps in 2013-14 towards seven day working across the trust.

“Work will then continue to further develop the urgent care model and the contract to reflect these new ways of working.”

In 2012-13 the total unpaid to Royal United Hospital under the marginal tariff rules was £3.4m, made up of £930,000 which remained with BANES, £1m with Wiltshire and £1.4m with Somerset.

Wiltshire CCG has agreed to provide an additional £940,000 during 2013-14 while BANES has agreed to contribute £660,000. Separate discussions are taking place with Somerset CCG to determine why there has been a significant increase in non-elective activity from the area and whether there should be a recalculation of its base funding level.

The CCGs have also agreed to provide non-recurrent funding in 2014-15, provided the marginal rate is still applied. The BANES report said once the new arrangements are embedded it is “assumed by the CCG that the RUH will be paid under tariff for all emergency activity”.