Consolidated Funding Framework (CFF) 2017-19
Year 2 2018 – 2019 Updated Metrics
CFF Areas and metrics
The CFF is a voluntary E & N Herts CCG Locally Enhanced Scheme (LES), aligned to the following key areas where we want to avoid duplication of effort and spend:
- GMS contract changes 2017 - 2019.
- GPFV creating sustainable primary care
- STP/QIPP requirements ensuring VFM for taxpayers
- Clinical priorities in the CCG’s 2 year Operational Plan
- Putting patients first through truly integrated services
Payment will be based on a percentage upfront to invest in additional capacity and the balance on achievement against the targets set for each of the metrics.The rates of remuneration are a rate per registered patient as at January 2018.
Core Requirements
This is Year Two of this CFF and we have built on last year’s framework and simplified the overall ask as well as reduced the reporting and monitoring requirements. Most of the structure and requirements are the same with a small number of new items.
As a LES the practice has a choice; should a practice choose not to sign up to the core requirements stated below,they will not have access to remuneration under the CFF. The core requirements are the same as last year as data sharing across patients and professionals is key to safe services and fully integrated services.
Core Requirements:
1. To continue to support the data integration program as signed up to in 2017 as part of the East and North Hertfordshire CCG Information Sharing Protocol for secondary care use.
2. To continue to seek explicit decision on consent for sharing from patients for whom information sharing would be of great benefit for them (e.g. those with complex care needs and co-morbidities) or practices to sign up to MyCare Record.
The CCG is continuing to supportthese two significant data sharing programmes that will allow information to be lawfully shared for the purpose of patient care (referred to as primary use) and population health analytics (referred to as secondary use.) Although these are described as two separate programmes, and will require separate data sharing arrangements, it should be emphasised that the two programmes are linked and progress with one programme will have either a direct or indirect effect on the other programme.
The CFF for 2018-2019 has been simplified and split into 5 Key Sections, across clinical and non-clinical areas.
Non-Clinical - £2.50
- Financial Balance - £1.50
- Engagement - £1.00
Clinical Services - £7.60
- Frailty and Care Management - £4.75
- Cancer - £1.75
- Planned Care - £1.10
Financial Balance
Remuneration: £1.50(per registered patient)
Outcome:
Overall locality spending to be no greater than the agreed budget for 2018-19 measured at the end of year 31st March 2019.
Metric:
If a locality achieves financial balance in 2018/19 (based on assessment by the CCG finance team following submission of end of year accounts), the Locality will be awarded £1.50 per registered patient.
If a locality fails to achieve financial balance in 2018/19, the Locality can be awarded up to 50p per registered patient in proportion to the overspend, if the overspend is less than that recorded in 2017/18.
Measurement and Reporting:
If the CCG and each locality does not stay in financial balance then the whole CFF is at risk as the CCG will need to address the areas of deficit probably with the CFF funding if we cannot demonstrate CFF VFM and impact on secondary care spend.
If a locality achieves financial balance in 2018/19 (based on assessment by CCG finance team following submission of end of year accounts), the locality will be awarded £1.50 per registered patient.
If a locality overspends in 2018/19, but has a lower overspend than was recorded in 2017/18 then the locality will be awarded a percentage of 50p per registered patient based on the percentage reduction compared to the 2017/18 overspend.
The funding distribution by Practice will be decided and agreed by the Locality Commissioning Committee (LCC).
This element will be monitored and measured by the CCG and reported to Localities quarterly and finally on following approval of the CCG’s Accounts in June 2019.
Engagement
Remuneration Total: £1.00 (per registered patient)
Outcome:
The overall aim is to achieve fully engaged practices in delivering agreed service priorities in 2018/19.
The 4 key outcome areas are :
1)To improve and maintain practice engagement throughintegrated locality working, CCG and STP activities and events.
2)To incentivise practices to engage with PPGs and improve patient communication and information.
3)Funding is to supportprimary care to participate in and lead locality collaborative working by jointly identifying and implementing a specific service transformation based on clinical need in an agreed priority areawith specific measurable outcomes. These outcomes should relate to improved patient care, safety and quality of service, such as most efficient use of resources, reduced A&E attendance or non-elective admissions. E.g. GPwSI, Phlebotomy, Mental Health
4)Improve primary care workforce data to help with recruitment and retention as well as addressing opportunities for skill mix and shared posts/risk.
Metric:
Engagement – Payment of £3798 per practice
This payment is an equitable payment per practice to enable participation in Locality Commissioning.
Practice clinicalrepresentations at the following meetings/events to be included under the engagement element are as follows. Each Practice Representative will need to attend a minimum of 6 out of the 7meetings/events listed.
Practice Level Representation:
Meeting / Event / Attendee / Number of meetings
Locality Commissioning
Committee Meetings / Practice Clinical Representative / 4
CCG Council of Members Meetings / Practice Clinical Representative / 1
CCG Wide localities workshops / Practice Clinical Representative / 2
As currently happens, practices will not be remunerated under the CFF engagement element for attendance at Target events as the cost for these are assigned against locality management costs to provide HUC cover. All clinical staff scheduled to work during the time of the events are required to attend, as this supports continuing professional development.
Attendance is expected at a minimum of 4 events per year (1 of whichmay be in-house) and audits of attendance will be undertaken. As in previous years, there is also an expectation that practices will continue to engage with other continuing professional development activities, such as the Prescribing Forum and other clinical fora.
Localities are to hold at least one scheduled education session at a TARGET event, focused on Cancer and of at least 3 hours duration per annum, or alternatively these could be 3 x 1hrs sessions. Agenda to be agreed with the CCG Cancer Lead GP (please refer to the Protected Learning Time 2018/19 policy).
Localities are expected to hold a minimum of 4 Locality Commissioning Committee meetings per year (1 per quarter); remuneration of this element is included in the CFF. Additional Locality Commissioning Committee meetings will not be remunerated within the CFF.
In order to deliver Locality service change priorities localities may choose to arrangeProject specific or Task and Finish groups to undertake specific agreed pieces of work, for which locality management funds may be used to appropriately reimburse clinical time, as approved by the relevant Locality Commissioning Committee.
Integrated Care Delivery Board Representation: Localities are expected to identify and nominate Primary Care Representativesfor the IntegratedCareDelivery Board (ICDB) Meetings for between 2-4 representatives, depending on the size of the locality, with a minimum of 2 GPs. A Federation may represent all the practices if so nominated. Representatives will need to attend at least 7 of the 8 meetings throughout the year. The nominated representatives attending these meetings on behalf of the locality will be reimbursed from the locality management budget. Split meetings between the LCC and ICPB (i.e. meetings held consecutively) will not attract two separate payments.
Meeting / Event / Attendee / Number of Meetings
Integrated Care Delivery Board Meetings / 2 – 4 Primary Care representatives (a minimum of 2 GPs) / 8
5p - PPG Engagement and Patient Communication
To encourage more effective patient information and PPG activity to help manage demand & improve disease specific healthcare information. Each practice to agree a PPG engagement plan (template provided) based on locality and practice clinical priority areas and submit the plan at the end of Q1 2018 to the LCC and the CCG. A report of evidence of progress in implementing at least two key actions to completion to be submitted to the LCC and the CCG at the end of Q4 2019.
55p - Collaborative Working
This pot, under the control of the LCC, has two main aims: to supportpractice & patient engagement in service change and facilitate the locality to work collaboratively across organisations by identifying a service transformation need on a locality priority area with agreed outcomes around patient care, and most efficient use of resources,such as reducing A&E attendanceor non-elective admissions. This can be locality / town based, but needs to be in accordance with the needs of the locality. E.g. GWPSWI, Phlebotomy, Care Home,Mental Health models in Primary Care, In-house Physiotherapists, shared workforce etc.
This is not practice specific money, it is intended to support those practices and individuals that deliver the agreed service changes of the LCC plan. The LCC should set out clearly what their local service change priorities are by end of Q1 and what will be delivered by working together through the Integrated Care Delivery Board (ICDB).
The Locality including the relevant providers will work collaboratively to identify a service transformation need in a priority service area. (N.B. This is not to be used for a service change that is already funded from another source). The collaborative working plan will be developed by the ICDB to deliver the priorities of the LCC.
A written costed project proposal (templates provided) should be submitted to and formally approved by the LCC. Planning and implementation will comply with the CCG policy on remuneration (if relevant to the locality plan).
5p - Workforce and Skills Data
Practice to complete a quarterly workforce data template and annual workforce skills/training needs template.All templates will be provided by the Primary Care Workforce and Education Team on a quarterly/annual basis when data is requested.
Measurement and Reporting:
Engagement – Practice based: The engagement element will be monitored by the CCG localities team (Inc. feedback from the prescribing forums and LTC Board). Payment will be 50% upfront and 50% final payment.The final payment requires attendance of a minimum of 6 out of the 7 practice level representation meetings, in addition to expected attendance at Target events, prescribing and other clinical fora, and agreed locality representation at a minimum of 7 out of 8 ICDB Meetings.
PPG Engagement and Patient Communication –Practice based. This will be measured through practices submitting a written plan to LCC during Q1 of planned changes and actions to improve and develop PPG & practice working.By the end of Q4 a final report is to be submitted to LCC providing evidence of successful implementation of at least two key areas. Payment will be 50% upfront and 50% on sign off of the final report by the LCC.
Collaborative Working–Locality based: The LCC is responsible for ensuring value for money in demonstrating delivery of the agreed measurable actions in each project agreed. Localities to develop a collaborative plan and submit to the CCG Localities Commissioning Committee for approval by end of Q1. Defined action plans for each LCC to be submitted to the CCG by beginning of Q2 2018/19. A final evaluation report is to be submitted to the LCC Locality managers will provide CCG wide progress reports on delivery and successful changes. Payment will be approved by the LCC against agreed projects or task & finish groups. No up-front payments will be provided. Remuneration will be as approved by the LCC in line with agreed CCG remuneration rates and other relevant policies, with invoices being submitted in line with the specific finance plan associated with each locality plan, as agreed by the LCC.
Workforce and Skills Data – Practice based:Payment will be 50% upfront and 50% on receipt of final quarter workforce return by the end of each quarter, with all 4 returns requiring completion for full payment.
In addition an annual report to be completed by the end of Q4. Workforce team to monitor submissions in line with deadlines set. Annual report to be provided back to practices on overview.
Frailty and Care Management
Remuneration: £4.75 (per registered patient)
Outcome:
To reduce the A&E attendance and non-elective admissions of those practices who are currently falling above the CCG average, with the focus on reducing clinically avoidable A&E attendance or non-elective admissions.
Metric:
£3.25 - Care Planning(N.B. Capped per practice list size.)
Following on from the work practices have already undertaken in 2017/18, using the Electronic Frailty Index (EFI), risk stratification and local clinical judgement, practices should identify all patients they believe may be at risk of admission if they do not have a managed care plan. Patients identified as “at risk” must have a care plan as part of this process.
Patients identified should include those where early intervention and managed anticipatory care will reduce clinically avoidable A&E attendance or non-elective admissions, including those patients at risk of:
- Frequent attendance at A and E or Ambulatory Care
- Pneumonia / LRTI (Lower Respiratory Tract Infections) or regular COPD exacerbation
- End stage Long Term Conditions (CHF( Congestive Heart Failure)NYHA (New York Heart Association) Stage 3/4 or COPD MRC(Medical Research Council) stage4/5 or O2 therapy or CKD (Chronic Kidney Disease) Stage 4/5 or rapidly declining neurological conditions) or those that exacerbate frequently
- Frequent admissions (greater than or equal to 2 admissions per annum)
- End of Life (within the last 12 months of life) or graded as moderately or severely frail
- Carers who support very vulnerable patients
The paymentwill be made as follows:
New care plans = £150
Annual or Clinically necessary Review of care plans = £50
The overall practice allocation for care planning is capped at £3.25 per practice list size. This is roughly expected to be split over the year as follows: 70% for new care plans and 30% care plan reviews. Should a practice wish to propose a change in the ratio of new and follow-up care plans being reimbursed, a written proposal with rationale and proposed amendment in the reimbursement ratio, must be submitted to the LCC for consideration and approval?
20p - Catheter Register
Practices to compile and maintain a catheter register, and use this to ensure there is active management of each patient with a catheter passport and appropriate follow up and escalation plans in place through their care plan.
25p - GSF/MDT Co-ordinator
Identify a practice or neighbourhood GSF/MDT Co-ordinator and host regular (every 4-6 weeks and with a minimum of 8 in a year) GSF/MDT meetings for complex including patients in the last 12 months of life and patients classed as severely frail by either theElectronic Frailty Index (EFI) or Rockwood tool.
10p - Post Death Audits
Practice to complete Post Death Audit for each practice death, using CCG provided template and return to the CCG.
Practice to analyse the data quarterly and report on the themes and any changes to practice procedures, date discussed at the MDT/GSF meetings and agreed action with all clinicians.
35p - Mental Health(N.B. Capped by practice). Payment will be made of £50 per dementia care plan and £30 per SMI Physical Health Check.
Two key groups of patients :
1)Dementia: Ensure Care Plans are in place for patients diagnosed with dementia (currently stands at 59% for CCG but varies widely by practice and locality) and shared with patient/family/carer including an annual review for all previously diagnosed in 2017/18. The expectation is that a minimum of 95% of patients diagnosed with dementia will have a care plan.
2)SMI: Practices to ensure an annual Physical Health Check is completed for patients with a Serious Mental Health (SMI). The expectation is that a minimum of 95% of patients with SMI will have an annual physical health checkand an active care plan.
Practices to identify patients on SMI register andliaise with HPFT community team to confirm numbers. Practice to complete the physical health check metrics (not covered via QOF and/or NHS check). Offer/refer to appropriate interventions; and ensure personalised care a plan isin place either at practice or with HPFT. Practices are encouraged to follow the jointly agreed Shared Care Protocol which sets out clinical responsibilities under shared care.
60p - Diabetes Prevention and Diabetes treatment.
Practices to identify a Diabetes lead for the practice or neighbourhood. Practices to review the existing practice diabetes care improvement plan from 2017/18.Identify progress made and plan for new or on-going areas of focus. The aim of the practice plan willbe to deliver consistent diabetic care sustainability.