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The team does not and cannot offer clinical advice. If you have any urgent medical enquiries we urge you to contact your GP, or NHS Direct at www.nhsdirect.nhs.uk or by calling 0845 4647. In an emergency call 999
Incentive structure
These can be used to encourage new work or new quality standards to be achived and can be written into contracts.
All providers have responsibilities to deliver to certain general quality standards, or within contracts such as the GMS (general medical services), PMS / APMS for primary care services. This included payments QOF (Quality and Outcomes Framework Guidance for GMS Contract fourth version 2011 PDF 700KB), a voluntary national scheme of points for achieving certain agreed national indicators, which included the ability to ‘exclude’ certain patients from the denominator, a facility which varies widely from practice to practice. QOF can make up to (15%) of a practices income.
Primary care
Current commissioners (PCTs) have a variety of options for further incentivisation which can be developed locally. These are developed under a number of different names including Local Enhanced Services (LES), Local Improvement Scheme and QOF Plus offering practices payments for additional activities including new work e.g. insulin initiation, care planning or various quality markers such as no ‘exclusions’, attendance at multidisciplinary meetings, referral to structured education etc. They may include element of structure, process and/or outcome. They are paid for in a variety of ways form additional QOF points to currencies recognising work for groups of patients or over time (a years’ care). Examples inclued QOF Plus and three different approaches used a traditional LES - North of Tyne, a LIS - Kirklees and an entirely new system of ‘packages of care’ based on practices stratifying registered patients according to biomedical variables and paying incentives to groups of practices for improvement.
Secondary/Community providers
CQUIN (Commissioning for quality and innovation) makes a proportion of providers income conditional on quality and innovation goals - and can be withheld if these re not achieved in 2011 – 2012 this makes up 1.5% of an organisations income.
