The total amount withheld from local commissioners has now reached almost £600m over three years, after NHS England paid out just a fifth of the available quality premium for 2015/16, data released this month reveal.
GP leaders said the loss of potential funding for services would deepen the NHS crisis and warned that practices thinking of signing up to the new multispecialty community provider (MCP) contract should learn the lesson that they risk losing more funding to politically motivated targets.
The quality premium is awarded by NHS England to reflect improvements in the quality of services CCGs commission, and is worth up to £5 per head of population.
But for the third year running NHS England has said the majority of potential quality premium money will not be handed over to local commissioners to spend on services. In a move that risks compounding pressure on commissioners, many CCGs were awarded nothing for 2015/16 because of their poor financial positions.
Results for the 2015/16 quality premium scheme revealed that just a fifth of the potential funding available has been handed over to CCGs. Of the £274m available under the incentive payment scheme just £56m will find its way to commissioners.
The 20% payout of available funds is the lowest so far. Last year commissioners were awarded just £73m, around a quarter of the £272m available for the 2014/15 scheme. The previous year, CCGs received £86.3m, just 32% of the available £269m quality premium pot for 2013/14.
CCGs have previously said that much or all of the premium funding they receive would be directed at improving primary care, meaning practices could be missing out on almost £600m over the three years.
CCGs were not eligible for premium funding if they ended the financial year with an 'adverse variance' against their planned surplus, breakeven or a financial deficit, required unplanned financial support, incurred a qualified audit report, were considered not to have properly managed public money, or if there were serious quality failures. A total of 49 CCGs have been awarded no quality premium money at all for 2015/16 due to financial or constitutional penalties.
GP leaders have opposed the quality premium scheme from the outset and have repeatedly called for the full amount to be put into CCGs' core funding for spending on patient services.
Commissioning groups are awarded premium cash according to five measures covering national and local priorities, including reducing years of life lost through causes amenable to healthcare, urgent and emergency care measures, mental health measures, improving antibiotic prescribing, and two local measures. Each priority measure is worth a percentage of the CCG’s maximum award.
GPC deputy chair Dr Richard Vautrey said the GPC opposed the created of the quality premium scheme because ‘vital funding for healthcare investment would be subject to achieving politically motivated targets and would be at risk of being lost to the system’.
‘We've now been proved right and with a dramatically worsening funding crisis, to lose such a large amount of funding just makes the already difficult situation worse,' Dr Vautrey said.
'Those considering entering into risk/gain agreements as part of an MCP contract in the future should learn these lessons as they too risk moving into a system where they could lose even more funding that could ultimately destabilise their organisation and seriously impact on the care they provide to their patients.’