System Specification template by Q9btea5

VIEWS: 5 PAGES: 54

									B.   THE SERVICES




      Page 1 of 54
B.1 - SCOPE

Part 2 Diagnostic Services – Direct Access Magnetic Resonance Imaging
Service Specifications
Mandatory headings 1 – 3. Mandatory but detail for local determination and
agreement.
Optional headings 4 – 6. Optional to use, detail for local determination and
agreement.

All subheadings for local determination and agreement.

Service Specification No.
                             Diagnostic Services – Direct Access Magnetic Resonance
Service
                             Imaging Service
Commissioner Lead            NHS Norfolk and Waveney
Provider Lead
                                          st
Period                       Initially to 31 March 2013
Date of Review

1. Population Needs
The NHS supports the need to develop improved access to diagnostic tests
as part of the drive to reduce waiting times and improve choice options for
patients. The need to develop community based diagnostic services is
supported by the Royal College of Radiologists and Royal College of General
Practitioners as part of a service strategy to improve access to tests and
ensure these tests are delivered at the right stage of the patient care pathway.
The overarching aims of the service are:
     To ensure patients receive the right test at the right time and in the
     most clinically appropriate local setting;
    To ensure diagnostic testing is integrated across pathways of care, that
     the report and/or images follows the patient and that there is no
     unnecessary duplication of investigation;
    To enable patients and referring clinicians to access a choice of
     provision according to Patient choice, clinical need and relevant care
     pathway; and
    To ensure diagnostic tests are appropriate, necessary, clinically
     correct, of high quality, with timely access and reporting.
To develop local service provision as part of a diagnostic commissioning plan
which aims to improve access and choice for Patients.

2. Scope

2.1 Aims and objectives of service

A local, direct access MRI service with staff qualified to appropriate levels of
skill and experience, using equipment which complies with the guidance set


                                   Page 2 of 54
by the Royal College of Radiologists, connection to NHS image transfer
solutions, the ability to integrate with the Choose and Book system, robust
performance management systems and stringent levels of clinical
governance.

The care pathway being commissioned is pre-appointment communication
with Patients, the diagnostic investigation and a report being sent to the
referrer which covers not only the description of the investigation and the
findings, but also covers a brief recommendation on a proposed management
plan for the Patient, meeting the clinical request of the referrer. Structured
reporting will be encouraged to support local referrers in their options for
further clinical management. The service will need to be fully quality assured,
validated and supported by the local Commissioners.

The Provider must aim to provide an excellent Patient experience during all
parts of the process – to include the examination and the administrative
services. In order to measure this, Providers should have in place robust
mechanisms for collecting Patient feedback using approaches that reflect the
diverse nature of their Patient population. This should include as a minimum,
a Patient satisfaction survey, and one real time feedback mechanism. There
must be a sound process for receiving and dealing with suggestions,
compliments and complaints.

The aim of the service is to aid early diagnostics and avoid the need for
unnecessary referral to secondary care, or to support the shift of activity in to
a primary care setting. It is important that the use of MRI is governed by
evidence-based guidelines for determining the diagnostic examination to
optimize imaging of certain conditions and reduce radiation dose where
possible.

2.2 Service description/ care pathway

2.2.1 Referral
     Referral should ideally be via the Choose and Book system. As a
     minimum referrals should be sent by secure email. Providers would be
     expected to aim to be connected to the Choose and Book system
     (directly or indirectly bookable) at the earliest opportunity.
    It is anticipated that the majority of referrals will be direct from General
     Practitioners or a Clinical Assessment Service. Some referrals may be
     received from secondary care following specific agreement with local
     Commissioners.
    Providers must have a clinical triage process in place to ensure
     appropriateness of referral. The Provider will be required to produce
     clear guidance on what is excluded – for example pacemakers and
     aneurysm clips – and will be required to monitor referrals and exclude
     as appropriate within [1] working day;
    Providers must provide literature for GPs and referrers to assist them in
     the decision making processes associated with the most suitable type
     of diagnostic test for the Patient and presentation that will achieve the
     best and quickest diagnostic outcome;


                                    Page 3 of 54
       Patients should be contacted within a maximum of [5] working days of
       acceptance of referral;
       The Patient should be offered a choice of day and time of appointment
       that is convenient to them;
       The Provider should ensure Patients have an adequate understanding
       of the proposed MRI scan before the appointment by providing written
       information in advance that explains the purpose of the scan, what it
       involves and when and how they can expect to receive the results. This
       information should be reinforced on arrival at the appointment
       consistent with the written information already received;
       The Provider shall not discriminate between or against Patients or
       Carers on the grounds of gender, age, ethnicity, disability, religion,
       sexual orientation or any other non-medical characteristics. The
       Provider shall provide, at its own cost, appropriate assistance and make
       reasonable adjustments for Patients and Carers who do not speak,
       read or write English or who have communication difficulties; and
       The Provider will provide to the Commissioner, detailed referral
       statistical information on referrers, referring organisation, service
       utilisation and clinical outcome to allow refinement of the clinical
       pathway.

2.2.2 Assessment
    Scanning should be undertaken within [10] working days of acceptance
     of referral and at an absolute maximum of [20] working days ([4]
     weeks);
    During the appointment, the radiographer should work in partnership
     with the Patient to understand their jointly agreed outcome
     expectations; and
    The Provider should not impart the results of the diagnostic to the
     Patient at the time of the investigation, but should explain that the
     diagnostic report will be sent to the doctor who referred the Patient.

2.2.3 Report
     A written clinical report should be sent to the referrer (and GP if this is
     not the same individual) within [2] working days following the
     examination and maximum of [5] working days. The information should
     be communicated electronically via a secure network.
    The Provider shall ensure that the Diagnostic Report is produced
     according to the guidance set out within the document ‘Standards for
     the Reporting and Interpretation of Imaging Investigations’ as published
     by the Royal College of Radiologists and as updated from time to time
     in the formal agreed with the Authority; and
    The report will provide the referrer with a differential diagnosis
     wherever possible – this will be based upon the presenting complaint
     described in the referral and the objective findings of the scan.
    If the radiographer requires input from a Consultant Radiologist, this
     should be available within 24 hours of the investigation.




                                   Page 4 of 54
       GPs or other clinical staff wishing to discuss individual cases will be
       provided access to the reporting radiologist through a central contact
       number.
       Patients with a suspected cancer are specifically excluded from this
       service. However, there will be occasions when a diagnostic reveals a
       high risk Patient. The Provider will need to have a clear Patient pathway
       for this group of Patients, which will ensure that the referrer is made
       aware of the potential diagnosis and the report is expedited for onward
       communication. This would include an immediate telephone
       conversation with the referrer, in line with guidance set out within the
       document ‘Standards for the communication of critical, urgent and
       unexpected significant radiological findings’, Royal College of
       Radiologists.
       The image and report is stored in electronic format, in accordance with
       The Royal college of Radiologists ‘Retention and Storage of Images
       and Radiological Patient Data’ publication ideally via a Picture Archiving
       and Communications System (PACS) system; and
       The image and report is forwarded, at no charge, to other Providers of
       NHS funded treatment applicable to the Patient care pathway, within a
       maximum of 5 working days of the request and sooner if necessary to
       correspond with patient care needs. This will require connection to the
       National Image Exchange Portal (IEP).
       Reasonable repeat requests for images and reports will be made
       available at no extra charge while the Provider holds a relevant
       contract.

2.3 Population covered
The population to be covered is the current populations of NHS Norfolk and
Waveney
From April 2013 this same population will be covered by the Clinical
Commissioning Groups listed below.

North Norfolk
South Norfolk
Norwich
West Norfolk
Health East

Providers may be an AQP for one or more of these areas; requirements apply
to each of the areas for which they wish to be an AQP and patients from the
entire population will be able to access any service provision within any of the
geographical areas.

Providers will be expected to work with commissioners to optimise access to
the services within each geographical area of the clinical commissioning
groups




                                    Page 5 of 54
2.4 Any acceptance and exclusion criteria

2.4.1 Acceptance Criteria
The MRI casemix and examinations will follow the guidelines defined in
Making Best Use of Radiology Departments (MBUR6) Version 6 or as
updated. The activity output should indicate the area of the body examined
aggregated by the following HRG codes:

HRG Code                  Description
RA01Z                     Magnetic Resonance Imaging Scan, one area, no contrast
                          agent
RA04Z                     Magnetic Resonance Imaging Scan, two – three areas, no
                          contrast agent
RA06Z                     Magnetic Resonance Imaging Scan, more than 3 areas

The use of sedation (prescribed Diazepam) for claustrophobic patients will
only be used in accordance within a defined protocol for selection,
administration and recording.

2.4.2 Exclusion Criteria

Referral criteria
The Provider will comply with relevant commissioner policies on clinical
referral thresholds and procedures of limited clinical value.

Clinical exclusions
Cancer – any Patient with suspected cancer should be referred through the
two week wait referral pathway;
Patients with a Body Mass Index exceeding the manufacturer’s health and
safety guidance for weight limits of the MRI unit or couch.
Patients with implanted medical devices that are MRI contraindicated and in
certain cases are MRI conditional.
The referrer has a responsibility to provide information on all such devices, but
the final responsibility for safety rests with the Provider in line with Provider
protocols and relevant safety guidelines and resources.

Other exclusions
       Children under the age of 18;
       Patients requiring a general anaesthetic;
       Scans requiring the use of contrast;
       Hospital inpatients; and
       Non-NHS Patients.

2.5 Interdependencies with other services
The Provider needs to develop their relationships with other Providers to
become an integral member of the Health and Social Care Community. This
includes third sector organisations providing help and support for Patients.
The development of local clinical networks will be encouraged with the aim of
providing parallel services, which provide complementary services allowing for
further clinical services to be offered closer to home and within the


                                    Page 6 of 54
community. The role of service users as key stakeholders will be an important
component of this development and Providers should ensure effective
mechanisms for their involvement and develop a positive relationship with the
local involvement network (Healthwatch).

The Provider will be required to be involved in local care pathway discussions
and work, ensuring the best and most efficient means of treating Patients is
adopted, including the movement of all the relevant clinical information (i.e.
images and clinical output report).

3.1 Applicable National Standards
       Right Test, Right Time, Right Place - Royal College of Radiologists and
       Royal College of General Practitioners (2006).
      Making the Best Use of a Department of Radiology, 6th edition
       (MBUR6) - Royal College of Radiologists (2007).
      Standards for the communication of critical, urgent and unexpected
       significant radiological findings - Royal College of Radiologists (2008).t
       vv
      Safety Guidelines for Magnetic Resonance Imaging Equipment in
       Clinical Use – MHRA Device Bulletin (2007).
This is intended as a non-exhaustive list. Clause [16] takes precedence

3.2 Applicable Local Standards

3.2.1 Staffing

The Provider shall ensure that the service is delivered by Staff who meets the
following service requirements:
    a)     UK Registered Radiologists on the GMC Specialist Register who
           have reported on a minimum of 1000 MRI scans in the in the last 12
           months. Cases should be of the anticipated referral casemix.

              Subspecialty             Minimum     number      of
                                       diagnostic         reports
                                       produced in the last year
                                       for     the       required
                                       anatomical area by the
                                       Reporting Clinician
              Neurology                250
              Head and neck            150
              Abdomen and Pelvis       350
              Musculoskeletal          500
              Vascular and MRA         200

b)       UK Registered Radiographers who have:
        A minimum of 1 years experience;
        Undertaken a minimum of 900 MRI examinations per annum;
        Assurance of competency assessment and up to date Continuous
         Professional Development; and



                                    Page 7 of 54
       Meet the specification set out in the ‘National Occupational Standards
       for Imaging’ (RD5- Produce MRI images for diagnostic purposes).
Staff will have English as a first language or have passed a suitable English
language examination to the level of requirement set out on the Health
Professions Council website
(http://www.hpc-uk.org/apply/international/requirements/).

3.2.2 Equipment
The Provider shall provide equipment that meets or exceeds the following:
       Fixed or mobile units shall contain one full body MRI scanner with a
       magnetic strength of at least 1.5 Tesla;
       Complies with the Guidelines for Magnetic Resonance Equipment in
       clinical use, MHRA (2007) as updated, superseded and replaced from
       time to time.
       Is a maximum of 7 years old; and
       Electrical Safety Testing is required annually with regular maintenance
       and quality assurance testing;
       Details of maintenance contracts to include regular and emergency
       service cover must be provided; and
       Replacement schedule must be available with the maximum age of
       equipment of 7 years.

3.2.3 IM&T
Provision of Digital Data between the Provider PACS systems should be
through the Image Exchange Portal or other data sharing systems to other
providers as specified by the commissioner, or in clinical circumstances that
require the transfer of the image to support the safe treatment of the patient.
For MRI this should be the provision of Digital Medical Image transfer to the
PACS Cluster or local Data stores using DICOM V3.0, HL7 v2.3/3.0
integration profiles including the provision for images to be marked for
teaching purposes as defined in IHE (UK) IP6.

The Provider should aim to work towards the ability to support the booking of
appointments and receipt of referrals from local commissioners by either
indirectly or directly bookable Choose and Book Services

In the event of cancellation of the contract (for whatever reasons), the
Provider will be required to maintain systems to allow continued access, in a
timely manner, to all of the patient information, images and associated patient
records.

3.2.4 Facilities
       Commissioners will consider mobile or static sites.
       All facilities, including mobile units, must have a minimum of a patient
       reception and waiting area –either on the unit or near by, access to a
       toilet and access to appropriate levels of security.



                                   Page 8 of 54
3.2.5 Quality Assurance
The proposed Quality Assurance process must include, as a minimum:
       Radiographers have a duty to maintain their statutory registration – this
       must be renewed on a two year cycle and requires evidence of relevant
       Continuing Professional Development;
       Ongoing 5% blind audit of image and report review for each
       radiographer and radiologist - exact mechanism to be agreed with
       Commissioner;
       Participation in ‘errors meetings’ or similar clinical governance
       processes.
       The recall rates for Patients (annual report) and the reasons.
       Monthly image reject analysis (including breakdown of the reason and
       at what stage the rejection occurred (e.g. triage, etc).

4. Key Service Outcomes
Key Service Outcome                         Method of Measurement
Patients reporting a good level of          Patient Satisfaction Survey to be sent
satisfaction of the service.                to a minimum of 95% of Patients
                                            using the service, with a minimum
                                            response rate target of 30%. Target
                                            of 95% of Patients reporting good
                                            level of overall satisfaction.
Reduced referral to secondary care          Secondary Uses Service (SUS)
and improved conversion rate – as           system – using previous year as
proxy for increased appropriateness         baseline.
of referrals.
Image and Report to follow Patient          Commissioner to audit random
pathway – no repeat scanning without        sample – results to be extrapolated.
clinical rationale.
Improved targeting of referrals to right    SUS system – using previous year as
secondary care clinic first time – less     baseline.
Consultant to Consultant referrals.


5. Location of Provider Premises

The Provider’s Premises are located at:

[Name and address of Provider’s Premises OR state “Not Applicable”]



6. Individual Service User Placement

Not applicable




                                     Page 9 of 54
7. Prices and Payment

HRG
         Currency Description                                     Price
Code

Magnetic Resonance Imaging Scan
                                                                  Current
         Magnetic Resonance Imaging Scan, one area, no contrast
RA01Z                                                             PbR tariff -
         agent                                                    £153
                                                                  Current
         Magnetic Resonance Imaging Scan, two - three areas, no
RA04Z                                                             PbR tariff -
         contrast agent                                           £193
                                                                  Current
RA06Z Magnetic Resonance Imaging Scan, more than three areas      PbR tariff -
                                                                  £271

Market Forces Factor will apply.

There will be no payment made for appointments where patients do not
attend.




                                   Page 10 of 54
SECTION B Part 2 - Essential Services
NONE




                                Page 11 of 54
SECTION B Part 3 - Indicative Activity Plan

N/A




                                Page 12 of 54
       SECTION B PART 4 – ACTIVITY PLANNING ASSUMPTIONS

None




                           Page 13 of 54
SECTION B PART 5 – ACTIVITY MANAGEMENT PLAN

                    N/A




                 Page 14 of 54
   SECTION B PART 6 - NON-TARIFF AND VARIATIONS TO TARIFF PRICES

Section B Part 6.1: Non-Tariff Prices
None




Section B Part 6.2: Variations to Tariff Prices
None




                                   Page 15 of 54
SECTION B PART 7 - Expected Annual Contract Values

Not Applicable




                             Page 16 of 54
                        SECTION B PART 8 - QUALITY


Section B Part 8.1: - Quality Requirements

Technical   Quality Requirement           Threshold           Method      of      Consequence of
Guidance                                                      Measurement         breach
Reference
                                                              Patient
            Patient Reported              [95%] report        satisfaction        Remedial   Action
            Satisfaction of an            overall             survey to be sent   Plan.
            overall good experience       satisfaction with   out to a minimum
            of the service.               the service.        of 95% of
                                                              Patients, with a
                                                              minimum
                                                              response rate of
                                                              30%.
            Reduced referral to
            secondary care and            Previous year as    SUS.                Remedial   Action
            improved conversion           baseline.                               Plan.
            rate as a proxy for
            increased
            appropriateness of
            referrals.
            Improved targeting of
            referrals to right            Previous year as    SUS.                Remedial   Action
            secondary care clinic         baseline.                               Plan.
            first time – less
            consultant to consultant
            referrals.
            Provider failure to
            ensure that ‘sufficient       No more than        TALs List.          Remedial   Action
            appointment slots’ are        [5%] slot                               Plan.
            made available on the         unavailable
            Choose and Book               bookings.
            system.
            Percentage of referrals                           Monthly             Remedial   Action
            received via the Choose       [40%]               Performance         Plan.
            and Book system.                                  Report.
            Rejections – total                                Monthly             Remedial Action
            number of referrals           [15%]               Performance         Plan – to work
            rejected by Provider.                             Report.             with Primary Care
                                                                                  to improve the
                                                                                  quality,
                                                                                  appropriateness
                                                                                  and completeness
                                                                                  of referrals.
            Number of Patients who
            have a repeat activity as     Greater than [1%]   Monthly             Repeat activity to
            a result of any                                   Performance         be provided at no
            incorrectly or                                    Report.             cost to the NHS.
            inadequately performed
            activity (expressed as a
            percentage of the total
            number of activities).
            Provider will provide
            triage of referrals to        [98%]               Monthly             Remedial   Action
            meet referral criteria                            Performance         Plan
            and accept or reject a                            Report



                                        Page 17 of 54
Technical   Quality Requirement            Threshold           Method      of    Consequence of
Guidance                                                       Measurement       breach
Reference
            referral within [1]
            working day.
            Initial contact to be                              Monthly           Provider        to
            made with patient within       [95%]               Performance       provide    patient
            [5] days of acceptance                             Report.           scan at no cost to
            of referral.                                                         the NHS.
            Patient offered choice
            on day and time of             [95%] of patients   Patient           Remedial   Action
            appointment that is            to be offered       Satisfaction      Plan.
            convenient to them.            choice.             Survey.
            Investigation                                      Monthly
            undertaken within [10]         80%                 Performance       Remedial   Action
            working days of                                    Report.           Plan.
            acceptance of referral.
            Investigation                                      Monthly
            undertaken within [20]         100%                Performance       Remedial   Action
            working days of                                    Report.           Plan.
            acceptance of referral.
            Report of investigation                            Monthly
            to be sent to referrer         80%                 Performance       Remedial   Action
            within [2] working days                            Report.           Plan.
            of investigation.
            Report of investigation                            Monthly
            to be sent to referrer         100%                Performance       Remedial   Action
            within [5] working days                            Report.           Plan.
            of investigation.
            Non-attendance:                                    Monthly
            Percentage of referrals        No more than        Performance       Remedial   Action
            not completed due to           [2.5%]              Report.           Plan.
            patient DNA or late
            cancellation.
            Provider cancellation of
            appointment for non-           No more than        Monthly           Non payment for
            clinical reasons either        [0.8%]              Performance       non investigation.
            before or after Patient                            Report.
            arrives for investigation.
            Patient waiting more                               Monthly
            than [30] minutes after        No more than        Performance       Remedial   Action
            appointment time before        [5%].               Report.           Plan.
            start of investigation
            activity (measured as a
            percentage of all
            Patients scanned).
            Complaints register to         No more than        Monthly           Remedial   Action
            be provided every              [5%] of             Complaints        Plan.
            month.                         complaints          Register.
                                           substantiated.
            A minimum of one GP
            satisfaction survey will       [85%]               Annual Referrer   Remedial   Action
            be designed and sent to                            Satisfaction      Plan.
            all referring GPs                                  Survey Report.
            annually. [85%] of GPs
            sampled should report
            overall satisfaction with
            service and target
            response rate of 30% is
            achieved.


                                         Page 18 of 54
Section B Part 8.2 -          Nationally Specified Events [as applicable]

Technical   Nationally    Specified    Threshold          Method            of   Consequence
Guidance    Event                                         Measurement            per breach
Reference
PHQ01       Ambulance       Clinical   75 % of all Cat    Performance measured   Monthly
            Quality-Category A 8       A calls within 8   monthly with annual    withholding of
            Minute Response Time       minutes            reconciliation         2% of actual
                                                                                 monthly
                                                                                 contract value
                                                                                 with an end of
                                                                                 year
                                                                                 reconciliation
                                                                                 with 2% of the
                                                                                 Actual Outturn
                                                                                 Value of the
                                                                                 Agreement
                                                                                 retained       if
                                                                                 annual
                                                                                 performance is
                                                                                 not met

                                                                                 or

                                                                                 the      withheld
                                                                                 sums returned
                                                                                 (with         no
                                                                                 interest)       if
                                                                                 annual
                                                                                 performance is
                                                                                 met

PHQ02       Ambulance     Clinical     95% within 19      Performance measured   Monthly
            Quality-Category A 19      minutes            monthly with annual    withholding of
            Minute Transportation                         reconciliation         2% of actual
            Time                                                                 monthly
                                                                                 contract value
                                                                                 with an end of
                                                                                 year
                                                                                 reconciliation
                                                                                 with 2% of the
                                                                                 Actual Outturn
                                                                                 Value of the
                                                                                 Agreement
                                                                                 retained       if
                                                                                 annual
                                                                                 performance is
                                                                                 not met

                                                                                 or

                                                                                 the      withheld
                                                                                 sums returned
                                                                                 (with         no
                                                                                 interest)       if
                                                                                 annual
                                                                                 performance is
                                                                                 met



                                       Page 19 of 54
Technical   Nationally     Specified     Threshold              Method              of   Consequence
Guidance    Event                                               Measurement              per breach
Reference

PHQ03-05    Proportion of patients                              Review   of   monthly    2%      of  the
            receiving first definitive                          Service       Quality    Actual Outturn
            treatment for cancer                                Performance Report       Value of the
            within 62 days of                                                            service    line
                                                                                         revenue
                -   an urgent GP         Operating
                    referral for         standard of 85%
                    suspected
                    cancer

                -   referral from an     Operating
                    NHS Cancer           standard of 90%
                    Screening
                    Service


                -       following a      N/A
                    consultant’s
                    decision        to
                    upgrade       the
                    Patient priority

PHQ06       Percentage            of     Operating              Review   of   monthly    2%      of  the
            patients receiving first     standard          of   Service       Quality    Actual Outturn
            definitive   treatment       96%                    Performance Report       Value of the
            within one month of a                                                        service    line
            cancer diagnosis                                                             revenue

PHQ07       Proportion of patients       Operating              Review   of   monthly    2%      of  the
            waiting no more than         standard          of   Service       Quality    Actual Outturn
            31 days for second or        94%                    Performance Report       Value of the
            subsequent     cancer                                                        service    line
            treatment - surgery                                                          revenue

PHQ08       Proportion of patients       Operating              Review   of   monthly    2%      of  the
            waiting no more than 31      standard          of   Service       Quality    Actual Outturn
            days for second or           98%                    Performance Report       Value of the
            subsequent       cancer                                                      service    line
            treatment    -     drug                                                      revenue
            treatments

PHQ09       Proportion of patients                              Review   of   monthly    2%      of  the
            waiting no more than         Operating              Service       Quality    Actual Outturn
            31 days for second or        standard          of   Performance Report       Value of the
            subsequent      cancer       94%                                             service    line
            treatment                                                                    revenue
            (radiotherapy
            treatments)
PHQ19-20    Percentage of patients       For    admitted        Review of monthly        As set out in
            seen within 18 weeks in      90% and over           report under Clause      Clause 43.4 of
            respect of Consultant-                              39.1 of the Core Legal   the Core Legal
            led Services to which        And                    Clauses                  Clauses   and
            the 18 Weeks Referral-                                                       Section B Part
            To-Treatment Standard        For             non-                            8.4
            applies                      admitted        95%
                                         and over



                                         Page 20 of 54
Technical   Nationally    Specified     Threshold            Method                of    Consequence
Guidance    Event                                            Measurement                 per breach
Reference

PHQ22       Percentage        of        Operating            Review of monthly           2%      of  the
            diagnostic waits > 6        standard        of   report under Clause         Actual Outturn
            weeks                       99%                  39.1 of the Core Legal      Value of the
                                                             Clauses                     service    line
                                                                                         revenue

            Percentage        of        Operating            Review of monthly           2%      of  the
            patients seen within        standard        of   report under Clause         Actual Outturn
            18 weeks for direct         95%                  39.1 of the Core Legal      Value of the
            access     audiology                             Clauses                     service    line
            treatment                                                                    revenue

            Percentage of A & E         Operating            Review of monthly           2%      of  the
PHQ23       attendances where the       standard        of   report under Clause         Actual Outturn
            patient spent four hours    95%                  39.1 of the Core Legal      Value of the
            or less in A & E from                            Clauses                     service    line
            arrival   to    transfer,                                                    revenue
            admission or discharge

PHQ24       Percentage of patients      Operating            Review   of   monthly       2%      of  the
            seen within two weeks       standard        of   Service       Quality       Actual Outturn
            of an urgent GP referral    93%                  Performance Report          Value of the
            for suspected cancer                                                         service    line
                                                                                         revenue

PHQ25       Percentage of patients      Operating            Review   of   monthly       2%      of  the
            with breast symptoms        standard        of   Service       Quality       Actual Outturn
            where     cancer     not    93%                  Performance Report          Value of the
            initially     suspected                                                      service    line
            referred to a specialist                                                     revenue
            who are seen within two
            weeks of referral

PHQ26       Sleeping                    >0                   Verification   of    the    Retention     of
            Accommodation Breach                             monthly data provided       £250 per day
                                                             pursuant to Section B       per      patient
                                                             Part      14.1    ,    in   affected as may
                                                             accordance          with    be        varied
                                                             Professional Letter         pursuant      to
                                                                                         Guidance

            Failure to publish a        0                    Publication (with easy      Retention of up
            Declaration          of                          access for the public) of   to 1% of all
            Compliance           or                          the    Declaration     of   monthly sums
            Declaration of Non-                              Compliance/Declaration      payable under
            Compliance pursuant to                           of Non-Compliance on        Clause         7
            Clause 30.1 of the Core                          Provider’s website          (Prices     and
            Legal Clauses                                                                Payment) of the
                                                                                         Core      Legal
                                                                                         Clauses      for
                                                                                         each month or
                                                                                         part month until
                                                                                         either         a
                                                                                         Declaration of
                                                                                         Compliance or
                                                                                         Declaration of



                                        Page 21 of 54
Technical   Nationally    Specified    Threshold       Method               of   Consequence
Guidance    Event                                      Measurement               per breach
Reference
                                                                                 Non-
                                                                                 Compliance    is
                                                                                 published

            Publishing            a    0               Publishing            a   Retention of up
            Declaration of Non-                        Declaration   of   Non-   to 1% of all
            Compliance pursuant to                     Compliance                monthly sums
            Clause 30.3 of the Core                                              payable under
            Legal Clauses                                                        Clause        7
                                                                                 (Prices     and
                                                                                 Payment) of the
                                                                                 Core       Legal
                                                                                 Clauses in the
                                                                                 month following
                                                                                 publication

PHQ28       Rates of     Clostridium   N/A             Review    of   monthly    As set out in
            difficile                                  report under Clause       Section B Part
                                                       39.1 of the Core Legal    8.5
                                                       Clauses




                                       Page 22 of 54
Section B Part 8.3 -Never Events
Never Events                  Threshold           Method               of    Never        Event
                                                  Measurement                Consequence
                                                                             (per occurrence)

Wrong site surgery            >0                  Review    of    reports    In accordance with
                                                  submitted to National      applicable
                                                  Patient Safety Agency      Guidance, recovery
                                                  (or          successor     of the cost of the
                                                  body)/Serious              procedure and no
                                                  Incidents reports and      charge              to
                                                  monthly        Service     Commissioner       for
                                                  Quality Performance        any        corrective
                                                  Report                     procedure or care

Wrong implant/prosthesis      >0                  Review     of    reports   In accordance with
                                                  submitted to National      applicable
                                                  Patient Safety Agency      Guidance, recovery
                                                  (or           successor    of the cost of the
                                                  body)/Serious Incidents    procedure and no
                                                  reports and monthly        charge              to
                                                  Service          Quality   Commissioner       for
                                                  Performance Report         any        corrective
                                                                             procedure or care

Retained foreign     object   >0                  Review     of    reports   In accordance with
post-operation                                    submitted to National      applicable
                                                  Patient Safety Agency      Guidance, recovery
                                                  (or           successor    of the cost of the
                                                  body)/Serious Incidents    procedure and no
                                                  reports and monthly        charge              to
                                                  Service          Quality   Commissioner       for
                                                  Performance Report         any        corrective
                                                                             procedure or care

Wrongly prepared high-        >0                  Review     of    reports   In accordance with
risk         injectable                           submitted to National      applicable
medication                                        Patient Safety Agency      Guidance, recovery
                                                  (or           successor    of the cost of the
                                                  body)/Serious Incidents    procedure and no
                                                  reports and monthly        charge              to
                                                  Service          Quality   Commissioner       for
                                                  Performance Report         any        corrective
                                                                             procedure or care

Maladministration    of       >0                  Review     of    reports   In accordance with
potassium-containing                              submitted to National      applicable
solutions                                         Patient Safety Agency      Guidance, recovery
                                                  (or           successor    of the cost of the
                                                  body)/Serious Incidents    procedure and no
                                                  reports and monthly        charge              to
                                                  Service          Quality   Commissioner       for
                                                  Performance Report         any        corrective
                                                                             procedure or care

Wrong                route    >0                  Review    of   reports     In accordance with
administration          of                        submitted to National      applicable
chemotherapy                                      Patient Safety Agency      Guidance, recovery



                                          Page 23 of 54
Never Events                 Threshold           Method               of    Never        Event
                                                 Measurement                Consequence
                                                                            (per occurrence)

                                                 (or          successor     of the cost of the
                                                 body)/Serious Incidents    procedure and no
                                                 reports and monthly        charge             to
                                                 Service         Quality    Commissioner      for
                                                 Performance Report         any       corrective
                                                                            procedure or care

Wrong                route   >0                  Review     of    reports   In accordance with
administration          of                       submitted to National      applicable
oral/enteral treatment                           Patient Safety Agency      Guidance, recovery
                                                 (or           successor    of the cost of the
                                                 body)/Serious Incidents    procedure and no
                                                 reports and monthly        charge              to
                                                 Service          Quality   Commissioner       for
                                                 Performance Report         any        corrective
                                                                            procedure or care

Intravenous                  >0                  Review     of    reports   In accordance with
administration         of                        submitted to National      applicable
epidural medication                              Patient Safety Agency      Guidance, recovery
                                                 (or           successor    of the cost of the
                                                 body)/Serious Incidents    procedure and no
                                                 reports and monthly        charge              to
                                                 Service          Quality   Commissioner       for
                                                 Performance Report         any        corrective
                                                                            procedure or care

Maladministration      of    >0                  Review     of    reports   In accordance with
Insulin                                          submitted to National      applicable
                                                 Patient Safety Agency      Guidance, recovery
                                                 (or           successor    of the cost of the
                                                 body)/Serious Incidents    procedure and no
                                                 reports and monthly        charge              to
                                                 Service          Quality   Commissioner       for
                                                 Performance Report         any        corrective
                                                                            procedure or care

Overdose of midazolam        >0                  Review     of    reports   In accordance with
during      conscious                            submitted to National      applicable
sedation                                         Patient Safety Agency      Guidance, recovery
                                                 (or           successor    of the cost of the
                                                 body)/Serious Incidents    procedure and no
                                                 reports and monthly        charge              to
                                                 Service          Quality   Commissioner       for
                                                 Performance Report         any        corrective
                                                                            procedure or care

Opioid overdose of an        >0                  Review     of    reports   In accordance with
opioid-naïve Patient                             submitted to National      applicable
                                                 Patient Safety Agency      Guidance, recovery
                                                 (or           successor    of the cost of the
                                                 body)/Serious Incidents    procedure and no
                                                 reports and monthly        charge              to
                                                 Service          Quality   Commissioner       for
                                                 Performance Report         any        corrective
                                                                            procedure or care



                                         Page 24 of 54
Never Events                  Threshold           Method               of    Never        Event
                                                  Measurement                Consequence
                                                                             (per occurrence)


Inappropriate                 >0                  Review     of    reports   In accordance with
administration of daily                           submitted to National      applicable
oral methotrexate                                 Patient Safety Agency      Guidance, recovery
                                                  (or           successor    of the cost of the
                                                  body)/Serious Incidents    procedure and no
                                                  reports and monthly        charge              to
                                                  Service          Quality   Commissioner       for
                                                  Performance Report         any        corrective
                                                                             procedure or care

Suicide     using     non-    >0                  Review     of    reports   In accordance with
collapsible rails                                 submitted to National      applicable
                                                  Patient Safety Agency      Guidance, recovery
                                                  (or           successor    of the cost of the
                                                  body)/Serious Incidents    procedure and no
                                                  reports and monthly        charge              to
                                                  Service          Quality   Commissioner       for
                                                  Performance Report         any        corrective
                                                   13.1                      procedure or care

Escape of a transferred       >0                  Review     of    reports   In accordance with
prisoner                                          submitted to National      applicable
                                                  Patient Safety Agency      Guidance, recovery
                                                  (or           successor    of the cost of the
                                                  body)/Serious Incidents    procedure and no
                                                  reports and monthly        charge              to
                                                  Service          Quality   Commissioner       for
                                                  Performance Report         any        corrective
                                                                             procedure or care

Falls from     unrestricted   >0                  Review     of    reports   In accordance with
windows                                           submitted to National      applicable
                                                  Patient Safety Agency      Guidance, recovery
                                                  (or           successor    of the cost of the
                                                  body)/Serious Incidents    procedure and no
                                                  reports and monthly        charge              to
                                                  Service          Quality   Commissioner       for
                                                  Performance Report         any        corrective
                                                                             procedure or care

Entrapment in bedrails        >0                  Review     of    reports   In accordance with
                                                  submitted to National      applicable
                                                  Patient Safety Agency      Guidance, recovery
                                                  (or           successor    of the cost of the
                                                  body)/Serious Incidents    procedure and no
                                                  reports and monthly        charge              to
                                                  Service          Quality   Commissioner       for
                                                  Performance Report         any        corrective
                                                                             procedure or care

Transfusion    of    ABO-     >0                  Review     of    reports   In accordance with
incompatible         blood                        submitted to National      applicable
components                                        Patient Safety Agency      Guidance, recovery
                                                  (or           successor    of the cost of the
                                                  body)/Serious Incidents    procedure and no



                                          Page 25 of 54
Never Events                  Threshold           Method               of    Never        Event
                                                  Measurement                Consequence
                                                                             (per occurrence)

                                                  reports and monthly        charge             to
                                                  Service        Quality     Commissioner      for
                                                  Performance Report         any       corrective
                                                                             procedure or care

Transplantation of ABO        >0                  Review     of    reports   In accordance with
incompatible organs as a                          submitted to National      applicable
result of error                                   Patient Safety Agency      Guidance, recovery
                                                  (or           successor    of the cost of the
                                                  body)/Serious Incidents    procedure and no
                                                  reports and monthly        charge              to
                                                  Service          Quality   Commissioner       for
                                                  Performance Report         any        corrective
                                                                             procedure or care

Misplaced naso- or oro-       >0                  Review     of    reports   In accordance with
gastric tubes                                     submitted to National      applicable
                                                  Patient Safety Agency      Guidance, recovery
                                                  (or           successor    of the cost of the
                                                  body)/Serious Incidents    procedure and no
                                                  reports and monthly        charge              to
                                                  Service          Quality   Commissioner       for
                                                  Performance Report         any        corrective
                                                                             procedure or care

Wrong gas administered        >0                  Review     of    reports   In accordance with
                                                  submitted to National      applicable
                                                  Patient Safety Agency      Guidance, recovery
                                                  (or           successor    of the cost of the
                                                  body)/Serious Incidents    procedure and no
                                                  reports and monthly        charge              to
                                                  Service          Quality   Commissioner       for
                                                  Performance Report         any        corrective
                                                                             procedure or care

Failure to monitor and        >0                  Review     of    reports   In accordance with
respond    to    oxygen                           submitted to National      applicable
saturation                                        Patient Safety Agency      Guidance, recovery
                                                  (or           successor    of the cost of the
                                                  body)/Serious Incidents    procedure and no
                                                  reports and monthly        charge              to
                                                  Service          Quality   Commissioner       for
                                                  Performance Report         any        corrective
                                                                             procedure or care

Air embolism                  >0                  Review     of    reports   In accordance with
                                                  submitted to National      applicable
                                                  Patient Safety Agency      Guidance, recovery
                                                  (or           successor    of the cost of the
                                                  body)/Serious Incidents    procedure and no
                                                  reports and monthly        charge              to
                                                  Service          Quality   Commissioner       for
                                                  Performance Report         any        corrective
                                                                             procedure or care

Misidentification        of   >0                  Review     of    reports   In accordance with



                                          Page 26 of 54
Never Events                 Threshold           Method               of    Never        Event
                                                 Measurement                Consequence
                                                                            (per occurrence)

Patients                                         submitted to National      applicable
                                                 Patient Safety Agency      Guidance, recovery
                                                 (or          successor     of the cost of the
                                                 body)/Serious Incidents    procedure and no
                                                 reports and monthly        charge              to
                                                 Service         Quality    Commissioner       for
                                                 Performance Report         any        corrective
                                                                            procedure or care

Severe     scalding     of   >0                  Review     of    reports   In accordance with
Patients                                         submitted to National      applicable
                                                 Patient Safety Agency      Guidance, recovery
                                                 (or           successor    of the cost of the
                                                 body)/Serious Incidents    procedure and no
                                                 reports and monthly        charge              to
                                                 Service          Quality   Commissioner       for
                                                 Performance Report         any        corrective
                                                                            procedure or care
Maternal death due to post   >0                  Review     of    reports   In accordance with
partum haemorrhage after                         submitted to National      applicable
elective caesarean section                       Patient Safety Agency      Guidance, recovery
                                                 (or           successor    of the cost of the
                                                 body)/Serious Incidents    procedure and no
                                                 reports and monthly        charge              to
                                                 Service          Quality   Commissioner       for
                                                 Performance Report         any        corrective
                                                                            procedure or care




                                         Page 27 of 54
Section B Part 8.4: 18 Weeks Referral-to-Treatment Standard for Consultant-
led Services Financial Adjustments Table


           Percentage by which         Percentage      of    the
           the            Provider     revenue, derived from
           underachieves the 18        the provision of the
           Weeks       Referral-to-    (underachieved)
           Treatment      Standard     specialty in the month of
           threshold set out in        the underachievement, to
           Section B Part 8.2 for      be    deducted     under
           each     specialty   (in    Clause 43.4 subject to
           respect of Consultant-      the cap of 5% of the
           led Services to which       Contract Month Elective
           the 18 Weeks Referral-      Care 18 Weeks Revenue
           to-Treatment Standard       pursuant to Clause 43.6
           applies)                    of   the    Core   Legal
                                       Clauses

                  Up to 1%                       0.5%
                 >1% to 2%                       1%
                 >2% to 3%                       1.5%
                 >3% to 4%                       2%
                 >4% to 5%                       2.5%
                 >5% to 6%                       3%
                 >6% to 7%                       3.5%
                 >7% to 8%                       4%
                 >8% to 9%                       4.5%
                 >9% to 10%                      5%
                 >10%                            5%




                                 Page 28 of 54
Section B Part 8.5: Clostridium difficile Adjustments Tables

Table 1 - Baseline Threshold is greater than 75

           Percentage by which Percentage    of   Total
           Provider exceeds the Acute Services Contract
           Baseline Threshold   Year Revenue to be
                                deducted under Clause
                                44.5

                  Up to 1%                        0%
                  >1% to 2%                       0.2%
                  >2%to 3%                        0.4%
                  >3% to 4%                       0.6%
                  >4% to 5%                       0.8%
                  >5% to 6%                       1%
                  >6% to 7%                       1.2%
                  >7% to 8%                       1.4%
                  >8% to 9%                       1.6%
                  >9% to 10%                      1.8%
                  >10%                            2%

Table 2 Baseline Threshold is between 35 to 74 and the number of cases
is greater than 75

           Percentage by which Percentage    of   Total
           Provider exceeds the Acute Services Contract
           Baseline Threshold   Year Revenue to be
                                deducted under Clause
                                44.6

                  Up to 1%                        0%
                  >1% to 2%                       0.2%
                  >2%to 3%                        0.4%
                  >3% to 4%                       0.6%
                  >4% to 5%                       0.8%
                  >5% to 6%                       1%
                  >6% to 7%                       1.2%
                  >7% to 8%                       1.4%
                  >8% to 9%                       1.6%
                  >9% to 10%                      1.8%
                  >10%                            2%

Table 3 Baseline Threshold is between 35 to 74 and the number of cases
is less than 75




                                  Page 29 of 54
          Percentage by which Percentage    of   Total
          Provider exceeds the Acute Services Contract
          Baseline Threshold   Year Revenue to be
                               deducted under Clause
                               44.7

                Up to 1%                       0%
                >1% to 2%                      0.1%
                >2% to 3%                      0.2%
                >3% to 4%                      0.3%
                >4% to 5%                      0.4%
                >5% to 6%                      0.5%
                >6% to 7%                      0.6%
                >7% to 8%                      0.7%
                >8% to 9%                      0.8%
                >9% to 10%                     0.9%
                >10% to 11%                    1%
                >11% to 12%                    1.1%
                >12% to 13%                    1.2%
                >13% to 14%                    1.3%
                >14% to 15%                    1.4%
                >15% to 16%                    1.5%
                >16% to 17%                    1.6%
                >17% to 18%                    1.7%
                >18% to 19%                    1.8%
                >19% to 20%                    1.9%
                >20%                           2%

Table 4 Baseline Threshold less than 35

          Percentage by which Percentage    of   Total
          Provider exceeds the Acute Services Contract
          Baseline Threshold   Year Revenue to be
                               deducted under Clause
                               44.8

                Up to 1%                       0%
                >1% to 2%                      0.05%
                >2% to 3%                      0.1%
                >3% to 4%                      0.15%
                >4% to 5%                      0.2%
                >5% to 6%                      0.25%
                >6% to 7%                      0.3%
                >7% to 8%                      0.35%
                >8% to 9%                      0.4%
                >9% to 10%                     0.45%
                >10% to 11%                    0.5%
                >11% to 12%                    0.55%
                >12% to 13%                    0.6%


                               Page 30 of 54
Percentage by which Percentage    of   Total
Provider exceeds the Acute Services Contract
Baseline Threshold   Year Revenue to be
                     deducted under Clause
                     44.8

     >13% to 14%                   0.65%
     >14% to 15%                   0.7%
     >15% to 16%                   0.75%
     >16% to 17%                   0.8%
     >17% to 18%                   0.85%
     >18% to 19%                   0.9%
     >19% to 20%                   0.95%
     >20% to 21%                   1%
     >21% to 22%                   1.05%
     >22% to 23%                   1.1%
     >23% to 24%                   1.15%
     >24% to 25%                   1.2%
     >25% to 26%                   1.25%
     >26% to 27%                   1.3%
     >27% to 28%                   1.35%
     >28% to 29%                   1.4%
     >29% to 30%                   1.45%
     >30% to 31%                   1.5%
     >31% to 32%                   1.55%
     >32% to 33%                   1.6%
     >33% to 34%                   1.65%
     >34% to 35%                   1.7%
     >35% to 36%                   1.75%
     >36% to 37%                   1.8%
     >37% to 38%                   1.85%
     >38% to 39%                   1.9%
     >39% to 40%                   1.95%
     >40%                          2%




                   Page 31 of 54
           SECTION B PART 9 - QUALITY INCENTIVE SCHEMES


Section B Part 9.1: - Nationally Mandated Incentive Schemes

[For national determination]




                               Page 32 of 54
Section B Part 9.2: Commissioning for Quality and Innovation (CQUIN)

Table 1: CQUIN Scheme

[The Parties are recommended to use the on-line standard template for
CQUIN schemes available on the website of the NHS Institute for Innovation
and                                Improvement                            (at
http://www.institute.nhs.uk/world_class_commissioning/pct_portal/cquin.html)
to facilitate the completion and recording of their CQUIN scheme.

Where the Parties use the on-line standard template, a copy of the completed
scheme must still be printed and appended to this Section B Part 9.2 Table 1
in place of the tables below.]


Quality Incentive Payments can be agreed to be paid monthly or by single
annual payments.
PLEASE DELETE AS APPROPRIATE “The Parties agree that Quality
Incentive Payments shall be paid monthly and therefore the provisions set out
in paragraphs 5 to 13 below shall apply.” OR “The Parties agree that Quality
Incentive Payments shall be paid annually and therefore the provisions set out
in paragraphs 14 to 19 below shall apply.
Summary of goals1
 Goal   Goal Name                         Description      of Goal                         Expected           Quality Domain
 Number                                   Goal                weighting                    financial          (Safety,
                                                              (%       of                  value of           Effectiveness,
                                                              CQUIN                        Goal (£)           Patient
                                                              scheme                                          Experience     or
                                                              available)                                      Innovation)
            1 VTE                         [insert goal on
                                          VTE from “Using
                                          the       CQUIN
                                          Payment
                                          Framework – an
                                          addendum to the
                                          2008        policy
                                          guidance        for
                                                    2
                                          2010/11” ]
            2 Patient                     [insert goal on
              experience                  improving
                                          responsiveness
                                          to       personal
                                          needs            of
                                          Patients     from
                                          “Using         the

1 The on-line standard template on the website of the NHS Institute for Innovation and Improvement contains some
additional fields to assist its automated functions. Parties may include these additional fields in the completed version
of the scheme included in the contract
2
  Adopt table in “Using the CQUIN Payment Framework – an addendum to the 2008 policy guidance for 2010/11”



                                                     Page 33 of 54
                                      CQUIN Payment
                                      Framework – an
                                      addendum to the
                                      2008       policy
                                      guidance      for
                                               3
                                      2010/11” ]
           3     Dementia             [Insert goal on
                                      dementia from
                                      2012/13     NHS
                                      Standard
                                      Contracts web
                                      page]

           4    NHS Safety [Insert goal on
                Thermometer NHS      Safety
                            Thermometer
                            from    2012/13
                            NHS Standard
                            Contracts web
                            page]

           5                          [insert  locally
                                      agreed goals]
           6                          [insert  locally
                                      agreed goals]
          etc                         [insert  locally
                                      agreed goals]
                                      Totals:                      100.00%




Summary of indicators
    Goal   Indicator Indicator Name                                Indicator               Expected
    Number Number4                                                 Weighting               financial
                                                                   (% of CQUIN             value     of
                                                                   scheme                  Indicator
                                                                   available)              (£)
    1                           [insert the indicator or
                                indicators that are
                                agreed in respect of
                                each goal]
    2
    3
    Etc
                                Totals:                                     100.00%


3
 Adopt table in “Using the CQUIN Payment Framework – an addendum to the 2008 policy guidance for 2010/11”
4 There may be several indicators for each goal



                                                Page 34 of 54
Detail of indicator (to be completed for each indicator)
Indicator number
Indicator name
Indicator                                    weighting
(% of CQUIN scheme available)
Description of indicator
Numerator
Denominator
Rationale for inclusion
Data source
Frequency of data collection
Organisation responsible for data collection
Frequency of reporting to commissioner
Baseline period/date
Baseline value
Final indicator period/date (on which payment is
based)
Final indicator value (payment threshold)

Rules for calculation of payment due at final indicator
period/date (including evidence to be supplied to
commissioner)

Final indicator reporting date
Are there rules for any agreed in-year milestones that
result in payment?
Are there any rules for partial achievement of the
indicator at the final indicator period/date?




Milestones (only to be completed for indicators that contain in-year
milestones)
Date/period milestone relates Rules for achievement of      Date          Milestone
to                            milestones       (including   milestone     weighting (%
                              evidence to be supplied to    to       be   of     CQUIN
                              commissioner)                 reported      scheme
                                                                          available)




                                                            Total:




                                   Page 35 of 54
Rules for partial achievement at final indicator period/date (only complete
if the indicator has rules for partial achievement at final indicator period/date)
  Final indicator value for the % of CQUIN scheme
  part achievement threshold         available for meeting final
                                     indicator value




1.     Subject to paragraph 2 (below), if the Provider satisfies a Quality
       Incentive Scheme Indicator set out in Section B Part 9.2 Table 1, a
       Quality Incentive Payment shall be payable by the Commissioners to
       the Provider in accordance with this Section B Part 9.2.

2.     The Commissioners shall not be liable to make Quality Incentive
       Payments under this Section B Part 9.2 to the Provider in respect of
       any Contract Year which in aggregate exceed the applicable Actual
       Outturn Value percentage for the relevant Contract Year set out below:

               Contract Year        Maximum        aggregate      Quality
                                    Incentive Payment
               1st Contract Year    2.5% of the Actual Outturn Value
               2nd Contract Year    [For national determination and local
                                    insertion]


       and for the avoidance of doubt this paragraph shall limit only those
       Quality Incentive Payments made under this Section B Part 9.2, and
       shall not limit any Quality Incentive Payments made under any Quality
       Incentive Scheme set out in Section B Part 9.1 or Section B Part 9.3.

3.     The Provider shall in accordance with Clause 45 of this Agreement
       (Service Quality Review) submit to the Co-ordinating Commissioner a
       Service Quality Performance Report which shall include details of the
       Provider’s performance against and progress towards the Quality
       Incentive Scheme Indicators set out in Section B Part 9.2 Table 1 in the
       month to which the Service Quality Performance Report relates.

4.     The provisions set out in paragraphs 5 to 13 below apply in respect of
       Quality Incentive Payments made by monthly instalments. The
       provisions set out in paragraphs 14 to 19 apply in respect of Quality
       Incentive Payments made by a single annual payment.

       Monthly Quality Incentive Payments

5.     Where the Co-ordinating Commissioner and the Provider have agreed
       that Quality Incentive Payments should be made on a monthly basis by
       any Commissioners, then in each month after the Service
       Commencement Date during the term of this Agreement each relevant


                                    Page 36 of 54
      Commissioner shall make the default Quality Incentive Payment set out
      below to the Provider:

             Commissioners   Monthly Quality Incentive Payment
                             – 1st Contract Year
             [insert name of [Insert monthly payment : see
             each            guidance which states that the default
             Commissioner    payment will normally be 1/12th of
             making monthly 50% of the expected Actual Outturn
             CQUIN           Value for the relevant Commissioner,
             payments]       unless the Parties agree otherwise]



      and the Provider and the Co-ordinating Commissioner may from time to
      time, whether as a result of a review performed under paragraph 6
      below or otherwise, agree to vary the default monthly Quality Incentive
      Payment for any Commissioner set out above.

6.    The Co-ordinating Commissioner shall review the Quality Incentive
      Payments made by the Commissioners under paragraph 5 on the basis
      of the information submitted by the Provider under this Agreement on
      the Provider’s performance against the Quality Incentive Scheme
      Indicators. Such reviews shall be carried out as part of each Review
      under Clause 46.

7.    In performing the review under paragraph 6 the Co-ordinating
      Commissioner shall reconcile the Quality Incentive Payments made by
      the relevant Commissioners under paragraph 5 against the Quality
      Incentive Payments that those Commissioners are liable to pay under
      paragraph 1 on the basis of the Provider’s performance against the
      Quality Incentive Scheme Indicators, as evidenced by the information
      submitted by the Provider under this Agreement.

8.    Following such reconciliation, where applicable, the Provider shall
      invoice the relevant Commissioners separately for any reconciliation
      Quality Incentive Payments.

9.    Within [10] Operational Days of completion of the review under
      paragraph 6, the Co-ordinating Commissioner shall submit a Quality
      Incentive Payment reconciliation account to the Provider.

10.   In each reconciliation account prepared under paragraph 9 the Co-
      ordinating Commissioner:

      10.1    shall identify the Quality Incentive Payments to which the
              Provider is entitled, on the basis of the Provider’s performance
              against the Quality Incentive Scheme Indicators set out in
              Section B Part 9.2 Table 1 in those months of the relevant
              Contract Year that have elapsed at the time of the review;




                                 Page 37 of 54
      10.2    shall ensure that the Quality Incentive Payments made to the
              Provider in respect of completed Contract Years comply with
              the requirements of paragraph 2;

      10.3    may correct the conclusions of any previous reconciliation
              account, whether relating to the Contract Year under review or
              to any previous Contract Year; and

      10.4    shall identify any reconciliation payments due from the Provider
              to any Commissioner, or from any Commissioner to the
              Provider.

11.   Within [5] Operational Days of receipt of the Quality Incentive Payment
      reconciliation account from the Co-ordinating Commissioner, the
      Provider shall either agree, or, acting in good faith, contest such
      reconciliation account.

12.   The Provider’s agreement of the Quality Incentive Payment
      reconciliation account (such agreement not to be unreasonably
      withheld) shall trigger a reconciliation payment by the relevant
      Commissioner(s) to the Provider, or by the Provider to the relevant
      Commissioner(s), as appropriate, and such payment shall be made
      within [10] Operational Days of the Provider’s agreement of the
      reconciliation account and the Provider’s invoice.

13.   If the Provider, acting in good faith, contests the Co-ordinating
      Commissioner’s Quality Incentive Payment reconciliation account:

      13.1    the Provider shall within [5] Operational Days notify the Co-
              ordinating Commissioner, setting out reasonable detail of the
              reasons for contesting such account, and in particular
              identifying which elements are contested and which are not
              contested;

      13.2    any uncontested payment identified in the Quality Incentive
              Payment reconciliation account shall be paid in accordance
              with paragraph 12 by the Party from whom it is due; and


      13.3    if the matter has not been resolved within 20 Operational Days
              of the date of notification under paragraph 13.1, either Party
              may refer the matter to dispute resolution under Clause 53
              (Dispute Resolution),

      and within [20] Operational Days of the resolution of any Dispute
      referred to dispute resolution in accordance with this paragraph 13 the
      relevant Party shall pay any amount agreed or determined to be
      payable.

      Single annual payment of Quality Incentive Payments




                                 Page 38 of 54
14.   Where the Provider and Co-ordinating Commissioner have agreed that
      one single Quality Incentive Payment should be made to the Provider
      by any Commissioner at the end of each Contract Year, then at the end
      of each Contract Year during the term of this Agreement each
      Commissioner set out in the table in this paragraph 14 shall, subject to
      the Provider’s performance against the Quality Incentive Scheme
      Indicators, make a single Quality Incentive Payment to the Provider in
      accordance with the procedure set out in paragraphs 15 to 19 below.

               Commissioners        making     single
               annual Quality Incentive Payment at
               the end of the Contract Year
               [insert name of any Commissioner
               making a single annual CQUIN
               payments]         [Insert amount of the
               single annual CQUIN payment for each
               relevant Commissioner]



15.   The Co-ordinating Commissioner shall, within [10] Operational Days of
      the end of the Contract Year to which the Quality Incentive Payments
      relate or its receipt of final information from the Provider on its
      performance against the Quality Incentive Scheme Indicators during
      that Contract Year (whichever is the later), submit to the Provider a
      statement of the Quality Incentive Payments to which the Provider is
      entitled on the basis of the Provider’s performance against the Quality
      Incentive Scheme Indicators during the relevant Contract Year, as
      evidenced by the information submitted by the Provider under this
      Agreement.

16.   Within [5] Operational Days of receipt of the Quality Incentive Payment
      statement from the Co-ordinating Commissioner under paragraph 15,
      the Provider shall either agree, or, acting in good faith, contest such
      statement.

17.   The Provider’s agreement of the Quality Incentive Payment statement
      (such agreement not to be unreasonably withheld) shall trigger a
      payment by the relevant Commissioner(s) to the Provider, and such
      payment shall be made within [10] Operational Days of the Provider’s
      agreement of the statement and the Provider’s invoice.

18.   In the event that the Quality Incentive Payment under paragraph 17 is
      paid before the final reconciliation account for the relevant Contract
      Year is agreed under Clause 7 (Prices and Payment) of this
      Agreement, then if the Actual Outturn Value for the relevant Contract
      Year is not the same as the Expected Annual Contract Value against
      which the Quality Incentive Payment was calculated, the Co-ordinating
      Commissioner shall within [10] Operational Days of the agreement of
      the final reconciliation account under Clause 7 send the Provider a



                                 Page 39 of 54
      reconciliation statement reconciling the Quality Incentive Payment
      against what it would have been had it been calculated against the
      Actual Outturn Value, and a reconciliation payment in accordance with
      that reconciliation statement shall be made by the relevant
      Commissioner to the Provider or by the Provider to the relevant
      Commissioner, as appropriate, within [10] Operational Days of the
      submission to the Provider of the reconciliation statement under this
      paragraph 18.

19.   If the Provider, acting in good faith, contests the Co-ordinating
      Commissioner’s Quality Incentive Payment statement under paragraph
      15 or reconciliation statement under paragraph 18:

      19.1    the Provider shall within [5] Operational Days notify the Co-
              ordinating Commissioner, setting out reasonable detail of the
              reasons for contesting the relevant statement, and in particular
              identifying which elements are contested and which are not
              contested;

      19.2    any uncontested payment identified in the relevant statement
              shall be paid in accordance with paragraph 17 by the relevant
              Commissioner or the Provider, as the case may be; and

      19.3    if the matter has not been resolved within 20 Operational Days
              of the date of notification under paragraph 19.1, either Party
              may refer the matter to dispute resolution under Clause 53
              (Dispute Resolution),

and within [20] Operational Days of the resolution of any Dispute referred to
dispute resolution in accordance with this paragraph 19 the relevant Party
shall pay any amount agreed or determined to be payable.




                                 Page 40 of 54
Section B Part 9.3: - Locally Agreed Incentive Schemes

NONE




                               Page 41 of 54
SECTION B PART 10 - Eliminating Mixed Sex Accommodation Plan

[Insert/append EMSA Plan]




                            Page 42 of 54
SECTION B PART 11 - Service Development and Improvement Plan

Description of     Milestones         Timescales          Expected           Consequence
Scheme                                                    Benefit            of
                                                                             Achievement/
                                                                             Breach
[insert as         [insert as         [insert as          [insert as         Subject to
defined locally]   defined locally]   defined locally]    defined locally]   clause [32]
                                                                             (Contract
                                                                             Management)




                                          Page 43 of 54
SECTION B PART 12 – SERVICE USER, CARER AND STAFF SURVEYS

Part 1 – Service User, Carer and Staff Surveys
[Mandatory but for local agreement – set out survey type, frequency, how it is
to be reported and publication method where relevant]




                                  Page 44 of 54
SECTION B PART 13 - Clinical Networks and Screening Programmes

Part 1 - Clinical Networks and Screening Programmes
[For local agreement and not to conflict with any information in Service
Specifications]




                               Page 45 of 54
SECTION B PART 14 – REPORTING AND INFORMATION MANAGEMENT


Section B Part 14.1: - National Requirements Reported Centrally

   1. The Provider and Commissioner shall comply with the reporting
      requirements of SUS and UNIFY2 where applicable.

   2. Compliance with the required format, schedules for delivery of data and
      definitions as set out in the Information Centre guidance, Review of
      Central Returns (ROCR) and all Information Standards Notices (ISNs),
      where applicable to the service being provided.

   3. The Provider shall ensure that each dataset that it provides under this
      Agreement contains the Organisation Data Service (ODS) code for the
      relevant Commissioner, and where the Commissioner to which a
      dataset relates is a Specialised Commissioning Group, or for the
      purposes of this Agreement hosts, represents or acts on behalf of a
      Specialised Commissioning Group, the Provider shall ensure that the
      dataset contains the ODS code for such Specialised Commissioning
      Group.

   4. The Provider shall collect and report to the Commissioner on the
      patient-reported outcomes measures (PROMS) in accordance with
      applicable Guidance.

   1. Providers of substance misuse services shall comply with the reporting
      requirements for the National Drug Treatment Monitoring System
      (NDTMS) returned to the National Treatment Agency where applicable.




                                  Page 46 of 54
Section B Part 14.2: - National Requirements Reported Locally

1.    Monthly activity report, as described in Clause 41.9 [Frequency, format
      and method for delivery to be determined locally].

2.    Monthly Service Quality Performance Report, as described in Clause
      45.1, and details of performance against the Quality Requirements,
      including without limitation details of all Quality Requirements satisfied,
      and details of and reasons for any failure to meet the Quality
      Requirements [Frequency, format and method for delivery to be
      determined locally].

3.    Report monthly on performance against the HCAI Reduction Plan
      [Frequency, format and method for delivery to be determined locally].

4.    Equality monitoring report [Frequency, format and method for delivery
      to be determined locally].

5.    Complaints monitoring report [Frequency, format and method for
      delivery to be determined locally].

6.    Report against performance of the Service Development and
      Improvement Plan (SDIP) [Frequency, format and method for delivery
      to be determined locally].

7.    Report on performance against the EMSA Plan and on any breaches of
      milestones set out in the EMSA Plan [Frequency, format and method
      for delivery to be determined locally].

8.    Report on Mixed Sex Associated Breaches [Frequency, format and
      method for delivery to be determined locally].

9.    Monthly report of local audits of the percentage of patients risk
      assessed for venous thromboembolism who receive the appropriate
      prophylaxis in accordance with Guidance [Format and method for
      delivery to be determined locally].

10.   Where radiotherapy services are provided, report and provide data in
      accordance with Guidance to support the Commissioners monitoring of
      the 31 day standard for radiotherapy (according to which Patients
      should not wait more than 31 days from Consultant referral to
      commencement of radiotherapy treatment) [Frequency, format and
      method for delivery to be determined locally].

11.   In relation to the Cancer Registration dataset reporting (ISN), report on
      staging data in accordance with Guidance [Frequency, format and


                                   Page 47 of 54
      method for delivery as defined in the ISN]

12.   Report and provide monthly data and detailed information relating to
      violence-related injury resulting in treatment being sought from Staff in
      A&E departments, Urgent Care and Walk in Centres, and from
      Ambulance Services Paramedics (where the casualties do not require
      A&E department, Urgent Care and Walk in Centre attendance), to the
      local Community Safety Partnership (CSP) in accordance with
      applicable Guidance (College of Emergency Medicine Clinical
      Guideline Information Sharing to Reduce Community Violence (July
      2009)). Format and method of delivery shall be in accordance with the
      applicable Guidance.

13.   Where abortion services are provided, report and provide data to
      support the monitoring of delivery of contraception at abortion services
      [Frequency (not less than 6 monthly), format and method for delivery to
      be determined locally].

15.   Monthly summary report of all incidents requiring reporting [Format and
      method for delivery to be determined locally].

16.   Report, where appropriate, performance against the 18 week Referral-
      to-Treatment Standard [Format and method for delivery to be
      determined locally].

17.   Where appropriate, report of progress against milestones in Data
      Quality Improvement Plan [Frequency, format and method for delivery
      to be determined locally as part of the plan].

18.   In light of the requirements of the Climate Change Act 2008, the
      Department’s Sustainability Strategy “Taking the long term view”, and
      in line with the national NHS Strategy: “Saving Carbon, Improving
      Health”, the Provider shall, as applicable, demonstrate their measured
      progress on climate change adaptation, mitigation and sustainable
      development, including performance against carbon reduction
      management plans [Frequency, format and method for delivery to be
      determined locally].




                                  Page 48 of 54
Section B Part 14.3: - Local Requirements Reported Locally
Diagnostic data is not a mandated Commissioning Data Set (CDS) and will
therefore not flow into SUS, so a local dataset will need to be specified that
will enable linkage to other mandated CDS’ and aid contract monitoring.

Commissioners should consider data that will identify patient demographics,
referral information, diagnostic test data and outcome results.


Data Quality Thresholds : Expected levels of completeness/validity


Data Item                              Expected      level of      Expected level of coverage
                                       coverage Non SUS data       (SUS submissions)
                                       (diagnostics)
DOB complete/valid                     99%                         99%
First attendance                       100%                        100%
Attended/DNA                           98%                         98%
NHS Number**                           97%                         97%
Referral source                        97%                         97%
Organisation code code of referrer     98%                         98%
Type of diagnostic test                99%                         n/a



*= complete and valid codes
Default codes ( V81997/V81998/V81999 ) not be counted as valid codes.

** if NHS number not given then patient name must be provided

The table below suggests some information that might be useful in monitoring
a diagnostic contract, but local knowledge and experience should prevail.




                                      Page 49 of 54
Type of collection   Data Type                    Essential   /   Comments                         Format/definition
                                                  Desirable
Demographic          NHS Number                   E               To enable linkage to other       10 digit NHS Number
                                                                  providers on pathway
Demographic          Patient Date of Birth        D               To validate NHS Number on        Date format DD/MM/YYYY
                                                                  Summary Care Record
Referral             Unique referral identifier   E               To monitor repeat activity, if   Format to be confirmed by diagnostic provider, but
                                                                  another attendance offered       suggest numerical /integer
                                                                  then same referral identifier
                                                                  should be used in second and
                                                                  subsequent attendances
Referral             Organisation code of         E               Practice Code                    6 digit national GP practice code
                     referrer
Referral             Organisation code of         D               PCT Code                         3 or 5 digit national code
                     commissioner
Referral             Organisation code of         D               Provider Code                    As per NHS Data Dictionary Coding Frames
                     provider
Referral             Date sent by referrer        E               To monitor time on pathway       Date format DD/MM/YYYY
Referral             Date received by             E               To monitor time on pathway,      Date format DD/MM/YYYY
                     provider                                     system delays                    Date of referral is date the referral was received by
                                                                                                   the service
Referral             Date referral accepted       E               To monitor time on pathway,      Date format DD/MM/YYYY
                     by provider                                  system delays
Referral             Referral source              E               Taken from NHS Data              Initiated by the CONSULTANT responsible for the
                                                                  Dictionary definition            Consultant Out-Patient Episode
                                                                                                   01 following an emergency admission
                                                                                                   02 following a Domiciliary Consultation
                                                                                                   10 following an Accident and Emergency Attendance
                                                                                                   (including Minor Injuries Units and Walk In Centres)
                                                                                                   11 other - initiated by the CONSULTANT responsible
                                                                                                   for the Consultant Out-Patient Episode
                                                                                                   Not initiated by the CONSULTANT responsible for the
                                                                                                   Consultant Out-Patient Episode
                                                                                                   03 referral from a GENERAL MEDICAL
                                                                                                   PRACTITIONER




                                                                      Page 50 of 54
Type of collection   Data Type                    Essential   /   Comments                           Format/definition
                                                  Desirable
                                                                                                     92 referral from a GENERAL DENTAL
                                                                                                     PRACTITIONER
                                                                                                     12 referral from a General Practitioner with a Special
                                                                                                     Interest (GPwSI) or Dentist with a Special
                                                                                                     Interest (DwSI)
                                                                                                     04 referral from an Accident and Emergency
                                                                                                     Department (including Minor Injuries Units and Walk
                                                                                                     In Centres)
                                                                                                     05 referral from a CONSULTANT, other than in an
                                                                                                     Accident and Emergency Department
                                                                                                     06 self-referral
                                                                                                     07 referral from a Prosthetist
                                                                                                     13 referral from a Specialist NURSE (Secondary
                                                                                                     Care)
                                                                                                     14 referral from an Allied Health Professional
                                                                                                     15 referral from an OPTOMETRIST
                                                                                                     16 referral from an Orthoptist
                                                                                                     17 referral from a National Screening Programme
                                                                                                     93 referral from a Community Dental Service
                                                                                                     97 other - not initiated by the CONSULTANT
                                                                                                     responsible for the Consultant Out-Patient Episode
Referral             Test requested               D               Reason for referral, to check      Text field
                                                                  referral compliance
Attendance           Unique activity identifier   E               To separate multiple tests on      Format to be confirmed by diagnostic provider, but
                                                                  same day. This is not the          suggest numerical /integer
                                                                  same as the unique referral
                                                                  identifier
Attendance           Date and time of             E               To monitor time on pathway,        Date format DD/MM/YYYY hh:mm
                     diagnostic test                              contract activity reconciliation
Attendance           Duration of attendance       E               To monitor contract activity       Numerical/integer
                                                                                                     Number of minutes
Attendance           First Attendance             E               To monitor contract delivery       1 First attendance face to face (First Diagnostic)
                                                                                                     2 Follow-up attendance face to face (Repeat




                                                                      Page 51 of 54
Type of collection   Data Type                   Essential   /   Comments                       Format/definition
                                                 Desirable
                                                                                                Diagnostic)
                                                                                                3 First telephone or telemedicine consultation (N/A)
                                                                                                4 Follow-up telephone or telemedicine consultation
                                                                                                (N/A)
Attendance           Type of diagnostic test     E               What diagnostic test /         OPCS4 codes or locally defined list?
                                                                 procedure did the provider
                                                                 perform? To monitor contract
                                                                 delivery
Attendance           Anatomical site             D               To monitor contract delivery   Add the area of the body requiring diagnostic
Attendance           Staff type seeing patient                   To monitor contract delivery    Lead Care Professional
                                                 E
                                                                                                 Member of Care Professional team
Attendance           Attend / DNA                                To monitor contract delivery   5 Attended on time or, if late, before the relevant
                                                                                                CARE PROFESSIONAL was ready to see the
                                                                                                PATIENT
                                                                                                6 Arrived late, after the relevant CARE
                                                                                                PROFESSIONAL was ready to see the PATIENT, but
                                                                                                was seen
                                                                                                7 PATIENT arrived late and could not be seen
                                                 E
                                                                                                2 APPOINTMENT cancelled by, or on behalf of, the
                                                                                                PATIENT
                                                                                                3 Did not attend - no advance warning given
                                                                                                4 APPOINTMENT cancelled or postponed by the
                                                                                                Health Care Provider
                                                                                                0 Not applicable - APPOINTMENT occurs in the future
                                                                                                *
Attendance           Seen By                     E               To monitor contract delivery   Name of person completing
Outcome              Patient Outcome             E                                              1 Discharged from CONSULTANT's care (last
                                                                                                attendance)
                                                                                                2 Another APPOINTMENT given
                                                                                                3 APPOINTMENT to be made at a later date
Outcome              Date result reported        D               To monitor time on pathway,    Date format DD/MM/YYYY
                                                                 system delays
Outcome              Date result                 E               To monitor time on pathway     Date format DD/MM/YYYY




                                                                     Page 52 of 54
Type of collection   Data Type                  Essential   /   Comments                  Format/definition
                                                Desirable
                     communicated to
                     referrer
Contract             Currency type              E               Contract monitoring and   PBR/nonPBR?
                                                                reconciliation
Contract             HRG                        E               Contract monitoring and   Refer to list of HRGs
                                                                reconciliation
Contract             Base HRG cost              D               Contract monitoring and   Numerical/Decimal
                                                                reconciliation
Contract             MFF cost                   D               Contract monitoring and   Numerical/Decimal
                                                                reconciliation
Contract             Total cost of diagnostic   E               Contract monitoring and   Numerical/Decimal
                     test provided                              reconciliation            Zero cost for DNAs/Cancellations or repeat test for
                                                                                          non-clinical reason




                                                                   Page 53 of 54
Section B Part 14.4: - Data Quality Improvement Plan

Data            Quality   Data     Quality   Method      of   Milestone Date           Consequence
Indicator                 Threshold          Measurement


[for local definition]    [for local         [for local       [for local definition]   [for        local
                          definition]        definition]                               definition]




                                         Page 54 of 54

								
To top