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Outcomes Framework

DOCUMENT 18

Dudley Multi-Specialty Community Provider Outcomes Framework

The entire body of the MCP Outcomes will be structured across 4 themes:

1. Population Health

2. Access, Continuity and Coordination

3. Empowering People and Communities

4. System and Staff

See figure 1 below for the four themes and high level outcome descriptors.

Principles

Figure 1: MCP Outcome Framework Themes and broad outcome descriptors

The graphic above shows the high level view of the MCP Outcomes Framework.

Each theme has a number of outcomes incorporated within, with each outcome

item containing the following details:

• Description of the Outcome

• Brief description of the Outcome Goal

• The data source

• Frequency of data submission required

• Current performance where known

• Target/Requirement for year one of the MCP Contract

• Indicative targets for years 2 to 5 of the contract.

1


The MCP Outcomes Framework will be housed within specific schedules within the new

national MCP Contract (currently in draft form).

The MCP Outcomes will therefore be situated within distinct parts of the Particulars

Schedule 5 within the MCP Contract;

The entire locally developed MCP Outcomes Framework is therefore contractually split into

2 sections: ‘Non-Incentivised’, feeding into Schedule 5 Part C and ‘Incentivised’ feeding

into Schedule 5 Part D

Please note that NHS England are currently developing an MCP Health and Care

Framework (HCF). Some of these measures will form part of the Improvement Payment

Scheme (IPS) and will be nationally mandated; the remainder of the IPS items will be the

incentivised Dudley MCP Outcomes Framework.

Schedule 5 Part C : Local Quality and Outcomes Requirements (Annex 1)

This schedule will contain the locally developed MCP Outcomes but there is no financial

incentive or penalty attached to any of the Outcomes contained therein.

Schedule 5 Part D – Improvement Payment Scheme (Annex 1)

This Schedule will contain both the nationally mandated and locally developed

requirements that will be incentivised through ‘top slicing’ a proportion of the total Contract

value. Please note that the nationally mandated items are currently in development and

therefore not yet available. The Contract value proportion that will be allocated to

nationally mandated items is yet to be confirmed but the working assumption is that it will

be 2.5% of the total Contract value. It is proposed that the Contract value proportion

allocated to the locally incentivised items will be 7.5% of the contract value. Therefore the

total IPS Scheme will be 10% of the proposed £270m total Contract value (£27m).

The Contractual Context of the MCP Outcomes Framework

2

Locally developed MCP Incentive

Outcomes

A: Operational Standards

B: National Quality Requirements

C: Local Quality and Outcomes Requirements

D: Improvement Payment Scheme (IPS)

Locally developed MCP Outcomes

(not incentivised)

MCP Contract Particulars: Schedule 5

3

Outcome Targets

Outcome targets for the locally developed MCP Outcomes Framework have been derived

from historical data where available and based on a statistically significant improvement

from the baseline. At this stage, the targets are therefore indicative as this process will

need to be refreshed in the light of more recent data being available prior to Contract

signature.

Certain targets within the first 2 years of the Contract are not based on numerical

attainment but aligned to systems set up and/or baseline establishment. This is an

important feature which gives the MCP Provider transitional headroom to establish new

methodologies and data flows alongside managing the cultural shift to a truly outcomes

based contract.



The incentivised items within the local Dudley MCP Outcomes Framework will feed into the

IPS (see diagram above) and will be allocated a top sliced 7.5% of the total MCP Contract

value.

Over recent years Dudley CCG has developed a local GP incentive Scheme as an

alternative to the National Primary Care Quality Outcomes Framework (QOF). This new

scheme is called the Dudley GP Outcomes Framework (GPOF). Although the GPOF has

been developed independently from the MCP Outcomes Framework there are clear

synergies between both frameworks’ underpinning ambition. Therefore the GPOF is

incorporated within the MCP Framework in its entirety. However it is important to note how

this will work in practice.

• The GPOF incorporates Directly Enhanced Service(DES), Local Incentive Scheme (LIS)

and QOF items along with many newly devised outcomes.

• Dudley CCG cannot double delegate DES and QOF in whole or part to the MCP

Provider.

• Therefore the GPOF will be funded directly to GPs through the current Primary Care

mechanism with the exception of LIS’s. The LIS amount (currently £1.3m) will be ring

fenced within the larger MCP IPS.

• The whole of the GPOF is incorporated within the MCP IPS and all GPOF items are

allocated an incentive within the MCP IPS to incentivise matrix working where possible.

However, only the £1.3m for LIS’s is ring fenced (see diagram below).

MCP Improvement Incentive Scheme

4

7.5% allocated to the Local Incentivised items


2.5% allocated to Nationally Mandated items

Local Dudley MCP Incentivised items

Dudley MCP Outcomes Framework

Non-Incentivised items


Direct Enhanced Services

QOF New items


QOF New items

Dudley GP Outcomes Framework


QOF New items

Dudley GP Outcomes Framework


QOF New items

GP Local Incentive Scheme (ring fenced value within IPS)

GP Local Incentive Scheme (ring fenced value within IPS)

Dudley GP Outcomes Framework (GPOF)

Local Incentive Scheme Not incentivised through Primary Care route

Local Incentive Scheme Not incentivised through Primary Care route

Total IPS Value = £27m

Nationally mandated items = £6.7m

Local Items = £20.25 of which £1.3m ring fenced for LIS’s

Primary Care Funding Route

Primary Care Funding Route

MCP IPS Funding Route MCP IPS Funding Route

5

Phasing of the Incentive Scheme reward by Outcome Framework Domain shown as a percentage

The financial incentive allocated to each of the Outcomes within the IPS will be achieved

against one of the following three achievement structures:

1. Meeting or exceeding the target values. Using historical data the current performance

level Confidence Limits are assigned across the 90% to 100% achievement reward.

This essentially offers the Provider a 95% likelihood of achieving 90% or greater of the

assigned reward for the particular outcome in question and gives the maximum reward

to a statistically significant improvement. Using this methodology the whole of the

practical financial risk likelihood within the MCP IPS can be calibrated to match the

current practical financial risk likelihood associated with current incentive schemes.

This ameliorates the risk of significant loss of income. In other words, historically across

the system 85% of incentive schemes have been achieved (15% [£2.084m] practical

financial loss risk likelihood on incentive schemes). By finely calibrating the MCP stretch

targets using statistical process methodology and auto-regressive moving annual

forecasting, the same financial loss risk value (not percentage) can be matched.

2. Achieving targets for metrics without underpinning historical data. Some

Outcomes (for example some of the new GP Outcomes Framework metrics) do not have

historical performance data to draw upon. In these circumstances targets have been

scaled based on the formerly agreed parameters (agreed during the GPOF

development).

The IPS incentive allocation will have distinct phases throughout the life of the 15 year

MCP Contract. The allocation to the Population Health Domain will more than double

during the entire span of the Contract (see chart below).


Where monies are retained for non achievement against the IPS, this money will be held by

the Commissioner. The Provider will be entitled to bid for this retained sum through a

business case mechanism but will need to demonstrate a cogent plan for rectifying any

performance shortfalls and accomplish all relevant milestones in order that the specific

retained monies can be released back to the MCP Provider.

A resetting of the targets associated with any of the outcomes may be required on an

annual basis due to new performance data being available. Any changes required for this

purpose can be enacted through the Variations clause of the MCP Contract.

However, it is not intended that the Outcomes will be reviewed for inclusion or exclusion on

an annual basis. It is proposed that these more fundamental reviews should be undertaken

on a 3 year cycle.

Once set, the reward proportions associated with the Outcomes are not intended to

change.

Exceptional circumstances may require consideration regarding any of the above and this

can be enacted through the Variation clause of the MCP Contract at any point.

An outline of the proposed process for monies withheld be the Commissioner

for IPS underperformance is described in Annex 3.

3. Transition and development targets. In the first 2 years of the MCP Contract some

of the Outcomes will require data capture systems and processes to be developed

and thereafter a baseline to be established. Therefore the achievement against these

type of Outcomes will be evidenced by Provider assurance reports.

For the IPS financial reward and predictive achievement For a worked example of how

the above methods would work in practice, see Annex 5

In addition to the above, the Incentive Scheme proportions allocated to each theme of

the Outcomes Framework within the Incentive Scheme will vary over the lifetime of the

Contract..

Business Rules for Changes to the MCP Outcomes Framework

6

MCP Outcomes by Service Group

All the Outcomes within the MCP Outcomes Framework have been mapped to the MCP

Service Groups within the Service Scope.

This matrix is presented in Annex 1.


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